- Sarah Butterworth, Swaran Singh, Max Birchwood, Zoebia Islam, Emily Munro, Panos Vostanis, Moli Paul, Alia Khan and Douglas Simkiss
- Child and Adolescent Mental Health Volume 22 (2017)
Young people in the care system often have greater mental health needs than their peers in the general population. These may be exacerbated when young people move towards independent living. Young people leaving care may experience several accelerated and compressed transitions - research by Wade and Dixon (2006) found that they typically move to independent living much younger than the national average, while Stein and Munro (2008) found that they have fewer resources and less support than their peers. Those receiving support from child and adolescent mental health services (CAMHS), often experience a concurrent transfer to adult services (AMHS), which can create a gap between services and a period of heightened uncertainty.
There is little evidence that explores what care leavers with mental illness believe is important in the transition process, the barriers to engagement with mental health services and how these may be overcome. This small-scale study aimed to explore these issues by interviewing 12 care leavers with mental health needs.
Care journey attitudes
- Care leavers reported feelings of abandonment when told they would be moving to independent living at 18, characterised by changes in social care teams and CAMHS ending abruptly with no onward referral, rejected referral or no communication from adult services.
- Participants collectively described mistrust, both in past and current social and professional relationships. Consequences included young people avoiding services and discontinuing psychiatric medication.
- There was a fear of professional power and its application with a feeling of division rather than collaboration. Young people felt disregarded, powerless to influence their care and feeling concerns around safety were not taken seriously.
Social care and CAMHS
- Social care transition: most of these young people experienced a difficult transition and were often shocked and unprepared for the reduction of support. They experienced few handover meetings, little joint working and communication about moves happened with little warning.
- Mental health support in care: CAMHS contact was, for several participants, a positive experience with supportive staff relationships and continuity of care. For others, engagement with CAMHS followed a crisis and subsequent A&E or inpatient admission. Some held little confidence in CAMHS staff and treatment, citing clinicians' overemphasis on medication, unsuitable and boring environments, a reluctance to diagnose until adulthood and little communication about mental illness. Specialist youth services, when experienced, were viewed as more accessible, appropriate and collaborative.
- Transition in mental health teams: Most participants were informed of their transition from CAMHS to AMHS but very few experienced joint working between these services. Transition left them with gaps between services or on long waiting lists, with little communication. Abrupt endings to supportive work left several people highly anxious about their care and in some cases, young people's mental health declined. Care leavers felt passed around multiple agencies with little co-ordination or responsibility.
- Mental health support after leaving care: The adult approach to mental health care was preferred by some, but others had little confidence that staff could support their high level of emotional needs. AMHS were perceived as not regarding young people as a group with specific needs. Lack of service flexibility and communication led to missed appointments and uncertainty around expectations, creating further anxiety. Adult wards and other clinical areas were considered intimidating with limited choice of treatments and overemphasis on medication.
Implications for practice
Participants thought social care and supported accommodation staff needed training in understanding and managing mental health difficulties. Participants wanted staff to better prepare them for transition, with this process starting earlier in their care journey.
Young people wanted one holistic, flexible mental health service, with specialist teams having specialist knowledge of young people in care. They wanted 24-hour support, including a less formal, flexible, youth-focused approach.
Key recommendations from young people included:
- Increased contacts during transitions by both social care and mental health staff
- Communicating in a way they understand, especially for those lacking insight into their own needs
- Asking them directly about their mental health, as volunteering information spontaneously is difficult
- Clarifying who is ultimately responsible for the co-ordination of mental health care
- Increasing joint working between CAMHS and AMHS to improve continuity of care
- Working in collaboration with care leavers, with trust and ongoing support being key to successful transition and achieving independence.
The research section for this special report is based on a selection of academic studies which have been explored and summarised by Research in Practice part of the Dartington Hall Trust.
This article is part of CYP Now's special report on Children's Mental Health. Click here for more