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Mind the gap: the interface between child and adult mental health services

  • Swaran P. Singh (a1), Navina Evans (a2), Lester Sireling (a3) and Helen Stuart (a4)
Extract

Adolescents with mental health problems are poorly served by mental health services, since responsibility for care often falls between child and adult services. Within the UK, there is no consensus on how service boundaries should be delineated. Some services use an age cut-off at some point between 16 and 18 years, whereas others consider child services to be appropriate only for those in full-time education. The Audit Commission (1999) reported that nationally 29% of health authorities commissioned child and adolescent mental health services for young people before their 16th birthday only, although adult services were not considered suitable for those under 17 years old. The report highlighted the poor development of adolescent services and their inadequate links with other agencies, including adult mental health services.

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This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Audit Commission (1999) Children in Mind. London: Audit Commission.
Maitra, B. & Jolley, A. (2000) Liaison between child and adult psychiatric services. In Family Matters: Interface Between Child and Adult Mental Health (eds Reder, P., Mcclure, M. & Jolley, A.), pp. 285302. London: Routledge.
Mental Health Foundation (1999) Bright Futures. Promoting Children and Young People's Mental Health. London Mental Health Foundation.
Reder, P., Mcclure, M. & Jolley, A. (2000) Interface between child and adult mental health. In Family Matters: Interface Bet ween Child and Adult Mental Health (eds Reder, P., Mcclure, M. & Jolley, A.), pp. 320. London: Routledge.
Scott, S. (1998) Aggressive behaviour in childhood. BMJ, 316, 202206.
Select Committee on Health (2000) Transitions between child/adolescent and adult services. In Fourth Report. Provision of NHS Mental Health Services. London: Stationery Office (available at http://www.parliament.the-stationery-office.co.uk/pa/cml99900/cmselect/cmhealth/373/37312.htm).
While, A., Forbes, R., Ullman, S., et al (2004) Good practices that address continuity driving transition from child to adult care: synthesis of the evidence. Child Care Health and Development, 30, 439452.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
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Mind the gap: the interface between child and adult mental health services

  • Swaran P. Singh (a1), Navina Evans (a2), Lester Sireling (a3) and Helen Stuart (a4)
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eLetters

A sizeable gap

Anne E Thompson, Consultant Child & Adolescent Psychiatrist
25 August 2005

Sir

Singh et al (2005) discuss the risk of disrupted care for young people who outgrow child and adolescent mental health services (CAMHS).

Lincolnshire Partnership NHS Trust has a protocol for good practice surrounding transfer of a young person’s care from child to adult mental health services. However in an audit of these procedures involving 82 young people aged 17 or 18 who were discharged from 3 of our community CAMHS teams over a 2 year period, only 7 had been transferred to adult services. CAMHS clinicians identified 32 other young people who left theservice with unresolved mental health problems: a suitable adult service could not be found for 1 young person, 21 young people dropped out of CAMHS and 10 young people did not want to be referred to adult services.

The paucity of psychological therapies in adult mental health services created difficulties for CAMHS clinicians in finding suitable follow-on services. Perhaps the prospect of an inevitable ending with no further support contributed to the high drop out rate of young people approaching the end of the service available to them in CAMHS? Some youngpeople clearly said they did not want to have to “start from the beginning” in establishing a therapeutic relationship with a new worker. Others were perhaps influenced in declining ongoing care by the perceived stigma of adult services.

Our audit findings add to the evidence that the current differing perspectives of CAMHS and adult mental health services create gaps in services through which fall vulnerable young people.

Yours faithfully

Dr Anne ThompsonMB BS MRCP (UK) MRCPsychConsultant in Child & Adolescent Psychiatry
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Conflict of interest: None Declared

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