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Process, outcome and experience of transition from child to adult mental healthcare: multiperspective study

  • Swaran P. Singh (a1), Moli Paul (a2), Tamsin Ford (a3), Tami Kramer (a4), Tim Weaver (a4), Susan McLaren (a5), Kimberly Hovish (a6), Zoebia Islam (a7), Ruth Belling (a5) and Sarah White (a8)...

Many adolescents with mental health problems experience transition of care from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS).


As part of the TRACK study we evaluated the process, outcomes and user and carer experience of transition from CAMHS to AMHS.


We identified a cohort of service users crossing the CAMHS/AMHS boundary over 1 year across six mental health trusts in England. We tracked their journey to determine predictors of optimal transition and conducted qualitative interviews with a subsample of users, their carers and clinicians on how transition was experienced.


Of 154 individuals who crossed the transition boundary in 1 year, 90 were actual referrals (i.e. they made a transition to AMHS), and 64 were potential referrals (i.e. were either not referred to AMHS or not accepted by AMHS). Individuals with a history of severe mental illness, being on medication or having been admitted were more likely to make a transition than those with neurodevelopmental disorders, emotional/neurotic disorders and emerging personality disorder. Optimal transition, defined as adequate transition planning, good information transfer across teams, joint working between teams and continuity of care following transition, was experienced by less than 5% of those who made a transition. Following transition, most service users stayed engaged with AMHS and reported improvement in their mental health.


For the vast majority of service users, transition from CAMHS to AMHS is poorly planned, poorly executed and poorly experienced. The transition process accentuates pre-existing barriers between CAMHS and AMHS.

Corresponding author
Swaran P. Singh, Health Services Research Institute, Medical School Building, Gibbet Hill Campus, University of Warwick, Coventry CV4 7AL, UK. Email:
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The TRACK study is funded by the National Institute of Health Research (NIHR) Service Delivery and Organisation (SDO) programme ( The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR SDO programme or the Department of Health.

Declaration of interest


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Process, outcome and experience of transition from child to adult mental healthcare: multiperspective study

  • Swaran P. Singh (a1), Moli Paul (a2), Tamsin Ford (a3), Tami Kramer (a4), Tim Weaver (a4), Susan McLaren (a5), Kimberly Hovish (a6), Zoebia Islam (a7), Ruth Belling (a5) and Sarah White (a8)...
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Addressing transition across systems

Peter Trigwell, Consultant in Liaison Psychiatry
22 November 2010

I read with interest the recent paper by S. P. Singh et al (1). Thisis an important and timely paper, focussing upon the lack of effective approaches to assisting young people during transition from CAMHS to AMHS,i.e. regarding mental health during the transition period. The authors quite rightly point to the importance of services paying attention to the developmental needs of this age group in areas beyond healthcare transition, such as changes in educational and vocational domains, independent living and social and legal status. I would urge, however, that physical health conditions, especially long-term conditions, should be added to this list for specific consideration. Transition (generally referring to people moving from child to adult services when between the ages of 16 and 25 years (2)) has elsewhere been described as “the purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child-centred to adult-orientated healthcare systems” (3). It is currently receiving increasing attention in some long-term physical health conditions with regard to policy formation and service development, perhaps most notably diabetes services.One large regional survey recently demonstrated the awareness of need regarding psychological support and care for young people with diabetes inthe transition period (4). The findings also demonstrated multiple gaps in services, however, despite a range of relevant NSF Standards and NICE requirements which already exist specifically in relation to psychologicalcare in the context of diabetes. The findings mirror those of Singh et alin mental health services, and may be taken as evidence for the need for anew and clearly defined but broad approach to helping people at the transition stage across all health, educational and social care systems.

References1 Singh, SP., Paul, M., Ford, T., Kramer, T., Weaver, Tim., McClaren, S.,Hovish, K., Islam, Z., Belling, R and White, S. Process outcome and experience of transition from child to adult mental healthcare: Multi perspective study. British Journal of Psychiatry 2010; 197: 305-312.

2 Trigwell, P., Rana, A. Diabetes and liaison psychiatry: what about transition? Psychiatric Bulletin 2009; 33 (4): 154.

3 Blum, R., Garell, D., Hodgman, C, et al. Transition from child-centred to adult healthcare systems for adolescents with chronic conditions. A position paper for the Society of Adolescent Medicine. Journal of Adolescent Health 1993: 14: 570-6.

4 Trigwell, P., Jawad, S. Psychological support and care for young people with diabetes in the “transition” period. Practical Diabetes International 2010; 27 (4): 1-7.
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