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Child to adult mental health transfer is inadequate

Report recommends a more flexible approach

Jo Carlowe

Tuesday, 10 July 2018

Many young people with mental health problems experience a difficult transition from child to adult care, a new report* shows.

It is estimated that more than 25,000 young people transition from child and adolescent to adult mental health services each year at the exact time when they are “most vulnerable”.

The report was sparked by the suicide of an 18-year-old patient shortly after moving from child to adult mental health services.

In its report, the Healthcare Safety Investigation Branch (HSIB), recommends a more flexible approach to moving young people into adult services.

Many young people, including those who participated in this investigation, do not have a positive experience of transition and, as a result, may disengage from services putting their health and wellbeing at risk, the report states.

Chief investigator, Keith Conradi, whose experience includes six years as the chief investigator of the Air Accident Investigation Branch, said: “Young people’s mental health has received considerable national interest in recent years, with particular attention paid to how young people are supported in transition to adult services. Experts have documented the elements of a safe and effective transition for many years however, many young people still do not have a positive experience and, as a result, disengage from services.

“I believe this is a very important issue of increasing significance for young people today and I am pleased to publish our second report. The report is the culmination of many months of rigorous and independent investigation, working closely with those involved in the care of this young person, who sadly died by suicide, as well as relevant organisations and subject matter experts. We undertook this investigation with the sole purpose of learning and have made six safety recommendations to three national NHS organisations with the intention of preventing future, similar events. In addition, we also made two safety observations which also warrant attention. We will publish organisational responses to our recommendations in the coming months on our website.”

The HSIB identified the following key findings:

  • Young people using child and adolescent mental health services would benefit from a flexible, managed transition to adult mental health services which has been carefully planned with the young person, provides continuity of care and follow-up after transition. A duration of shared-care would help to ensure readiness and continuity for the young person.
  • Young people and their families may also benefit from the use of tools in their transition planning to allow for structured conversations and to empower them to ask questions and take ownership of their diagnosis, needs and treatment.
  • In the acute and mental health trusts visited, there were no standardised methods or tools used to manage transition.
  • There is evidence that moving to a flexible model which has the capacity to provide mental health services up to the age of 25, can minimise some of the barriers and reduce the risks associated with transition.
  • Research suggests that young people want flexible services which do not have strict “cut-off” points. Flexible services are especially important for young people with emotional problems, complex needs, mild learning disability, attention deficit hyperactivity disorder, and autism spectrum disorder, for whom there are limited available services in the adult mental health setting.
  • Research indicates that early intervention reduces the impact on both the young person and subsequently the NHS through improved outcomes and a reduction in the need for longer-term resources.
In publishing its findings the HSIB has made six safety recommendations to three organisations and two safety observations. Amongst others, it recommends that the Care Quality Commission extend its remit of its inspections to ensure the whole care pathway, from child and adolescent mental health services to adult mental health services, is examined.

In addition, it calls on NHS England and NHS Improvement to work with commissioners and providers of mental health services to ensure that the care of a young person before during and after transition is shared in line with best practice, including joint agency working.

*Investigation into the transition from child and adolescent mental health services to adult mental health services. A report prepared by the Healthcare Safety Investigation Branch, July 2018.

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