Determinants of Transition From Child and Adolescent to Adult Mental Health Services: A Western Australian Pilot Study

Abstract

Objective The aim of this research was to explore the transition pathways of transition‐aged youth out of child and adolescent mental health services in Perth, Western Australia. A secondary aim was to identify factors that have some impact upon the transition process. Method Cases discharged from seven child and adolescent mental health community clinics in the Perth metropolitan area, from 1 June 2004 to 30 June 2013, at transition age (16–25 years of age), were examined retrospectively. Two hundred and forty‐five cases met the selection criteria and were reviewed on the Psychiatric Services Online Information System. Results Four specific pathways of referral and acceptance into an adult mental health service were identified: not referred, referred with immediate engagement, referred with delayed engagement, and referred with no engagement and not accepted. Principal discharge diagnosis, length of stay, and housing situation on discharge were all found to influence likelihood of referral. Only principal discharge diagnosis was found to influence successful acceptance into an adult mental health service. Conclusions The factors found to influence transition pathways in the present study were largely consistent with findings from the UK. Findings of the present research can assist clinicians to make more informed decisions when discussing transition with clients. More broadly, findings can be used by policy makers to support the formation and maintenance of transition protocols.

Outcomes of young people who reach the transition boundary of child and adolescent mental health services: a systematic review

“…The 13 included studies represent research carried out in six different countries, Canada [17], England [2–4, 16, 18, 19], the Republic of Ireland [5, 20], France [21], Australia [22], and Italy [23, 24]. Two studies were service evaluations [17, 19]: one was a questionnaire study [24], one was a longitudinal study [16], and the remaining nine had a retrospective cohort study design [2–5, 18, 20–23].…”

Challenges during the transition from child and adolescent mental health services to adult mental health services

“…Moreover, receiving medication, having a history of hospital admissions and living with both parents or independently are all variables that can determine whether a young person is more likely to be referred. 4,[26][27][28] Even if a transition to adult services has been carefully planned, a young person's urge for autonomy and selfdetermination may influence their care trajectory. For example, the young person can decide to abandon psychological care or to not make the transition to AMHS, even when a referral has been made.…”

Care Transition from Child/Adolescents to Adult Services

“…Factors Associated with Transitioning/Not Transitioning to AMHS Young people are more likely to transition to AMHS if they have severe or enduring mental illness (Singh et al 2010b), a diagnosis of psychosis (Leavey et al 2019;McNicholas et al 2015), schizophrenia/related disorder (Stagi et al 2015), personality disorder (Stagi et al 2015), pervasive developmental disorder (Stagi et al 2015), or a mood disorder (Perera et al 2017) or if they have a comorbidity (Singh et al 2010b). In England, being admitted under the Mental Health Act or having had an inpatient stay due to mental illness has been shown to increase the likelihood of transitioning to AMHS (Singh et al 2010b).…”

“…In contrast, young people with a diagnosis of an emotional or neurotic disorder, those with a neurodevelopmental disorder (ADHD or Autism Spectrum Disorder -ASD), or those with Oppositional Defiant Disorder have been found in most studies to be least likely to access AMHS after leaving CAMHS (Cappelli et al 2016;Islam et al 2016;Perera et al 2017;Tatlow-Golden et al 2017). In some instances, young people with a diagnosis of ADHD have been most likely to refuse a referral to adult services (McNicholas et al 2015).…”