When young people reach the upper age limit of child and adolescent mental health services (CAMHS), care should be transferred to an adult mental health service (AMHS) if they require ongoing support. However, many young people experience a significant disruption of their care during this transition, whilst others may fail to transition at all. Currently, there is no systematic appraisal of the international evidence regarding the outcomes of young people after transition. A systematic review was conducted which aimed to synthesise and review the existing research regarding outcomes after transition. We searched six databases from their inception until December 2017 for research relating to either the mental health or service use outcomes of young people after reaching their CAMHS age boundary. Results were synthesised narratively. The initial searches identified 18,287 papers, of which 213 were screened on full text. 13 papers were included in the review, representing 10 cohorts of young people who crossed the transition age boundary. No studies contained extractable data on mental health outcomes following transition, and therefore, this review focused only on service use outcomes. Results showed a quarter of young people transitioned to AMHS, with the other young people experiencing varied outcomes after leaving CAMHS and multiple transitions during this time. This review provides evidence for the varying service use outcomes of young people after reaching the upper age limit of CAMHS. However, longitudinal research into long-term outcomes is lacking, in addition to research regarding the mental health and functioning outcomes of young people following transition.Protocol registration The protocol for this systematic review has been registered with PROSPERO, ID number CRD42018085916.

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Forensic services focus on risk reduction and extol the value of multidisciplinary working. Due to the complex relationship of personality disorder and risk, a multidisciplinary approach to risk assessment, formulation, management and reduction is essential. Occupational Therapists provide a unique perspective; however, current literature pertaining to the contribution of Occupational Therapy is negligible. This paper aims to initiate discussion of the value of Occupational Therapy contributions to risk assessment and formulation with personality disordered offenders. A new approach is described that integrates occupational adaptation and multiple sequential functional analysis to provide a structured framework for Occupational Therapy risk assessment and formulation. A single case report is presented to demonstrate the advantages of the approach for identifying offenders' strengths and difficulties, predicting risk of reoffending, identifying offence paralleling behaviour and informing and evaluating efficacy of intervention, thereby supporting the aims of forensic practice settings to assess, manage, treat and reduce risk.

Cel pracyWyniki badań wskazują, że w wielu krajach europejskich wzrasta liczba pacjentów ośrodków psychiatrii sądowej oraz wydłuża się czas pobytu pacjentów w tych ośrodkach. Psychiatria sądowa funkcjonuje w szczególnych uwarunkowaniach społeczno-kulturowych. Obserwowana tendencja do wydłużania się czasu pobytu pacjentów sądowych nie może być jedynie tłumaczona charakterystyką tej grupy pacjentów. Prezentujemy wyniki pierwszego badania dotyczącego wpływu czynników zewnętrznych na czas pobytu w ośrodkach psychiatrii sądowej.MetodaPrzedstawiciele 16 krajów europejskich, w ramach projektu COST poświęconego psychiatrii sądowej, używając ustrukturyzowanego narzędzia, dokonali retrospektywnej oceny systemów psychiatrii sądowej. Dane analizowano z zastosowaniem analizy tematycznej.WynikiZidentyfikowano i opisano cztery grupy czynników wpływających na czas pobytu: rodzaje terapii i opieki, zasoby, rozwiązania prawne i systemowe oraz wymiana doświadczeń.WnioskiWyniki analizy wskazują na potrzebę wielospecjalistycznego podejścia do problemu wydłużania się czasu pobytu pacjentów w ośrodkach sadowych. Konieczne są dalsze badania nad opracowaniem opartych na dowodach naukowych europejskich standardów postępowania, mających na celu poprawę jakości opieki nad pacjentami w grupie ryzyka długoterminowego pobytu (ang. „long-stay”) w ośrodkach psychiatrii sądowej.