The CQC released the second phase of their review of children and young people’s mental health services last month, which noted that the transition from children’s to adults’ mental health services is an important turning point in young people’s treatment, with a number of barriers to high quality care.
The review found that advance planning, good communication and information sharing between services makes it easier for young people to make the transition between services and from children’s services to adult services. Proposals to better support young adults are included in Transforming Children and Young People’s Mental Health Provision: A Green Paper, with a proposed new national partnership to improve mental health services for those aged 16-25 years.
Ideas on how we could better support young people’s transitions between services were discussed at our IAPT Connect conference last year. We brought together those working in adult and CYP mental health services to look at the ways we can improve service delivery, efficiency and patient outcomes. We invited delegates to make suggestions on how to improve transitions for young people and a panel explored what can be done to reduce the gap between services that children and young people experience.
Chaired by Nicky Runeckles, the panel comprised James Woollard of Oxleas NHSFT, speaking from from the child and adolescent perspective; Morad Margoum of Dorset Healthcare NHSFT, speaking as an adult mental health specialist; Nesta Reeve of Norfolk and Suffolk NHSFT, where services are commissioned across both children and adults; Anna Burhouse of 2Gether Gloucester NHSFT bringing a quality improvement and systems perspective; and NHS England IAPT programme manager Ursula James.
Together with the audience, the panel explored suggestions around six themes and the summary below gives a brief overview of some key points for each theme:
The legal age of adulthood at 18 marks the transition to adult services in many areas. However, when it comes to the right point for an individual’s transition from child to adult mental health, the panel discussed how each of us is different and agreed that reaching a particular age should not be a reason to disrupt a successful and trusting therapeutic relationship.Mourad reminded us that the Five Year Forward View is focussed on reducing silos. “Psychologically we work on gradients, not in binary,” he said, and mental health services should be structured to reflect that. Anna suggested that good commissioning is key in ensuring services are joined up for CYP and adult age groups. If we were to approach the question purely from patient experience perspective, we would commission in a way that allowed the moment of transition to be left to individual choice.
2. Preparation for handover
How do we ensure the effective handover of an individual’s case from children’s to adult services? James raised that professional training and the workforce are both structured around the split between CYP and adult services. The adult IAPT workforce is specifically trained to work with adults with anxiety and depression, and Ursula highlighted that randomised control trials show that this system works for the people it was designed to serve.If the workforce begins serving other age groups, should top-up training be provided for staff that is specific to treating children and young people? Ursula stated that this is about more than simply working together. Rather, it’s about moving from silos to a place where everyone is clear about the needs of the child, the needs of the individual at the point of transition, and the needs of the adult, and about how each phase impacts the next.
3. Mind the gap
The transition between home and university is a point at which young people often experience a ‘gap’ in care. James highlighted that many young people move area to study and then return. Anna suggested that more can be done to link CAMHS with university mental health services or adult mental health services in order to plan for a young person’s transition.She also explained the value of connecting the young person with their future care coordinator in advance, so that a relationship can be established before transition, and that where that isn’t possible, sharing the details of local providers who can provide support – such as in the voluntary and third sectors – could be valuable for those who don’t meet the threshold for adult treatment.
4. Technology
The panel discussion touched on the role of digital tools and online therapy in increasing choice for young people who are waiting to access adult mental health services, in providing remote consultations for those who move away from their home area and in continuing to provide support for those who do not meet thresholds for adult services.Transitions are about information sharing, explained James. What if the young person were to become the controller of their own data, and could themselves share it with relevant parties as they transition? “I don’t think we understand yet the transformational power of giving people access to their records – because we haven’t tried it yet,” explained James.
5. Parental involvement
Currently, when the patient turns 18 years old, their family is no longer a legal stakeholder in their treatment. James recalled a couple of cases he was aware of, where a young person had been in crisis and their family had not been contacted. He suggested that it’s time to redesign services more effectively around the family and their involvement in supporting the young person’s care.
6. Transition services
Nesta described how commissioners have created a transition service in Suffolk, by bringing primary mental health workers together with other therapists that had been working in CYP mental health services, to create a wellbeing service for all ages, enabling individuals to keep the same care worker throughout an episode of treatment. Both young people and adults teams see 16-19 year olds, which has required them to skill up as well as employing a variety of specialists.
A commissioner in Kent said that they are considering a service for 17-25 year olds. “The patient is the most important person here and we should be working flexibly around them. My ambition is to see the adult and child service linking seamlessly.”
There are a wide range of challenges around transitions between services and the different ways services are responding. Our team at Mayden picked up several interesting themes around data and the role of digital tools to support young people’s transition, particularly in terms of placing young people at the centre of their care as the controllers of their own data, to ensure that information moves with them, and to support continuing care for those who do not meet thresholds for adult services.
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