Lost in Transition - moving on
smoothly from child to adult
mental health of learning
disability services
Sarah Bernard
Consultant Psychiatrist
Child and Adolescent Learning
Disability
Overview
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Service provision
Diagnosis
Management
The family
Social care
Occupation
Placement
Consent/capacity
Other
Service Provision
 CAMHS vs Adult LD
 Ref criteria
 “Proof of level of LD”
 “Proof of mental health issues”
 Do they have ASD
 Transitional services
 Why 18yrs?
Diagnosis
 ICD-10 vs DSM IV
 How do childhood diagnoses change at
transition?
 Psychometry vs adaptive functioning
Management
 Health vs Education vs Social Care
(Funding!)
 Community vs residential vs hospital
 Behavioural interventions – do they
change?
 Medication – how, why, when and what?
The Family
 Changing role
 Inclusion vs exclusion
 Aging parents
Social Care
 Referral criteria - conflicts
 Roles/Responsibilities
 Respite
Occupation
 School…college…employment
 What has this got to do with psychiatry?
Placement
 What is home?
 Moving on
 Catchment area
Consent and Capacity
 Watch this space!
 MCA – how is it used?
 DoLs – 18 yrs+, but must be considered in
childhood
 MHA – when?
Other issues
 Respecting each others services and
expertise
 Transitional planning – not an option!
Case
 AA
 17.5yrs
 Asylum seeker. Somalian.
 Previous history of abuse
 UK 2 yrs
 Probable sexual abuse
 Aggressive ++
Cont…
 Breakdown of school placement
 Placed in respite unit – breakdown of
placement
 Witness in criminal proceedings
 Charged with assault
 Diagnosis – ASD, MLD. Probable PTSD
Cont….
 Options: move to adult placement? Move to
residential school?
 Fitness to plead assessment
 Outcome…….to discuss
Conclusions
 Transition from child to adult services
requires planning and co-operation
 Care pathways for transition should be
established
 Differences between child and adult
services are inevitable
 CAMHS – LD and Mental health of Adult
LD should/must work together
A WISH LIST
 Respect on both sides
 Good child/adolescent services
 Sufficient funding (without arguments)
 Clear transition pathway (useful meetings!)
 Research