Discussed more frequently in parliament, than in daily life, is the process of transitioning from Child and Adolescent Mental Health Services (CAMHS), to Adult Mental Health Services (AMHS). This post, drawing on research, will discuss the current issues with the system and ways it can be improved.
Stuck Between the Cracks: What’s the Problem?
Firstly, let’s address the stigma associated with seeking out and using mental health services. We all know of and have most likely experienced stigma before- and it goes without saying that stigmatisation affects the decisions we make. The same can be said for young people considering treatment for mental health issues. Due to this stigmatization, they may not be aware of what is available to them or where to go and may refrain from seeking help (Singh & Tuomainen, 2015). This is an issue right at the core of transition- if we don’t tackle one of the fundamental experiences of young people during this time, then the results of other changes cannot be truly seen.
The average lifestyle and experience of a young person is one of many transitions- whether it be developmental or situational, emotional or relationship-based, in an environment of constant change, the newness of service transition can contribute to the bewilderment young people feel during this phase in their lives.
Transition has been described as like “having to move house due to a flood”; it is abrupt and unplanned, rather than being a process underpinned by choice, informed decision-making and appropriate and helpful advice. Consequently, young people living with mental health issues frequently see themselves without support from professionals or even a referral to adult services. In the cases where they are referred, adult services are often ill-equipped to meet the needs of the young person (Singh & Tuomainen, 2015).
There are a range of obstacles hampering communication and collaborative work between CAMHS and AMHS- separate funding and governing structures means each service is underpinned by a separate system, a lack of understanding of the services which fall between these two systems, and a rigid set of boundaries and rules. As well as this, logistical, legal and clinical differences, combined with resource and time constraints means that service workers are prevented from working collaboratively in order to provide parallel care. This limited experience of working together has resulted in a lessened understanding of what is required and expected and what the overall purpose and impact of a high transitionary service can be.
Currently young people going through transitionary care risk falling through the child-adult service margin. Their experience of poor care here means that they are more likely to disengage from services, abandoning care all together. Additionally, this period in a young person’s life is a critical time in which mental health disorders emerge most. This means that changes in transitional care can have an astronomical effect on upshots of youth mental health.
How Should It Be Changed?
Recent evidence confirms the sooner the treatment in the earlier stages of a disorder occurs, the higher the likelihood of a more cost-effective and clinically-efficient service. This has led to further argument that an early intervention paradigm should be applied to all disorders occurring in youth onset. Instead of working on a bridging between two different models of care, with which neither truly adhere to the needs of young people, a radical and unambiguous re-design should be adopted. This structure would be based on the preferences and needs of young people and promote well-being, fulfilment and autonomy, as well as entirely combating stigma in mental health (Singh & Tuomainen, 2015).
In its ideal form, transition should consist of an orderly, planned and purposeful process of change between two services, with the specific needs of each service user being taken into consideration. This process should no longer be seen as an administrative event, because this means that health and social care needs are being unmet (Singh et al, 2010).
Improving the liaison between CAMHS and AMHS has also been suggested, where psychiatrists from each service attend each other’s clinical meetings in which they will jointly combat the mental health requirements of their service users. Others have suggested a designated specific transition worker, whose position is split between AMHS and CAMHS. With this information in mind then, it would be more beneficial to no longer underpin CAMHS and AMHS as two entirely different structures, but rather, two related disciplines and systems which can work together during the transition period, in order to be more attentive to young people’s concerns and experiences.
Regardless of which route is taken to change, the commonality amongst different proposals is the importance of ensuring that there is care given to all aspects of a young person’s life, other than healthcare in transition. Educational fluctuation, vocational influences, social and legal status and living situation should all be taken into consideration and understood. If we treat transition as a phase in itself, we can ensure that our young people are given a voice and the tools to thrive.
How can APPA help?
APPA’s services create an environment for young people to talk and discuss mental health. This is aimed at removing stigma associated with mental health difficulties, and therefore combats one of the fundamental issues in this field of change.
It provides a private and safe environment in which young people can assess their well-being and mental health, taking control of their own autonomy and understanding how to meet issues head-on. These principles can be utilised and harnessed during challenging times, including through transitionary phases.
Singh. P. Swaran., Paul. M., Ford. T., Kramer. T., Weaver. T., McLaren. S., Hovish. K., Islam. Z., Belling. R., White. S., (2010). Process Outcome and Experience of Transition from Child to Adult Mental Healthcare: Multiperspective Study. The British Journal of Psychiatry.
Singh. P. Swaran., Youmainen. H., (2015). Transition from Child to Adult Mental Health Services: Needs, Barriers, Experiences and New Models of Care. Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick.