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Transition Between Childhood and Adult Care

The way ahead for young people’s mental
health support is about a better transition between childhood and adult care.

Professor Swaran Singh, Warwick Medical School, Warwick

Mental disorders afflict the young and rob them of their most productive years.

Those disorders usually emerge around the age of 18, which is also the age boundary between child and adult mental health services.

I began to wonder what happens to young people under the care of child and adolescent mental health services (CAMHS) as they move to adult care. In the first ever study of transition from CAMHS to adult care in England, called the TRACK study, we made some astounding findings.

Almost half of young people ‘fell off a cliff edge’ on reaching 18 and never received further care. Those that moved to adult care had very experiences in their transition from child to adult services.

So we assembled a consortium of clinicians, academics, young service users, advocacy groups, and third sector organisations to collect a cohort of over 1000 young people who had crossed the CAMHS adult transition boundary in eight European countries to determine how they experienced that transition. Within a subgroup of these young people, we implemented a model of ‘managed transition’ to see if closer collaboration between clinicians across the transition divide, young people, and their families could improve transitional care.

This was the MILESTONE study, the first-ever randomised controlled trial of transitional care in any branch of medicine anywhere in the world, funded by the European Union.

Our work has conclusively shown that improving transitional care should be a key priority for mental health services. It has led to changes in national and international mental health policy across the world, with the implementation of several novel models of youth mental health care. In the UK, NICE has introduced evidence-based guidelines on Transition from Paediatric to Adult Care, the first of their kind in the world. And we have shown that transitional care can be improved with a relatively modest investment of resources.

Mental Health and Wellbeing Unit at Warwick has a long and proud tradition doing research that makes a genuine difference to the lives of young people with mental health problems. We were the pioneers in developing and implementing Early Intervention in Psychosis services and in meeting the needs of young people from ethnic minority groups. It was both exciting and opportune to build on this legacy and we at Warwick are international leaders in the area.

Our work has shown that the current service models do not meet the needs of vulnerable young people. I am glad to say that all over the world, there are now efforts to improve mental health care and the bridge the gap for those patients.

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