Process, outcome and experience of transition from child to adult mental healthcare: multiperspective study
Open accessAbstract
Background: Many adolescents with mental health problems experience transition of care from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). Aims: As part of the TRACK study we evaluated the process, outcomes and user and carer experience of transition from CAMHS to AMHS. Method: 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. Results: 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. Conclusions: 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.
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The reason few patients make a successful transition is that the transition is to traditional older adult models of care that are not personalised to the clinical and developmental needs of the young person.
“because this transition is to traditional older adult models of care that are not personalised to the clinical and developmental needs of the young person. 222,223”
From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [223]
The Results report that fewer than 5% of young people who reached adult mental health services experienced an optimal transition. The Discussion links discontinuity to the child–adult service split, and “Bridging the divide” calls for attention to young people’s developmental needs. The paper does not establish that few transitions succeed *because* care follows traditional older-adult models that are not personalised to young people’s clinical and developmental needs. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe result of the limitations of the paediatric and adult model is that the very group of patients with the greatest need for care and the best prospects of responding to early intervention and treatment (ie, emerging adults) have the worst access to care across the whole lifespan.
“The result of the limitations of this model is that the very group of patients with the greatest need for care and the best prospects of responding to early intervention and treatment (ie, emerging adults) have the worst access to care across the whole lifespan. 223,227”
From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [223]
The Discussion (page unavailable) says the paediatric–adult split creates discontinuities in care during adolescence, when serious mental disorders may emerge and provision is often patchy. It does not say emerging adults have the greatest need or the best prospects of responding to early intervention, nor does it compare their access with every other age group across the lifespan. (LLM, conf=0.87)
Experimental — accuracy not yet measuredEven when care is accessed from child and adolescent mental health services, few patients make a successful transition to adult mental health services.
“Studies have confirmed that even when care is accessed from child and adolescent mental health services, few patients make a successful transition to adult mental health services”
From The Lancet Psychiatry Commission on youth mental health (2024) · cites this paper as [223]
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References 20 · Cited by 398
Research works printed but not linked: 14
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- Singh SP, Paul M, Ford T, Kramer T, Weaver T. Transitions of care from child and adolescent mental health services to adult mental health services (TRACK study): a study of protocols in Greater London. BMC Health Serv Res 2008; 8: 1-7.
- Ritchie J, Spencer L. Qualitative data analysis for applied policy research. In Analysing Qualitative Data (eds A Bryman, R Burgess): 172-94. Routledge, 1994.
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- National CAMHS Review. Children and Young People in Mind: the Final Report of the National CAMHS Review. Department for Children, Schools and Families and Department of Health, 2008.
- Maitra B, Jolley A. Liaison between child and adult psychiatric services. In Family Matters: Interface Between Child and Adult Mental Health (eds P Reder, M McClure, A Jolley): 285-302. Routledge, 2000.
- Health and Social Care Advisory Service. CAMHS to Adult Transition: A Literature Review for Informed Practice. Health and Social Care Advisory Service (HASCAS) Tools for Transition. Department of Health and HASCAS, 2006 (http://www.hascas.org.uk/pdf_files/HASCAS%20tools%20for%20 transition%20Lit%20Review.pdf).
- Authors
- Singh, S. P., Paul, M., Ford, T., Kramer, T., Weaver, T., McLaren, S., Hovish, K., Islam, Z., Belling, R., & White, S.
- Affiliations
- University of Warwick (GB)
- Peninsula College of Medicine and Dentistry (GB)
- Imperial College London (GB)
- London South Bank University (GB)
- Birmingham and Solihull Mental Health NHS Foundation Trust (GB)
- St George's, University of London (GB)
- Corresponding author
- Singh, Swaran P.
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2010-10
- Volume
- 197
- Issue
- 4
- Pages
- 305-312
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2157936277
- Cited by
- 398
- References
- 20
- Citations by year
- 2026: 22 · 2025: 25 · 2024: 25 · 2023: 25 · 2022: 38 · 2021: 25 · 2020: 37 · 2019: 33 · 2018: 30 · 2017: 36 · 2016: 24 · 2015: 28 · 2014: 19 · 2013: 20 · 2012: 5
- FWCI
- 26.68
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
- Middlesex University Research Repository (Middlesex University Of London) (submittedVersion)
- Funders
- National Institute for Health and Care Research
- Topics
- Health Sciences › Health Professions › Speech and Hearing › Adolescent and Pediatric Healthcare
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Keywords
- care transitions, child and adolescent mental health services, adult mental health services, continuity of care, transition planning, service user experiences, caregiver experiences, clinician experience
- MeSH terms
- Adolescent, Adult, Mental Disorders, Child, Continuity of Patient Care, England, Female, Health Services Research, Humans, Interprofessional Relations, Male, Medical Records, Mental Health Services, Outcome and Process Assessment, Health Care, Referral and Consultation, Cohort Studies, Adolescent Health Services, Qualitative Research
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