Mapping transitional care pathways among young people discharged from adolescent forensic medium secure units in England

Abstract

This study tracked young offenders transitioning from national adolescent forensic medium secure units to adult services in the UK within a six-month period. We used a mapping exercise to identify eligible participants moving during the study period from all national adolescent forensic medium secure units in England. Young people older than 17.5 years or those who had turned 18 years (transition boundary) and had been referred to adult and community services were included. Of the 34 patients identified, 53% moved to forensic adult inpatient services. Psychosis was the most prevalent symptom among males (29%), and emerging personality disorder symptomatology was commonly reported among females (18%) followed by learning disability (24%). The mean time for transition to adult mental-health services and community settings was eight months. There were no shared transition or discharge policies, and only two hospitals had discharge guidelines. The findings highlight the need for consistency between policy and practice among services along with the development of individualised care pathways. Future qualitative research is needed to understand and reflect on young people’s and carers’ experiences to improve transition service delivery.

A retrospective case note review of young people in transition from adolescent medium secure units to adult services

“…From an attachment theory perspective, moving away from secure services may break attachments between young people and staff leading to an experienced abandonment or rejection and subsequently, increased susceptibility to relapse (Seager, 2014). Despite this, delayed and/or abrupt transitions for young people discharged from medium secure units have been reported in previous studies (Livanou et al, 2019).…”

“…The transition age boundary according to a national mapping exercise study for adolescent medium secure units is 18 years old (Livanou et al, 2019). However, young people may remain in CAMHS until their 19 th birthday where it is deemed clinically appropriate or where a receiving placement cannot be found in time.…”

“…Transitioning away from key staff is difficult for this group of young people, particularly as engagement and rapport build over time (Livanou et al, 2019). Young people seem to be sensitive to adult environmental changes and can respond with maladaptive coping mechanisms (Wheatley et al, 2013).…”

“…Self-harming was evident in both sexes in the current sample and was integral to most of the young people's developmental history, with males engaged in self-harming behaviour as much as females. However, research findings show that adolescent male offenders with mental disorders in detention have lower self-harming rates than females (Livanou et al, 2019). Yet, the self-harming rates amongst males in the present study could be explained due to differences in settings and presentation of mental health problems and histories, which are more severe and complex compared with other establishments.…”

“…Young people in secure services encounter additional difficulties compared with community youth transitioning to adult services, such as developmental trauma, maladaptive coping strategies, attachment difficulties and other risk factors (Liddiard et al, 2019). This cohort of young people presents with complex and multiple needs, including comorbid mental health problems, which may escalate during periods of transition (Livanou et al, 2019). Furthermore, they are more likely to be looked after children (LAC) and/or have experienced inconsistent parenting (Wright et al, 2016).…”