A retrospective case note review of young people in transition from adolescent medium secure units to adult services

Abstract

Purpose There is substantial evidence that young people moving from child and adolescent mental health services to adult services are more likely to experience poor transitions. However, little is known about the care pathways of young people transitioning from forensic services. This retrospective case note review sought to examine the clinical characteristics, transition pathways and psychosocial indicators of transition outcomes amongst young people in forensic medium secure services discharged to adult services. Design/methodology/approach The electronic records of 32 young people, who transitioned from six adolescent medium secure units in England to adult services between May 2015 and June 2016, were examined. Findings Approximately 65% of young people were between 18 and 19 years at the time of transition and the average waiting time from referral to discharge was six months. A total of 63% young people transitioned to community placements and adult medium secure services. Four pathways describing the journey into and out of adolescent medium secure services were identified in a subsample of 12 young people. A total of 25% young people with neurodevelopmental problems moved to specialist services. Practical implications The results suggest that diagnosis, severity of offence and clinical background are associated with transition pathway. Promoting a person-centred approach and gradual independence of the young person may improve current practice. Originality/value These results inform existing policy and clinical practice in an effort to reform transition guidelines around young people’s needs during transition times. Further studies in adolescent forensic services are needed to understand complex neurodevelopmental problems and comorbidities.

Annual Research Review: A systematic review of mental health services for emerging adults – moulding a precipice into a smooth passage

“…Most included studies used data extraction and coding tools specifically designed for the purpose of the study. Eight studies reported assessing their tool for reliability or using a tool with proven psychometric properties; however, none reported any psychometric values (Appleton, 2021; Asl, 2014; Livanou, Lane, D'Souza, & Singh, 2020; McNicholas et al., 2015; McNicholas & Singh, 2015; Reale, Costantino, Sequi, & Bonati, 2018; Singh, 2012, 2013, 2014, 2015; Singh et al., 2010, 2021; Tatlow‐Golden et al., 2018).…”

“…We identified 24 papers describing 19 unique studies that focused on the transition of young people to AMHS regardless of their specific mental health condition (see Table ). Twelve studies included participants with any MH diagnoses without further specification (Adamopoulos & Samuel, 2021; Cohen, Klodnick, Kramer, Strakowski, & Baker, 2020; Garcia, Boix, Vegue, & De Angel, 2019; Islam et al., 2016; Leeb et al., 2020; Livanou et al., 2020; McNicholas et al., 2015; Paul et al., 2013; Pottick, Bilder, Vander Stoep, Warner, & Alvarez, 2008; Reneses et al., 2018; Saour, 2021; Singh et al., 2010, 2021; Stagi, Galeotti, Mimmi, Starace, & Castagnini, 2015). One study focused on ‘serious’ mental health disorders and provided the following example: schizophrenia spectrum, bipolar and major depressive disorders (Cohen et al., 2020).…”

“…Notably, young people living in Italy, the Netherlands and the United Kingdom were least likely to transition to adult services compared to other participating countries (Appleton, 2021). Similarly, a UK-based study showed transition was more successful among young people in forensic medium secure services, which is likely to be related to severity and complexity of the young people's presentation (Livanou et al, 2020). All 32 patients eligible for transition were referred within 10 weeks before their 18th birthday, and the average time between referral and transition was 6 months.…”

“…All 32 patients eligible for transition were referred within 10 weeks before their 18th birthday, and the average time between referral and transition was 6 months. Nearly 40% of young people transitioned to Early Intervention Services, 25% to adult medium secure hospitals and the remaining individuals to secure units of different levels, prison, rehabilitation or educational services and psychiatric hospital (Livanou et al., 2020).…”

Transition outcomes for young people discharged from adolescent medium secure services in England: A qualitative study exploring adolescents’ and carers’ experiences

“…All local collaborators (five consultant forensic psychiatrists and one consultant forensic psychologist) completed a mapping exercise a priori regarding the number of young people eligible to transition within the next 6–9 months. The mapping tool was distributed to local collaborators between May 30th, 2016 and November 30th, 2016 and collected information about annual transition caseloads, demographics of the cohort and standard transition preparation procedures ( Livanou et al, 2020 ). The same mapping exercise was used in the TRACK study which is the largest UK study exploring transition outcomes from mainstream CAMHS to adult-oriented settings ( Singh et al, 2008 ).…”