By Becky Appleton
When young people reach the upper age limit of child and adolescent mental health services (CAMHS), they must leave that service and, if needed, access further support for their mental health in services designed for over 18s. If a young person requires support from adult mental health services, then care should be transferred through a managed process known as transition.
However, it is widely known that the transition process is often poorly conducted, and young people experience extremely poor continuity of care during this time. My PhD research therefore aimed to explore the experiences of young people who fell through the gap between young people’s and adult mental health services. My findings indicated that young people had largely negative experiences, with little choice on the support available, problems accessing medication, long waiting lists and high thresholds for adult care meaning they were left unsupported.
Young people reported being told they were ‘too ill’ for young people’s wellbeing services or IAPT, but ‘not ill enough’ for secondary care adult services
However, whilst I was focusing on the gap between CAMHS and adult mental health services, my research identified several other gaps in the current service provision, with adult services unable to meet the needs of the young people in my study. These gaps are not specific to young people leaving CAMHS, but instead reflect the problems faced by adults when trying to access mental health support in England.
Firstly, I identified a group of young people who still need further support for their mental health when they reach the upper age limit of CAMHS, but are unable to do so as they do not meet the eligibility criteria of adult services. Young people reported being told they were ‘too ill’ for young people’s wellbeing services or Improving Access to Psychological Therapies (IAPT), but ‘not ill enough’ for secondary care adult services, which left them unable to access any type of mental health support. One young person I interviewed was told she was “too big of a risk” for her local youth service to see her because she had previously received care from CAMHS.
Whilst good access to mental health support at university is needed, those who choose not to go to university have even fewer opportunities to access mental health support
Young people who went to university in a different area to their home also reported problems in continuity of care. As it is often a requirement for young people to register with the GP in their university town, this meant they struggled to access support when they were back home for the long university summer holidays and reported poor information sharing across services. Participants also described variable experiences of the mental health provision offered by their university, and in turn differing rates of satisfaction with the care they received. This echoes findings from Centre for Mental Health’s report Finding our own way which highlighted the importance of good continuity of mental health care for young people during the transition to university, with the need for access to services both in their university town and at home.
Whilst good access to mental health support at university is needed, those who choose not to go to university have even fewer opportunities to access mental health support – raising issues around equal access to care for young people across different socio-economic backgrounds, with those from a poorer background less likely to go to university.
Other gaps in care provision were also identified. Young people reported being ‘passed around’ to different services for different conditions, with each service unable or unwilling to take responsibility for that person’s care. The most extreme example of this was a young man with alcohol addiction and comorbid depression who was unable to leave his home due to his poor mental health. He was not able to access mental health support due to his addiction, despite his depression being the trigger for his problematic relationship with alcohol. Other young people reported limits on the support they could access after moving across commissioning boundaries, indicating a postcode lottery regarding what services are available across different localities.
It is clear the current structure of service provision is unable to meet the mental health needs of young people after they leave CAMHS
There is no one solution for bridging these gaps in service provision; a large-scale overhaul of how mental health services are funded and commissioned is likely needed. Some attempts have been made, for example the introduction of 0-25 services, which has the potential to reduce the ‘cliff edge’ of service provision at 18 – although it does not solve the problems of unequal provision across geographic areas, or disjointed care for young people at university. Implementation of these services has had variable success, and initial research indicates that without additional funding and resources, keeping young people in CAMHS after they’ve turned 18 negatively impacts the service’s ability to accept new referrals.
Recent advances in the use of telemental health (using phone or video conferencing to provide mental health support) since the Covid-19 pandemic could be another solution, allowing young people to access care from their home provider when away at university. This could also be used to enable young people to access specialist services which are unavailable in their local area, without having to travel.
It is clear the current structure of service provision is unable to meet the mental health needs of young people after they leave CAMHS. Further innovations in service delivery, commissioning and funding are needed to reduce inequalities in access and ensure people do not fall through the gaps.