Mental Health Services: From Childhood To Adult Therapy

OVERVIEW

Young people in Australia with mental health challenges often have to move from child to adult mental health services when they turn eighteen (18). This transition happens during a critical time in their lives, as they face many changes and challenges, such as growing independence, emotional struggles, and social pressures. Many of these young people are still developing essential life skills and may not feel ready for the adult system, which expects them to act independently and manage their mental health. Without proper support, this gap in care can leave them feeling lost and vulnerable, making it harder for them to get the help they need. 

This study investigates the real-life experiences of young adults about their transition to adult mental health services, including the perspectives of significant individuals in their lives.

 

THE STUDY BACKGROUND

In Australia, young people who have mental health issues must move from Child and Adolescent Mental Health Services (CAMHS) to adult mental health services when they turn 18. This transition is required by current policies, funding rules, and clinical practices [1]. Unfortunately, this change happens during a critical phase in their lives, when they are already dealing with multiple challenges, including social and developmental changes. Research shows that these young individuals often face emotional, cognitive, and social difficulties, which may be caused by trauma, mental health conditions, risky behaviors, or other challenging life experiences [2]. Without proper support, these challenges can slow down their personal growth and negatively affect their future as adults [3].

The transition from adolescence to adulthood is already complicated for many young people. This stage of life, sometimes called “emerging adulthood,” often extends into the mid to late twenties. Many young people are still figuring out their identity and depend on their families for support. For those with mental health challenges, this extended phase of development makes the shift to adult mental health services even harder [4]. Adult mental health systems expect individuals to act independently, understand their mental health needs, and seek help on their own. However, many young people are not ready for these responsibilities, which creates a mismatch between their needs and the services available [5].

This mismatch can leave young people feeling disconnected from care, especially during a time of increased stress and vulnerability. Research suggests that adult mental health models are not well-equipped to address the specific needs of young people transitioning from CAMHS [6]. As a result, many struggle to access or stay engaged with adult mental health services. This gap in care has significant consequences, potentially worsening mental health outcomes and delaying their ability to lead fulfilling adult lives.

This study highlights the need for a better understanding of how the transition to adult mental health services impacts young people. It emphasizes that the existing model of care often does not meet their needs, risking long-term consequences for their mental health and overall well-being.

 

THE STUDY METHOD

The researchers conducted a systematic review to explore the transition experiences of young people moving to adult mental health services. They followed established guidelines, including PRISMA, JBI Appraisal tools, and Cochrane qualitative evidence synthesis, to ensure a thorough and rigorous review process. Before starting, the team agreed on explicit inclusion and exclusion criteria. The search spanned multiple databases, such as PsychInfo, Medline, PubMed, and others, covering studies published between January 2009 and February 2022. They used a comprehensive list of youth, mental health, transitions, and care keywords. 

The inclusion criteria focused on qualitative studies or the qualitative components of mixed-methods research, targeting young people aged 16–24 and their parents, carers, and clinicians. The studies needed to address perspectives on the transition to adult mental health services. Exclusion criteria ruled out purely quantitative studies, participants outside the age range, and those focused solely on physical illnesses or specific neurodiverse conditions. Two reviewers independently assessed the eligibility of titles and abstracts, resolving disagreements with the involvement of additional reviewers to ensure consistency and accuracy. This systematic approach allowed the researchers to capture a broad yet focused understanding of the topic.

 

ANALYSIS

The researchers analyzed the data by extracting key information from the selected studies. They identified common themes across the studies and combined these findings to understand the topic better. The data they collected included details like where the study location, the groups of people involved, the study designs, and the settings. They also looked at the main issues addressed in each study, the key findings, and any mentioned limitations. It helped them organize the information and highlight the most critical insights from the research.

 

