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TRANSITIONS 2016ADULT MENTAL HEALTH SERVICES LIZ FLETCHER AND JONATHAN MITCHELL
OBJECTIVES
• Explore what transitions is and who is making the transition
• What do we want for young adults • It’s more than Children’s and Adults services• Highlight difficulties/barriers • What have we done? • Plans for the future….
“CONCLUSIONSFOR THE VAST MAJORITY OF SERVICE USERS, TRANSITION FROM CAMHS TO AMHS IS POORLY PLANNED, POORLY EXECUTED AND POORLY EXPERIENCED. THE TRANSITION PROCESS ACCENTUATES PRE-EXISTING BARRIERS BETWEEN CAMHS AND AMHS.”
Swaran P. Singh et al (2010) Process, outcome and experience of transition from child to adult mental healthcare: multiperspective study. The British Journal of Psychiatry 197, 305–312. doi: 10.1192/bjp.bp.109.075135
TransitionsCAMHS - Children and Adolescent mental health services
AMHS- Adult mental health services
Who is transitioning and what do they want?
AnxietyDepressionSelf-harm
Hearing VoicesSchizophrenia
Neuro- developmentalPersonality disorderEmotional/neurotic
disordersBehavioural disorders
Autism-spectrumPTSD
Stigma Discrimination
“Suicide is a leading cause of death among young people worldwide” . WHO 2014, Nock et al 2014
Suicide Violence
Abuse Substance use
What do we want for Young Adults?support -connection -understanding -empathy -direction- consistency- hope -value
“Many young people had multiple transitions between AMHS teams, among care coordinators and in their personal circumstances,
the cumulative effect of which was complex and unsettling for service users.” Swaran P. Singh et al (2010)
The right support at the right timein the right place
with the right person
Transitions “it’s everyones business”
AMHSCommunity EducationCharity
EmploymentVoluntary
Drug and Alcohol IAPT
CAMHS
‘our single most important recommendation is the need to integrate youth mental health programmes, including those in the health sector (such as reproductive and sexual health) and outside this sector (such as education)’.Patel et al 2007
• Separate teams e.g human contact and connection • Separate assessments / notes • Different ways of working e.g family v individual • Culture • Communication e.g. text / email / social media /
FaceTime• Time and resources
Barriers
“Decision-making is particularly challenging because the needs of this population vary widely and the available resources to respond to these needs are limited.” Spooner M, Martinovich Z (2015)
Barriers• Service criteria• Available therapies e.g. psychology and counselling• EXPECTATIONS• Service structures
“Numerous studies now indicate that the prevalence of mental health problems in
young people could be as high as 1 in 4 or 5 “ Patel et al. 2007
What have we done?
• Shared transitions clinics (CAMHS and AMHS)• Transitions Group• Draft re-write of the Transitions Protocol• SCIE - 10 min film http://www.scie.org.uk/socialcaretv/video-player.asp?v=transitions2
Transitions Group
“The evidence base demonstrating the benefits of peer support in mental health across the UK is increasing. This has persuaded UK
governmental bodies to encourage the development of peer support services, of which there is a number of models and examples,
although the current economic climate poses challenges to their development.” Lawton-Smith 2013
• 10 weeks• Strong-peer support focus (facebook)• Mix of different session (practical, market place, employment and volunteering)
• Bio-psychosocial approach
More….
• Links with Interchange and Chilipep• Sunrise • Development of a link worker role
Transitions and trust wide developments
• Recovery Philosophy - Shift in service delivery • Peer support - Paid peer support roles • Collaborative care-planning
• Build on what we have • Work together to help adapt mental health services• Strengthen links with CAMHS and other organisations• Explore new ways of working and connecting with young
adults (e.g. digital, social media, apps)• NICE recommendations
Future?
Transitions working together
McGorry P (2007) The specialist youth mental health model: strengthening the weakest link in the public mental health system. Med J Aust (suppl)187: s53–6.
Nock MK, Borges G, Bromet EJ, Cha CB, Kessler RC, Lee S (2008) Suicide and suicidal behaviour. Epidemiol Rev 2008;30:133-54. PMID: 18653727. doi: 10.1093/ epirev/mxn002.
Nock MK, Hwang I, Sampson N, Kessler RC, Angermeyer M, Beautrais A, et al. (2009) Cross-national analysis of the associations among mental disorders and suicidal behavior: Findings from the WHO World Mental Health Surveys. PLoS Med 2009;6(8):e1000123. PMID: 19668361. doi: 10.1371/journal.pmed. 1000123.
Patel V., Flisher A., Hetrick S., et al. (2007) Mental health of young people: a global public-health challenge. The Lancet 369, 1302–1313
Simon Lawton-Smith , (2013),"Peer support in mental health: where are we today?", The Journal of Mental Health Training, Education and Practice, Vol. 8 Iss 3 pp. 152 - 158
Permanent link to this document:http://dx.doi.org/10.1108/JMHTEP-03-2013-0009
Spooner M, Martinovich Z (2015) Shifting the Odds of Lifelong Mental Illness Throughan Understanding of the Profiles of Adolescents and Young Adults with Serious Mental Health Conditions.
Community Ment Health J (2014) 50:216–220 DOI 10.1007/s10597-013-9662-y
Swaran P. Singh et al (2010) Process, outcome and experience of transition from child to adult mental healthcare: multiperspective study. The British Journal of Psychiatry 197, 305–312. doi: 10.1192/bjp.bp.109.075135
World Health Organization. Injuries and Violence: The Facts . Geneva, Switzerland: WHO Press, 2010. Available at: http://whqlibdoc.who.int/publications/2010/9789241599375_eng.pdf(Accessed June 23, 2014).
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