Leaving child and adolescent mental health services (CAMHS): the impact of diagnosis and medication management on optimal discharge or transition

Purpose This study aims to explore how young people in child and adolescent mental health services (CAMHS) in the UK, Ireland, The Netherlands and Croatia, experienced leaving CAMHS and identified a range of factors impeding optimal discharge or transition to adult mental health services (AMHS). Design/methodology/approach Interviews about discharge or transition planning, including what information was provided about their ongoing mental health needs, undertaken with 34 young people aged 17–24, all previous or current attendees of CAMHS. Some interviews included accounts by parents or carers. Data were thematically analysed. Findings A number of previously well-documented barriers to a well-delivered discharge or transition were noted. Two issues less frequently reported on were identified and further discussed; they are the provision of an adequately explained, timely and appropriately used diagnosis and post-CAMHS medication management. Overall, planning processes for discharging or transitioning young people from CAMHS are often sub-optimal. Practice with regard to how and when young people are given a diagnosis and arrangements for the continuation of prescribed medication appear to be areas requiring improvement. Originality/value Study participants came from a large cohort involving a wide range of different services and health systems in the first pan-European study exploring the CAMHS to adult service interface. Two novel and infrequently discussed issues in the literature about young people’s mental health transitions, diagnosis and medication management were identified in this cohort and worthy of further study.

[1]  T. van Amelsvoort,et al.  Cohort profile: demographic and clinical characteristics of the MILESTONE longitudinal cohort of young people approaching the upper age limit of their child mental health care service in Europe , 2021, BMJ Open.

[2]  C. Prigent,et al.  Effect of managed transition on mental health outcomes for young people at the child–adult mental health service boundary: a randomised clinical trial , 2021, Psychological Medicine.

[3]  A. Canaway,et al.  “I’m just a long history of people rejecting referrals” experiences of young people who fell through the gap between child and adult mental health services , 2020, European Child & Adolescent Psychiatry.

[4]  Lindsey M Lenters,et al.  “Objectively terrifying”: a qualitative study of youth’s experiences of transitions out of child and adolescent mental health services at age 18 , 2020, BMC Psychiatry.

[5]  T. Franić,et al.  A cross-cultural qualitative study of the ethical aspects in the transition from child mental health services to adult mental health services. , 2020, Child and adolescent mental health.

[6]  S. McMillan,et al.  Young people's experiences with mental health medication: A narrative review of the qualitative literature , 2020, Journal of mental health.

[7]  C. O’Connor,et al.  Diagnostic trajectories in child and adolescent mental health services: exploring the prevalence and patterns of diagnostic adjustments in an electronic mental health case register , 2019, European Child & Adolescent Psychiatry.

[8]  S. Farooq,et al.  Sharing information about diagnosis and outcome of first‐episode psychosis in patients presenting to early intervention services , 2019, Early intervention in psychiatry.

[9]  H. Tuomainen,et al.  Outcomes of young people who reach the transition boundary of child and adolescent mental health services: a systematic review , 2019, European Child & Adolescent Psychiatry.

[10]  G. Peryer,et al.  Experiencing mental health diagnosis: a systematic review of service user, clinician, and carer perspectives across clinical settings. , 2018, The lancet. Psychiatry.

[11]  C. O’Connor,et al.  How does psychiatric diagnosis affect young people's self-concept and social identity? A systematic review and synthesis of the qualitative literature. , 2018, Social science & medicine.

[12]  D. Wolke,et al.  A systematic review of the literature on ethical aspects of transitional care between child- and adult-orientated health services , 2018, BMC Medical Ethics.

[13]  J. Moncrieff,et al.  The least worst option: user experiences of antipsychotic medication and lack of involvement in medication decisions in a UK community sample , 2018, Journal of mental health.

[14]  S. Singh,et al.  Managing the link and strengthening transition from child to adult mental health Care in Europe (MILESTONE): background, rationale and methodology , 2018, BMC Psychiatry.

[15]  F. Verhulst,et al.  The interface between child/adolescent and adult mental health services: results from a European 28-country survey , 2018, European Child & Adolescent Psychiatry.

[16]  T. Ford,et al.  Exploring social identity change during mental healthcare transition , 2017 .

[17]  A. Charach,et al.  Youth experiences of transition from child mental health services to adult mental health services: a qualitative thematic synthesis , 2017, BMC Psychiatry.

[18]  J. Madan,et al.  Protocol for a cohort study of adolescent mental health service users with a nested cluster randomised controlled trial to assess the clinical and cost-effectiveness of managed transition in improving transitions from child to adult mental health services (the MILESTONE study) , 2017, BMJ Open.

[19]  Deborah E. White,et al.  Thematic Analysis , 2017 .

[20]  R. Roose,et al.  Continuity of care in youth services: A systematic review , 2017 .

[21]  P. Schnurr,et al.  Emergence of Transdiagnostic Treatments for PTSD and Posttraumatic Distress , 2016, Current Psychiatry Reports.

[22]  P. McGorry,et al.  Why We Need a Transdiagnostic Staging Approach to Emerging Psychopathology, Early Diagnosis, and Treatment. , 2016, JAMA psychiatry.

[23]  J. Jones,et al.  ‘Are you by chance on the spectrum?’ Adolescents with autism spectrum disorder making sense of their diagnoses , 2015 .

[24]  H. Tuomainen,et al.  Transition from child to adult mental health services: needs, barriers, experiences and new models of care , 2015, World psychiatry : official journal of the World Psychiatric Association.

[25]  B. Mullan,et al.  A Qualitative Exploration of Service Users’ Information Needs and Preferences When Receiving a Serious Mental Health Diagnosis , 2015, Community Mental Health Journal.

[26]  V. Parker,et al.  Facilitators and Barriers to the Active Participation of Clients with Serious Mental Illnesses in Medication Decision Making: the Perceptions of Young Adult Clients , 2015, Journal of Behavioral Health Services & Research.

[27]  T. Ford,et al.  Who is in the transition gap? Transition from CAMHS to AMHS in the Republic of Ireland , 2015, Irish Journal of Psychological Medicine.

[28]  T. Ford,et al.  Transition from child and adolescent to adult mental health services in the Republic of Ireland: an investigation of process and operational practice , 2014, Early intervention in psychiatry.

[29]  C. Murphy,et al.  3Avoiding the 'twilight zone': recommendations for the transition of services from adolescence to adulthood for young people with ADHD , 2011, BMC psychiatry.

[30]  V. Harpin,et al.  Young adults with ADHD: an analysis of their service needs on transfer to adult services , 2010, Archives of Disease in Childhood.

[31]  M. Welford,et al.  Impact of a diagnosis of psychosis: user-led qualitative study , 2009 .

[32]  C. Street,et al.  Transition between different UK mental health services ? young people?s experiences on what makes a difference. , 2018 .

[33]  T. Weaver,et al.  Transition experiences of mental health service users, parents, and professionals in the United Kingdom: a qualitative study. , 2012, Psychiatric rehabilitation journal.

[34]  P. Corrigan How clinical diagnosis might exacerbate the stigma of mental illness. , 2007, Social work.

[35]  V. Braun,et al.  Please Scroll down for Article Qualitative Research in Psychology Using Thematic Analysis in Psychology , 2022 .