A new investigation into the transition from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) has highlighted flaws in the process and a need to guarantee young people a safer transition.
Lea Legraien takes a closer look at the issue and what needs to change.
Last week, the Healthcare Safety Investigation Branch (HSIB) released its second report on the transition of young people with mental health issues into adult services.
According to the report, more than 25,000 young people transition from CAMHS to AMHS every year, with only a few experiencing an ‘ideal’ transition.
Research suggests that between the age of 16 and 18 young people go through significant change and are probably at their most vulnerable psychologically.
Despite this, it is at this age that they are either transitioned to AMHS or discharged if they do not meet the AMHS criteria.
Investigation background
The report follows the death by suicide of an 18-year-old man soon after he transitioned from CAMHS to AMHS.
The young man – whose identity has been withheld but who is referred to as ‘Ben’ in the report – had been diagnosed with autism spectrum disorder (ASD) at the age of 10. When he was 17, his GP referred him to CAMHS after he experienced low mood and suicidal thoughts.
The policy of the trust that handled his care is that the transition process from CAMHS to AMHS should start six months before a patient’s 18th birthday.
It was considered that as Ben was 17 and a half at the time of the GP referral, the support he needed could be completed before he turned 18. As a result, no referral to AMHS was made.
However, this decision was reversed when his mental health deteriorated. Three weeks after he turned 18, Ben met with a locum AMHS care coordinator.
People with ASD often find change difficult. Being seen by a locum meant that Ben might have had a different care coordinator in the future, which could have made the transition more challenging.
After this AMHS appointment, Ben met with a CAMHS care coordinator, to whom he raised concerns about transitioning to AMHS. Ben committed suicide later that day.
An NHS England spokesperson tells Healthcare Leader that as it is developing a long-term plan for the health service, mental health will be ‘a top priority, with young people supported from birth, through childhood and their teenage years, into early adulthood’.
‘Nobody should have to suffer when they make the move to AMHS’
Rethink Mental Illness associate director for marketing and communications James Harris comments: ‘This report makes for difficult reading.
‘It highlights clear flaws in the support some young people receive during the transition to adult services and echoes experiences that many of our supporters have told us about.
‘It’s important that the learnings from the report are taken into careful consideration so that young people get the support they need when they need it. Nobody should have to suffer when they make the move to adult services.
‘Providing flexible care instead of having a strict cut-off point, carefully planning the transition and following up with patients afterwards should be the norm for anyone moving from CAMHS to AMHS.
‘Getting it right can have a lasting impact on the young person’s wellbeing, and it’s vital that they get the help they need at such a crucial time in their lives.’
‘Moving from CAMHS to AMHS can feel like a cliff edge’
YoungMinds policy manager Matt Blow says: ‘Young people often tell us that moving from child to adult mental health services can feel like a cliff edge, where they’ve gone from tailored services that they know into a new environment that may not fit their needs.
‘Often young people face gaps while waiting for adult services, which can have a devastating impact on their recovery.
‘It’s crucial that there is a thorough plan for everyone transitioning to adult care, and that young people are meaningfully involved in developing this plan.
‘But it’s also important to look into whether changing services for young people at the age of 18 is the right thing for them.
‘This is often a time of significant change anyway, when young people may be leaving school, starting university, looking for their first job or losing their support network.
‘Some areas are trialling services that support young people from 0-25. We need to evaluate how this is working and look further into other ways to ensure people get the right support during this time.’
Taking action
The report makes six safety recommendations, including calling on the Care Quality Commission (CQC) to ‘extend the remit of its inspections to ensure the whole care pathway, from CAMHS to AMHS, is examined’.
However, the CQC does not have the legal authority to implement the measure that lies with the Department of Health and Social Care (DHSC).
Under the Health and Social Care Act 2008, the CQC inspects providers or locations but not normally local systems.
CAMHS and AMHS are usually inspected separately. When CQC inspectors inspect CAMHS, they can look at the arrangements in place to manage how patients transition into adult services. Likewise, with AMHS, it can enquire about the interaction with CAMHS.
Earlier this month, the CQC released a report, Beyond Barriers, in which it called on the Government to implement new legislation that would allow it to regulate local systems as a whole and hold them to account for how people and organisations work together to support people to stay well and to improve the quality of care of the services.
As NHS Improvement, NHS England and the CQC have 90 days to respond to the HSIB report, a spokesperson for the DHSC could not confirm at this point whether it will grant more powers to the CQC.
The HSBI makes the following safety recommendations:
- NHS England should work with partners to identify and meet the needs of young adults with mental health issues who require support but do not meet AMHS criteria.
- NHS England should require CCG to demonstrate that the budget for services delivering care to people under 18 is spent only on this group.
- NHS England and NHS Improvement should ensure that transition guidance, pathways or performance measures have structured conversations with the young person transitioning to assess their readiness, develop their understanding of their condition and empower them to ask questions. They must also ensure that the effectiveness of this is robustly evaluated.
- NHS England should require services to move from an age-based transition process to a more flexible process based on individual’s needs.
- NHS England and NHS Improvement should work with mental health services commissioners and providers to ensure the care of a young person before, during and after transition is shared, including joint agency working.
- The CQC should extend the remit of its inspections to ensure that the whole care pathway, from CAMHS to AMHS, is examined.
