Mental Health Support For Young People In Transition to Adult Services in North Somerset

Dr Fiona BarlowConsultant Child and Adolescent PsychiatristNorth 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 HealthHalf of all life time psychiatric disorders

start by age 14Three 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 disordersDepression/Self-HarmObsessive –Compulsive DisorderEating DisordersADHDAutistic Spectrum

Disorders/Asperger`s SyndromeEmerging Personality DisordersPsychosisPTSD

Historical perspective2004 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 PerspectiveTRACK 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 StudyImplement clear transitions protocolsAudit protocolsTalk to colleagues across AMHS-CAMHS divideGood Information transfer across servicesArrange joint meetings/assessmentsPeriod of parallel care between services i.e.

seamlessTransitions workers across teamsExtend adult services for adolescents who fall

through the gap

Local DevelopmentsNorth 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, manager of Mental Health Liaison Team, Primary Care Liaison Team and Intensive Support team and WGH ED

Focus on strategic/service developmentTransitions Operations Group chaired by CTPLD

manager meeting 2 monthlyMultiagency 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 ArrangementsAny 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 ContdIf 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 LDTransition reviews start at 14 for children with SENIdeally families given Transitions Information PackAll young people with additional needs referred to

transitions social workers for FACS assessmentThis determines eligibility for access to relevant

adult services e.g. adult LD/social careParents can initiate this referral via LD4U websiteOnce referral received, information gathered from all

agencies involved.

Transition Arrangements for Children/adolescents with LDIf 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??