RESULTS

1. Study Selection Process:
   • The literature search initially found 314 results from nine databases, with an additional seven papers identified from grey literature and hand-searching references.
   • After removing duplicates, 245 titles and abstracts were screened, with 152 papers eliminated for being ineligible.
   • The researchers reviewed Ninety-three full-text articles. The scientists excluded Seventy-Five (75) of the reviewed articles for reasons such as focusing on chronic physical illnesses or not being primary research.
   • Eleven more papers were excluded after qualitative appraisal, leaving nine studies included for the qualitative synthesis.
2. Characteristics of Included Studies:
   • The studies used various methods such as Delphi, participatory action research, and interviews.
   • The research was conducted in settings like hospitals, universities, homes, and patient associations in Canada, the UK, and Sweden.
   • These studies aimed to understand the transition of young people to adult mental health services.
3. Main Themes Identified:
   • Young People: Key themes included empowerment, being treated individually, socio-developmental changes, trust and safety, and being prepared for a transition.
   • Parents/Carers: The central theme was the need for involvement and support in the transition process.
   • Clinicians: A common theme was fragmented service provision, with clinicians expressing concern about the lack of continuity between child/adolescent and adult mental health services.
4. Young People’s Experience of Transition:
   • Young people wanted to feel empowered, treated as individuals, and supported through the transition process.
   • They expressed feelings of being unprepared and uninformed about the transition, leading to anxiety and insecurity.
   • The transition process was often perceived as overwhelming, with young people feeling disconnected and unsupported by clinicians.
5. Parent and Carer Involvement:
   • Parents and carers emphasized the need for better communication, involvement in decision-making, and support during the transition period.
   • Many expressed feelings of being left in the dark, especially when their children turned 18 and were moved to adult services.
6. Clinician Perspectives:
   • Clinicians highlighted the challenges of fragmented care, with a lack of coordination between child/adolescent and adult mental health services.
   • They suggested that joint training and meetings between service providers could help improve the transition process.

This study found that better communication, involvement in decision-making, and more personalized care could significantly improve the transition experience for young people moving from child/adolescent mental health services to adult services.

 

DISCUSSION

This review examines the transition of young people from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). It highlights the challenges faced during this process, which often happens unexpectedly, such as when a young person turns 18 or experiences a mental health crisis. The review identifies several factors that influence the transition. First, age 18 is not a helpful trigger for transition, as it does not align with individual readiness. Young people want to be involved in planning the timing and process of their transition, while parents and carers also seek more involvement. Clinicians express concerns about the disconnect between CAMHS and AMHS services during transition [7] [8].

The study also emphasizes that the transition process should be individualized and well-planned to meet young people’s clinical, psychosocial, developmental, and educational needs. A key concern is the lack of coordinated care during the transition period. This disconnect can leave young people vulnerable to mental health issues and high-risk behaviors. Some studies show that the transition often comes at a time when young people are grappling with identity formation and mental illness, which can complicate the process of becoming independent [9] [10]. The review calls for developing a transition model that includes mental health professionals and the involvement of families and carers to support young people during this process [11].

Additionally, young people prefer being partners in the transition process, desiring more involvement in decision-making. They also seek practical support and mentoring throughout the transition. Clinicians suggest that improvements are needed in the form of key workers and joint working between CAMHS and AMHS to prepare young people for the transition [12] [13]. Despite the growing literature on this topic, there remains a gap in understanding what an effective transition program should look like. The review advocates for policies incorporating early involvement of young people, families, and clinicians in the transition process [14].

Further research is required to understand better how to bridge the gaps in policy and practice. The study calls for better coordination between services and a focus on training for mental health professionals to improve communication with young people. It could lead to clearer care pathways and more successful transitions [15]. Lastly, the review suggests that mental health services should adopt a lifespan approach to care, recognizing the extended developmental period between adolescence and adulthood. Emerging care models emphasize the importance of community-based support, peer workers, and integrated primary care programs [16] [17].

 

STUDY LIMITATIONS

1. Limited Number of Studies:
   • The researchers noted that very few qualitative studies focused on the experiences of young people transitioning to adult mental health services.
   • Not many studies included the perspectives of key influencers like parents, carers, and clinicians.
2. Reliance on Mixed-Method Studies:
   • The available mixed-method studies mostly used qualitative components to inform the review, limiting the depth of the findings.
3. Need for Higher-Quality Studies:
   • More high-quality qualitative studies are needed to understand better what makes the transition to adult mental health services effective for young people.
4. Research on Post-Transition Experiences:
   • Further research is needed to understand the experiences of young people after they transition, including what worked and what didn’t in the process.
5. Need for Transitional Intervention Trials:
   • Research is needed to design and test effective transitional programs for young people to improve the process.

 

CONCLUSION

This review examined the experiences of young people, their families, and clinicians during the challenging transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS). It concluded that the transition process needs careful planning to address the young person’s developmental, psychosocial, and mental health needs. Understanding their internal and external circumstances is essential to support their growth and success in adulthood. The review recommends further research to improve clinical practices and inform policies, highlighting the importance of training for clinicians to support these transitions. Additionally, it suggests that policymakers focus on creating adaptable and sustainable programs and emphasize the need for improved communication and health literacy in the care process.

