Continuity of care from child and adolescent to adult mental health services: evidence from a regional survey in Northern Italy

Abstract

To examine clinical and demographic factors associated with continuity of care from child-adolescent (CAMHS) to adult mental health services (AMHS), we undertook a record-linkage study to the Adult Mental Health Information System including all those 16 years old and over who were listed between 2010 and 2013 in the Child and Adolescent Neuropsychiatry Information System in Emilia-Romagna, an Italian region of nearly 4.5 million residents. From a cohort of 8239 adolescents attending CAMHS (population at risk about 144,000), 821 (19.4 %) moved to AMHS, excluding cases with specific developmental disorders, whose conditions were not managed by adult psychiatrists, and those with mental retardation who attended usually social services. Young people referred for treatment to AMHS were more likely to receive a discharge diagnosis of schizophrenia and related disorders (Odds Ratio [OR] 3.92; 95 % confidence interval [CI] 2.17-7.08), personality disorders (OR 2.69; 95 % CI 1.89-3.83), and pervasive developmental disorders (OR 2.13; 95 % CI 1.51-2.99). Further factors predicting transfer to AMHS were not living with parents, inpatient psychiatric admission, and being on medication in the previous 24 months. These findings suggest that a relatively small number of adolescents moved to AMHS and are likely to reflect the configuration of local mental health services and alternative care available, mainly for those with less-severe mental disorders.

The “Reggio Emilia At‐Risk Mental States” program: A diffused, “liquid” model of early intervention in psychosis implemented in an Italian Department of Mental Health

“…Indeed, adolescents receiving care from CAMHS are at high risk of falling through the child‐adult service gap as they cross the transition boundary between services, or experience poor care, leading to high risk of disengagement from services and discontinuity of care (Singh & Toumainen, ). In this regards, data suggest that only a small proportion (approximately 20%) of adolescents treated by CAMHS move to AMHS in Italy (Stagi, Galeotti, Mimmi, Starace, & Castagnini, ), and Italian programs addressing the problem of the lack in continuity of care for various reasons struggle to be established (Masillo et al, ). As focusing on transitional care has the potential for transforming outcomes in youth mental health, it is therefore necessary to urgently develop and implement reformed service models that are specifically geared to meeting the unique needs and preferences of adolescents and young adults rather than strictly aligned to chronology and rigid diagnostic boundaries, and provide high‐quality evidence‐based interventions that promote well‐being, self‐sufficiency, and autonomy (Raballo, Poletti, & McGorry, ).…”

“I’m just a long history of people rejecting referrals” experiences of young people who fell through the gap between child and adult mental health services

“…It was decided to limit recruitment to young people who had been identified in previous research (carried out in the UK) as being most likely to fall through the gap between services: those with a neurodevelopmental, anxiety disorder, or depression (3). Those with emerging personality disorder were included due to previous contradictory findings (3,18). Young people were eligible to take part if they had one of the above diagnoses and had fallen through the gap between CAMHS and AMHS.…”

Identifying core components and indicators of successful transitions from child to adult mental health services: a scoping review

“…The first is from Blum et al [15], who conceptualize a transition as "the purposeful, planned movement of adolescents and young adults with chronic medical conditions from child-centered to adult-oriented health care systems". Blum's definition was referred in nine of the reviewed articles, yet it is not specific to transitions in mental health care [3,7,13,14,[36][37][38][39][40].The second is from Singh et al [13], who build on the definition from Blum et al [15], adding four specific criteria for determining whether transitions in care were optimal or successful. Further, unlike Blum et al [15], these criteria are specific to transitions from CAMHS to AMHS.…”

“…Optimal mental healthcare is crucial throughout the life course, yet the transition from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) has been recognized as a uniquely problematic international health systems hurdle [1][2][3][4][5][6][7][8][9]. This common demarcation in mental health services that occurs at age 18, when youth must transition from CAMHS to AMHS, creates the risk of transition-related discontinuity of care.…”