Transition from child to adult mental health services: a French retrospective survey

Abstract

Purpose Adolescents and young adults’ mental health problems are an important health issue. However, the current organisation of the care pathway is not robust enough and transition between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) has been identified as a period of risk. The paper aims to discuss these issues. Design/methodology/approach A retrospective survey was conducted in Montpellier University Hospital concerning transitions organised between CAMHS and AMHS between 2008 and 2009. The aim was to assess if transitions met four criteria identified in literature as warranting an optimal transition. Findings In total, 31 transitions were included. Transition was accepted by AMHS in 90 per cent of cases but its organisation was rarely optimal. Relational continuity and transition planning were absent in 80 per cent of cases. The age boundary of 16 often justified the triggering of the transition regardless of patient’s needs. Discontinuity was observed in 48 per cent of transition cases, with an average gap of three months without care. Psychiatrists reported difficulties in working together. Finally, at the moment of the survey (one to three years later), 55 per cent of patients were lost to follow-up. Research limitations/implications This is a retrospective study on a small sample but it reveals important data about transition in France. Practical implications Transition process should include collaborative working between CAMHS and AMHS, with cross-agency working and periods of parallel care. Social implications Transition-related discontinuity of care is a major socioeconomic and societal challenge for the EU. Originality/value Data related to the collaboration between CAMHS and AMHS services are scarce, especially regarding the transition in France.

Managing the link and strengthening transition from child to adult mental health Care in Europe (MILESTONE): background, rationale and methodology

“…Yet, due to a policy-practice gap [ 28 ], few of those who do transition from CAMHS to AMHS experience ‘optimal transition’, which has been characterised by a period of parallel care between CAMHS and AMHS, at least one transition planning meeting, adequate information transfer and continuity of care [ 27 ]. Studies carried out in the Republic of Ireland [ 23 , 51 ] and France [ 52 ] suggest that problems of the same nature and magnitude at the CAMHS-AMHS interface are occurring in other European countries. This poses a major health, socioeconomic and societal challenge for the care and wellbeing of young people with mental health needs within the European Union (EU), which is exacerbated by the different mental health care service structures and provision in the member states [ 53 – 55 ].…”

Care Transition from Child/Adolescents to Adult Services

“…Engagement with AMHS is variable once referral to the service has taken place. Eighty-six percent of young people in three studies had at least one appointment at AHMS (Ogundele 2013;Paul et al 2013;Schandrin et al 2016;Singh et al 2010b); however, rates of engagement fell after this first contact (Appleton et al 2019). In Northern Ireland, 92% (170/184) of young people attended the first appointment, but 51% (86/170) were discharged afterward (Leavey et al 2019).…”

“…The percentage of unsuccessful referrals range from 3% to 73% in six studies (Appleton et al 2019;Leavey et al 2019). Discharge from CAMHS due to disengagement ranges from 3% to 40% of young people (Cappelli et al 2016;Moosa and Sandhu 2015;Schandrin et al 2016;Singh et al 2010b;Tatlow-Golden et al 2017).…”

Transitionspsychiatrie – Herausforderungen und Lösungsansätze

“…Im ungünstigsten Fall kommt es zu einer raschen und wiederkehrenden Entwicklung psychischer Krisen mit häufigen Notfallkontakten und dem sogenannten Drehtüreffekt. Diese Brüche in der psychiatrischen Versorgung führen auch unter Berücksichtigung heterogener Krankheitsverläufe gerade bei schweren psychischen Erkrankungen zu einer erheblichen Behandlungsverzögerung mit einem hohen Risiko für frühe Chronifizierungen [1,[12][13][14][15][16][17][18][19][20][21][22]. Die Folgen sind eine ausgeprägte und langfristige Krankheitslast für junge Menschen und ihre Angehörigen sowie hohe direkte und indirekte Kosten für die Gesellschaft [23].…”