Experiences of patients with anorexia nervosa during the transition from child and adolescent mental health services to adult mental health services

Abstract

Background: The transition between the Child and Adolescent Mental Health Services (CAMHS) and the Adult Mental Health Services (AMHS) is identified as an especially critical time for the continuity of care for patients with anorexia nervosa (AN). However, research on this topic is scarce. In the present study, we explore the patients' experiences of the transition between CAMHS and AMHS. Methods: A qualitative explorative study was carried out based on recorded interviews from one multi-step focus group and six individual interviews with patients who experienced the transition from CAMHS to AHMS in Norway. This study is service user-initiated, meaning service users were involved in all steps of the research process. Results: The adolescents' experiences are characterized by four overall themes regarding the transition process between CAMHS and AMHS: (1) "Being unprepared and alone in the transition process" describes how a lack of preparation for the transition between CAMHS and AMHS makes them feel alone and increases stress. (2) "It takes time to create a trusting relationship" describes how time influences patients' trust in therapists and motivation for treatment. (3) "We are not all the same" describes how adolescents develop differently but are not treated differently despite their diverse ability to be self-sufficient. (4) "How they see me and treat me affects my hope for the future" describes the interaction between adolescents and therapists. Conclusions: Acknowledging the patients' needs during the transition period and considering their readiness for the transition is important. Taking into account the four dimensions described in the present study might improve the transition process and enhance the patients' self-sufficiency and maturity.

“I’m not a teenager, I’m 22. Why can’t I snap out of it?”: a qualitative exploration of seeking help for a first-episode eating disorder during emerging adulthood

“…Such findings are consistent with previous research which has highlighted physical and mental health problems as important facilitators of help-seeking [14]. Indeed, in the wider FREED-Up cohort 53% of participants identified non-ED specific concernsmost commonly depression, anxiety, disturbed sleep and academic problems -as the desired focus of their treatment [47].…”

“…after first specialist contact). These included demographic data and measures of ED symptoms and duration of ED (for further details see [13]). Semi-structured interviews for this study were conducted on a one-to-one basis by RP (a researcher not involved in treatment), either over the phone (71%) or in person.…”

“…During this phase, emerging adults were often deeply ambivalent about receiving help. This ambivalence towards seeking and receiving help is also evident in the wider FREED-UP study where 9% of emerging adults referred for specialist treatment could not be contacted after referral or did not attend their assessment appointment [13].…”

“…Participants were drawn from the FREED-Up study, which focused on the continued evaluation of the effectiveness and scalability of the FREED service model (see [9,13] for further details). The FREED-Up study included 278 emerging adults (18-25 years old) with firstepisode, recent-onset (< 3 years) (as ascertained by a structured onset interview) DSM-5 EDs (AN, BN, BED or OSFED) who presented for treatment at four specialist ED services in England between 2016 and 2018.…”

“…FREED has been shown to reduce duration of untreated ED and improve clinical outcomes compared to treatment as usual [8,[10][11][12]. However, whilst initiatives like FREED address service-related delays in ED treatment, duration of untreated ED also encompasses patientrelated delays in treatment-seeking [13]. If strategies for early intervention for EDs are to be improved, a clear understanding of the patient-related component of duration of untreated ED is needed [9].…”