Mind the Gap

Ahead of the Chancellor’s Summer Budget, the majority of media attention has focused on where the Government’s foreshadowed £12bn in spending cuts will be found. The scale of the savings means many community groups and welfare providers are bracing themselves for unexpected surprises. This includes workers in the children’s and adolescent mental health sector, many of whom hold high suspicions that past assurances will  not hold in the coming squeeze.

The transition from child and adolescent to adult mental health services is already a difficult one. The point at which young people move from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) is determined by strict age limits, with ‘transition’ usually occurring at the time of the individual’s 18th birthday. The process of transitioning between these services is often fraught with difficulties, stemming from a lack of coordination and appropriate transition services from providers. In policy circles, the issue has been described as a “cliff edge”, illustrating the serious gaps in support and continuity of care for young adults with histories of mental health issues.

The impacts on these vulnerable young people are numerous and far-reaching. Some users may find themselves ineligible for AMHS services despite long histories of involvement with CAMHS. Others report a lack of proper consultation and planning during times of transition, resulting in confusion and the feeling that their move was “very inconvenient to services”.

These are significant issues, which compound difficulties in accessing care for some of society’s most vulnerable young people – at a critical stage of development. One of the effects of poor transition is a high rate of drop-out and disengagement from mental health providers altogether, translating in to poorer life outcomes for young people and poorer financial outcomes for public services who have to pick up the costs further down the line.

Having robust transition services in mental health is therefore an issue that should strike at the heart of the Government’s approach to targeted early intervention and a ‘life course’ approach to public health.

The problem of transitioning is beginning to attract a lot more attention from health professionals and public sector bodies.  Last year, the House of Commons Select Committee published its much-awaited report in to CAMHS services, which spoke of the “serious and deeply ingrained problems” teenage mental health provision faces. But aside from a commitment from the government to boost funding for youth mental health, how else might improved transition services be established? And what other initiatives can be developed within existing services and organisations to address the problem in the short term?

Some services have already responded by creating specialised youth services designed to ease transition from adolescence through to 25 years of age. In some cases, these services are well established and conduct evidence-based interventions for particular mental health disorders. A good example are Early Intervention in Psychosis (EIP) services, which offer early assessment and treatment for young people aged 14-35, based on robust evidence on the beneficial outcomes of timely interventions in early psychotic episodes. Other effective transition models work in partnership to provide services to young adults with ongoing mental health needs.  The City and Hackney CAMHS service, for example, uses links with primary and social care, youth services, adult services, third sector organisations and local education colleges to plug gaps in transition.

These programmes are encouraging, but they will ultimately need Government support and funding certainty, in order to be scaled up to a level where they can address the full scale of the risk we are facing as a society through letting people fall through the cracks. This is not just an issue of welfare: it is about equality of opportunity – helping all young people to overcome the challenges they face to participating fully and contributing positively in all aspects of their lives.