Transitions -CAMHs Dr Wendy Woodhouse

The gap , Cliff edge
• It is known that 50% of lifetime mental illness
(except dementia) begins by age 14 and 75%
by the age of 18
• 2000 16-17 yrs old using CAMHS services in
• Small numbers still in adult MH services at 6
months, more in community eating disorder
Where have all these young people
• They got better
• They went to uni
• They use other services
But, mental health problems overrepresented
in social disadvantaged groups
Why is there a GAP ?
• AMHS different thresholds
• Different cultures and expectation
• Multiple transitions, health, education,
employment, NEET
• Poor experience
• SCR, high risk of crisis presentation, increased
risk period
• Silos of commissioning
Track study, Singh et al 2010
• The optimal transition criteria were developed from an audit of CAMHS
transition protocols18 and literature on good practice in relation to
continuity of care.19 These criteria included:
• information transfer (information continuity): evidence that a referral
letter, summary of CAMHS care, or CAMHS case notes were transferred to
AMHS along with a contemporaneous risk assessment;
• period of parallel care (relational continuity): a period of joint working
between CAMHS and AMHS during transition;
• transition planning (cross-boundary and team continuity): at least one
meeting involving the service user and/or carer and a key professional
from both CAMHS and AMHS prior to transfer of care;
• continuity of care (long-term continuity) – either engaged with AMHS 3
months post-transition or appropriately discharged by AMHS following
• Sub-optimal transitions were those that failed to meet one or more of the
above criteria.
Closing the gap DOH 2014
• Outcomes led services for multiple needs
personalised transition plans that include, for
those young people who do need to transfer to
adult services, joint meetings with CAMHS and
adult mental health services. For those who do
not, it will include information on how to
access services if they become unwell. We will
need to take a cross-service approach,
involving housing, employment services and
social workers – and not least, the young
person themselves – so that we can ensure
they get the support they want.
At all
What works?
Transitions policy
New specification for commissioners
Transitions clinic
Services to 25
Services to fill the gap
Standards suggested
• Transitions policies agreed with CAMHS and
• Multimedia transition resources, smart phone
• Transitions care plans and care coordinator
• Access to peer support
• require integration with social care and
educational planning processes as set out by
the proposals within the Children and Families
Bill 2013 (for example the Birth – 25
Education, Health and Care Plan), Children
(Leaving Care) Act 2000 and the Children and
Young Person’s Act 2008.
Draft specification for transitions
Economic study Martin Knapp et al 2014
Cambridge CLAHRC study Aristidou,2011
Early intervention in psychosis pathways
Youth project board
Outreach Services for Children and
Adolescents Osca to 25
Pilot, up to 25 YP
EBP and other difficulties
Outcomes, IAPT
AMH ooh and admissions
Gaps, housing, education,
Specific needs, CSE
• Youth service, expand EIS services
• Outcomes led care plans
• Multiagency services to address life skills,
educational catch up, housing
• Student health services
• Pathways that YP can follow and access