 

References

1. Brazel M, Allison S, Bastiampillai T, Kisely SR, Looi JC. Child and Adolescent Mental Health Services in Australia: A Descriptive Analysis Between 2015–16 and 2019–20. Australas Psychiatry. 2023;31(4):445–451. https://doi.org/10.1177/10398562231160076
2. Australian Institute of Health and Welfare. Australia youth: Mental Illness. 2021  https://www.aihw.gov.au/reports/children-youth/mental-illness
3. Hovish K, Weaver T, Islam Z, Paul M, Singh SP. Transition experiences of mental health service users, parents, and professionals in the United Kingdom: A qualitative study. Psychiatr Rehabil J. 2012;35(3):251–257. https://doi.org/10.2975/35.3.2012.251.257
4. Arnett JJ, Žukauskienė R, Sugimura K. The new life stage of emerging adulthood at ages 18–29: Implications for mental health. Lancet Psychiatry. 2014;1(7):569–576.  https://doi.org/10.1016/S2215-0366(14)00080-7
5. Cleverley K, Lenters L, McCann E. “Objectively terrifying”: A qualitative study of youth’s experiences of transitions out of child and adolescent mental health services at age 18. BMC Psychiatry. 2020;20:147. https://doi.org/10.1186/s12888-020-02516-0
6. Dunn V. Young people, mental health practitioners, and researchers co-produce a transition preparation program to improve outcomes and experiences for young people leaving Child and Adolescent Mental Health Services (CAMHS). BMC Health Serv Res. 2017;17(1):293. https://doi.org/10.1186/s12913-017-2221-4
7. Abidi S. Paving the way to change for youth at the gap between child, adolescent, and adult mental health services. Can J Psychiatry. 2017;62(6):388-392. https://doi.org/10.1177/0706743717694166
8. Appleton R, Loew J, Mughal F. Young people who have fallen through the mental health transition gap: A qualitative study on primary care support. Br J Gen Pract. 2022;72(719):e413-e420. https://doi.org/10.3399/BJGP.2021.0678
9. Hendrickx G, De Roeck V, Maras A, et al. Challenges during the transition from child and adolescent mental health services to adult mental health services. BJPsych Bull. 2020;44(4):163-168. https://doi.org/10.1192/bjb.2019.85
10. Monahan KC, Steinberg L, Cauffman E, Mulvey EP. Psychosocial (im)maturity from adolescence to early adulthood: distinguishing between adolescence-limited and persisting antisocial behavior. Dev Psychopathol. 2013;25(4 Pt 1):1093-1105. https://doi.org/10.1017/S0954579413000394
11. Nguyen VT, Breakspear M, Hu X, Guo CC. The integration of the internal and external milieu in the insula during dynamic emotional experiences. NeuroImage. 2016;124(Pt A):455-463. https://doi.org/10.1016/j.neuroimage.2015.08.078
12. Cleverley K, Lenters L, McCann E. “Objectively terrifying”: A qualitative study of youth’s experiences of transitions out of child and adolescent mental health services at age 18. BMC Psychiatry. 2020;20:147. https://doi.org/10.1186/s12888-020-02516-0
13. Hovish K, Weaver T, Islam Z, Paul M, Singh SP. Transition experiences of mental health service users, parents, and professionals in the United Kingdom: A qualitative study. Psychiatric Rehabilitation Journal. 2012;35(3):251–257. https://doi.org/10.2975/35.3.2012.251.257
14. Dunn V. Young people, mental health practitioners, and researchers co-produce a transition preparation program to improve outcomes and experiences for young people leaving child and adolescent mental health services (CAMHS). BMC Health Services Research. 2017;17(1):293. https://doi.org/10.1186/s12913-017-2221-4
15. MacDonald K, Ferrari M, Fainman-Adelman N, Iyer SN. Experiences of pathways to mental health services for young people and their carers: a qualitative meta-synthesis review. Soc Psychiatry Psychiatr Epidemiol. 2021;56:339-361. https://doi.org/10.1007/s00127-020-01976-9
16. McGorry PD, Mei C, Chanen A, Hodges C, Alvarez-Jimenez M, Killackey E. Designing and scaling up integrated youth mental health care. World Psychiatry. 2022;21(1):61-76. https://doi.org/10.1002/wps.20938
17. Lynch L, Moorhead A, Long M, Hawthorne-Steele I. “If you don’t care for somebody, how can you help them?”: Exploring young people’s core needs in mental healthcare—directions for improving service provision. Community Mental Health Journal. 2024;60(4):796-812. https://doi.org/10.1007/s10597-024-01237-y

 

About Author