Annual Research Review: A systematic review of mental health services for emerging adults – moulding a precipice into a smooth passage

Abstract

Background: The transition between child and adult services should aim to support young people into the next stage of their life in a way that optimises their function. Yet financial, organisational and procedural barriers to continuity of care often hamper smooth transition between child and adult services. Aim and method: We reviewed studies of transition from child to adult mental health services, focusing on: (a) rates of referrals and referral acceptance; (b) barriers and facilitators of successful transition; (c) continuity of care during and post-transition and (d) service users' experience of transition. Studies were identified through systematic searches of electronic databases: PsycINFO, Medline, Embase and Child Development and Adolescent Studies. Findings: Forty-seven papers describing 43 unique studies met inclusion criteria. Service provision is influenced by previous history and funding processes, and the presence or absence of strong primary care, specialist centres of excellence and coordination between specialist and primary care. Provision varies between and within countries, particularly whether services are restricted to 'core' mental health or broader needs. Unsupportive organisational culture, fragmentation of resources, skills and knowledge base undermine the collaborative working essential to optimise transition. Stigma and young people's concerns about peers' evaluation often prompt disengagement and discontinuation of care during transition, leading to worsening of symptoms and later, to service re-entry. Qualitative studies reveal that young people and families find the transition process frustrating and difficult, mainly because of lack of advanced planning and inadequate preparation. Conclusions: Despite increasing research interest over the last decade, transition remains 'poorly planned, executed and experienced'. Closer collaboration between child and adult services is needed to improve the quality of provision for this vulnerable group at this sensitive period of development.

Commentary: State of transitional care for emerging adults – reflections on Anderson et al.

“…The first systematic reviews regarding mental health service transitions were by Paul, Street, Wheeler, and Singh (2015) and Mulvale et al (2019), but the evidence base has grown since then. The systematic review by Anderson et al (2022) is therefore welcome and timely as it captures the very latest published evidence. Unlike Appleton, Connell, Fairclough, Tuomainen, and Singh (2019) who focus on transition outcomes in the form of service destinations, the scope of Anderson’s et al review is more comprehensive and covers rates of referrals, barriers, and facilitators of successful transition, continuity of care, and service user experiences of transition.…”

Editorial: The times they are a‐changin’: paradigm shifts in child and adolescent psychology and psychiatry

“…The conceptual importance of the continuum extends to clinical practice, where the traditional divide between child and adult psychiatry has created a gap through which many young people fall in the transition from adolescence to young adulthood. As reviewed by Anderson et al (2022), many young people and their families experience the transition from child and adolescent to adult care as frustrating and difficult because of the financial, organizational, and procedural barriers that hinder a smooth transition. The authors call for significant changes in care provision that break down barriers between child and adolescent versus adult mental health services.…”

The effectiveness and cost-effectiveness of Acceptance and Commitment Therapy as a transdiagnostic intervention for transitional-age youth: study protocol of a randomized controlled trial

“…Also, in many countries, the collaboration between youth (i.e., below the age of 18) and adult (i.e., 18 years or older) mental health care facilities is not optimal, resulting in no or poor transitions from youth- to adult care after adolescents turn 18. These poorly executed transitions threaten the continuity of psychological care for TAY in this already challenging and critical developmental period [ 13 , 14 ]. Additionally, when TAY are referred for treatment, they often receive evidence-based interventions developed for either youth (i.e., below the age of 18) or adults (i.e., 18 years or older) [ 15 , 16 ].…”