December 2017 saw the Government publish its Green Paper on 'Transforming Children and Young People's Mental Health'. Part of that paper acknowledged that some people require ongoing support into early adulthood after they leave the children and young person's mental health service (CAMHS).
The transition from CAMHS to adult mental health services (AMHS) can leave patients vulnerable to deterioration in their mental health and is an issue the Department of Health intends to keep under review this year.
Transition from CAMHS to AMHS
The way mental health services are commissioned and delivered for young adults varies across England. For example, some young people are discharged from CAMHS aged 16, 18 or 25 depending on where they live. Upon discharge, the patient may be referred to AMHS but due to differing acceptance criteria, it may be that the patient is not accepted for AMHS and is discharged back to the care of their GP.
There is a risk that the lack of consistency between CAMHS and AMHS could impact on the delivery of safe and effective care.
What issues impact on a cohesive approach in the transition process?
Several factors were identified in the Green Paper as follows -
- Inconsistent policies for transition – in some areas the age of transfer to AMHS is 16 years old, in other areas it is 18 years old and certain areas are now trialling transfer at the age of 25.
- The threshold for access to AHMS is generally higher than CAMHS which can lead to a sudden withdrawal of services – for example CAMHS supports conditions such as ADHS and moderate ASD but AMHS tend to offer services only to those suffering severe and enduring illnesses such as psychosis or severe depression.
- Consistency of care planning systems – for example the use of the Common Assessment Framework versus the Care Programme Approach.
- A lack of communication between CAMHS and AHMS in general.
How can the transition process be improved?
The Green Paper has identified several key areas in which service providers should improve as follows -
- Policies and procedures should be consistent with national guidance supporting the transition process between CAMHS and AMHS.
- Commissioners can assist by bringing representatives from CAMHS, AMHS and the voluntary sector together to review and monitor transition protocols and process.
- CAMHS should begin the transition process at least 6 months before the patient is due to transfer to AMHS or another community based service. This should be a collaborative, multi-agency approach, and include the views of the young person to result in a clear transition plan. Evidence suggests that the transition process is often started very late leading to poor outcomes and distress.
The Healthcare Safety Investigation Branch is currently exploring possible safety issues within transition from CAMHS and AMHS and any significant developments should feed into the Government's wider review into transforming children and young people's mental health.
Bevan Brittan LLP has a dedicated Mental Health team who can advise you on all legal aspects of Children or Adult Mental Health Services, including the transition process.
For further information on the Green Paper or any of the points raised in this article, please contact Samantha Minchin, Solicitor or Hannah Taylor, Senior Associate.