Transition from child and adolescent MHS to adult MHS: what happens to young people with personality disorder?

Abstract

AimsHypothesis: Personality Disorder (PD) adolescents, compared to non-PD case, have a worse experience at transition.Aims: To describe the outcomes of referrals of adolescents for transition to adult services and compare PD and non-PD populations to identify potential improvements to allow for better transition experience of the PD patients.BackgroundBorderline PD is prevalent in adolescents - although there is a reluctance to make the diagnosis. When patients reach graduation from CAMHS, many fall through the ‘gap’ in services during the transition. Consequently, adding the paucity in research about the transition experience of PD patients, it is important to evaluate what happens to these patients during the transition process to help better understand their experience, and how it can be improved.MethodPatient's clinical records from Tower Hamlet CAMHS, East London NHS Foundation Trust, were reviewed retrospectively from July 2018 to November 2019, assessing whether optimal transition standards were met. A total of 41 cases that transitioned from CAMHS to AMHS were identified. Transition standards compared were: information sharing – case and risk, parallel care, transition planning and continuity. PD diagnosis was identified based on the recording of this diagnosis or meeting DSM5 criteria from the notes. PD and non-PD transition experience was compared.Result36 were given a diagnosis by the CAMHS clinician at transition and 5 had no diagnosis assigned. No cases had a PD diagnosis made by the CAMHS clinician, however 1 case mentioned ‘PD traits’, 1 mentioned ‘EUPD’ as a possible differential and 2 cases were labelled as ‘emotional dysregulation’. The research team found 17 cases that met DSM5 criteria for PD diagnosis.Comparing transition experience of PD vs non-PD patients, the PD patients had a less optimal transition process. Statistical analysis using Chi Square Tests, showed significantly less optimal transition planning (X2 = 5.103, p < 0.05) and continuity (Fisher's exact test p = 0.049). Cohens W indicated a medium effect for transition planning and continuity.ConclusionAdolescents with a diagnosis of PD transition less well to Adult MHS than those without the PD diagnosis. Implications of our findings point to 1) the importance of considering a diagnosis of PD 2) if the diagnosis of PD is made, to anticipate greater difficulties in transition 3) the need to identify specific reasons for transition difficulties related to patient, clinician and system factors and their interrelation.

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

“…The type of mental health condition as well as the severity of the young person’s difficulties influenced the likelihood of successful transition. Young people with serious and enduring mental disorders including psychosis (McNicholas et al., 2015) were most likely to be referred, while those with emerging personality, neurodevelopmental and emotional disorders were the least likely to transition successfully in several studies (Malkov et al., 2021; Singh et al., 2010).…”

“…The type of mental health condition as well as the severity of the young person's difficulties influenced the likelihood of successful transition. Young people with serious and enduring mental disorders including psychosis were most likely to be referred, while those with emerging personality, neurodevelopmental and emotional disorders were the least likely to transition successfully in several studies (Malkov et al, 2021;Singh et al, 2010). Leeb et al (2020) examined the factors affecting whether the care of young people with mental health, behavioural and developmental disorders included key elements of optimum transition using a 'transition measure' (Leeb et al, 2020).…”

“…One study focused on ‘serious’ mental health disorders and provided the following example: schizophrenia spectrum, bipolar and major depressive disorders (Cohen et al., 2020). Maslow included young people with a range of physical and MH conditions including psychosis, bipolar disorders and major depression (Maslow, 2016), and we found a single study that included only young people with personality disorders (Malkov et al., 2021). In addition, Appleton (2021) in a secondary analysis of data from the MILESTONE study (Singh et al., 2021) selected a cohort of a young people with anxiety, depression, neurodevelopmental and emerging personality disorders as prior work suggested that such young people were particularly likely to drop through gaps in services (Appleton, 2021).…”