Mental Health Support For Young
People In Transition to Adult
Services in North Somerset
Dr Fiona Barlow
Consultant Child and Adolescent
Psychiatrist
North Somerset CAMHS
Overview
 Brief overview of mental health issues in late
adolescence
 Historical perspective of care provision for 16-18
yr olds
 Developments wrt service provision over past 7
years
 Current transition forums
 Current transition arrangements
Adolescence
 Fascinating, critical complex stage of
development with enormous changes
 Physically ( pubertal changes, menarche)
 Cognitively ( brain fine tuning,)
 Emotionally ( personal identity, autonomy,
coping strategies)
 Socially ( peer groups, friendships, sexual
identity)
Adolescent Mental Health
 Half of all life time psychiatric disorders start
by age 14
 Three quarters start by age 24 ( Kessler et al
2005)
 16-18 yr olds experience a relatively high
incidence of mental health problems.
 Research indicates that 16-18 yr olds are at
additional risk of developing mental health
problems cf pre-16 or post-18.
 Less likely to seek professional help.
Adolescent Mental Health
 Highest number of admissions to hospital for
eating disorders is 15 yr old young people.
 Majority of people who self-harm are between 11
and 25.(Association for Young People`s Health)
 Completed suicide is rare. Rates for young men
has fallen since 2011.
 Source: Key Data for Adolescents 2013 Public Health England
Adolescent presentations within CAMHS/LD
 Anxiety disorders
 Depression/Self-Harm
 Obsessive –Compulsive Disorder
 Eating Disorders
 ADHD
 Autistic Spectrum Disorders/Asperger`s
Syndrome
 Emerging Personality Disorders
 Psychosis
 PTSD
Historical perspective
 2004 NSF for Children set out 10 yr plan to develop
services around the needs of children.
 Standard 9 The Mental Health and Psychological
Well-being of Children and Young People
 24 hour cover
 Comprehensive service for children with LD and
Mental Health problems
 Access for all 16 and 17 year-olds, regardless of
educational status
 Since 2007 N Somerset CAMHS commissioned up to
18th birthday
Historical Perspective
 TRACK study 2009 ( S Singh) national project looking at
transition period between CAMHS and AMHS over 6
different mental health trusts.
 Factors identified as important in making a transition
inc: parental presence at appts, having serious mental
illness, being on medication.
 Successful transfer inc period of parallel care and good
information transfer between services.
 Highlighted that typical cases that fall through the gap
inc neurodevelopmental disorders ( ADHD/ASD),
emotional disorders and emerging personality disorders.
Recommendations from TRACK Study
 Implement clear transitions protocols
 Audit protocols
 Talk to colleagues across AMHS-CAMHS divide
 Good Information transfer across services
 Arrange joint meetings/assessments
 Period of parallel care between services i.e. seamless
 Transitions workers across teams
 Extend adult services for adolescents who fall through
the gap
Local Developments
 North Somerset AMHS-CAMHS working group
was set up in 2007.
 Members included reps from AMHS, CAMHS,
NS PCT, EIPS, Adult Social Care, Crisis team,
mental health liaison team, Area Services
manager ,Consultant Psychiatrist from Riverside
Adolescent Unit, transitions social worker for
LD, BCH CAMHS
What has this Working Group achieved?
 Establishment of ‘link’ relationships between
adult and child teams
 Regular advice/liaison with commissioners
 Established clear protocols for transition to
adult services which are now integral to
multiagency transitions protocol.
 Clear pathway agreed between AWP and
WAHT for assessment of 16-18 year olds with
emergency presentations at WGH
AMHS-CAMHS Working Group
 Opportunity to discuss management of
emergency presentations
 Reflective learning from examples of poor
transitions
 Interface with many different agencies
working with young people with mental
health difficulties
 Contribution towards establishment of new
ADHD service for adults in 2010 with agreed
transition protocol
Current Forums for Transition
 AMHS-CAMHS Working Group meeting 6 monthly
 Reps from CAMHS, EIPS, Access Services manager,
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manager of Mental Health Liaison Team, Primary Care
Liaison Team and Intensive Support team and WGH ED
Focus on strategic/service development
Transitions Operations Group chaired by CTPLD
manager meeting 2 monthly
Multiagency forum with reps form adult LDSWT, AMHS,
CAMHS-LD, Housing, Weston College, Learning
Partnership West, OT, Social Care, CCG
Aim is to identify and plan for those young people with
complex needs who will need additional support in
adulthood
Current Transition Arrangements
 Any young person aged 17 and 6 months identified by
team as requiring ongoing support for mental health
needs
 Refer to Primary Care Liaison Service who act as
gateway into AMHS
 Ideally if referral is accepted, we arrange a joint
assessment between CAMHS-AMHS.
 Aim to complete joint assessment and arrange
handover meeting prior to young person`s 18th
birthday
Transition Arrangements Contd
 If following assessment, young person does not meet
criteria for AMHS, they will be signposted to other
possible avenues of support.
 For those young people with ADHD, clear transitions
referral pathway from 17 years to adult ADHD service
based in Bristol. Ideally handover meeting is held
locally to maximise engagement of young person.
Transition Arrangements for
Children/adolescents with LD
 Transition reviews start at 14 for children with SEN
 Ideally families given Transitions Information Pack
 All young people with additional needs referred to
transitions social workers for FACS assessment
 This determines eligibility for access to relevant adult
services e.g. adult LD/social care
 Parents can initiate this referral via LD4U website
 Once referral received, information gathered from all
agencies involved.
Transition Arrangements for
Children/adolescents with LD
 If LD eligible, young person is allocated a transitions
worker who links between both services and initiates
transitions assessment.
 This is a holistic assessment of the young person`s
strengths and needs and identifies support post 18.
 Where appropriate, there is a period of parallel care
between child and adult services partic for those with
complex health needs and/or challenging behaviour.
Any Questions??