Transitioning care‐leavers with mental health needs: ‘they set you up to fail!’

Abstract

Background Children in the UK care system often face multiple disadvantages in terms of health, education and future employment. This is especially true of mental health where they present with greater mental health needs than other children. Although transition from care – the process of leaving the local authority as a child‐in‐care to independence – is a key juncture for young people, it is often experienced negatively with inconsistency in care and exacerbation of existing mental illness. Those receiving support from child and adolescent mental health services (CAMHS), often experience an additional, concurrent transfer to adult services (AMHS), which are guided by different service models which can create a care gap between services. Method This qualitative study explored care‐leavers’ experiences of mental illness, and transition in social care and mental health services. Twelve care‐leavers with mental health needs were interviewed and data analysed using framework analysis. Results Sixteen individual themes were grouped into four superordinate themes: overarching attitudes towards the care journey, experience of social care, experience of mental health services and recommendations. Conclusions Existing social care and mental health teams can improve the care of care‐leavers navigating multiple personal, practical and service transitions. Recommendations include effective Pathway Planning, multiagency coordination, and stating who is responsible for mental health care and its coordination. Participants asked that youth mental health services span the social care transition; and provide continuity of mental health provision when care‐leavers are at risk of feeling abandoned and isolated, suffering deteriorating mental health and struggling to establish new relationships with professionals. Young people say that the key to successful transition and achieving independence is maintaining trust and support from services.

“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

“…In the most severe cases, young people struggled to manage on their own, which resulted in them missing out on education, work, or friendships. Most young people reported feeling abandoned by services, something also reported in other qualitative studies exploring young people's experiences of transition (5).…”

“…It has been well-documented that transition from CAMHS to AMHS rarely goes smoothly, with young people experiencing distress, uncertainty, and discontinuity as they cross the service transition boundary (3)(4)(5). This is often due to young people experiencing disruption to their care, sometimes having several moves between services and/or clinicians during this time (6,7) and struggling to develop new therapeutic relationships (8).…”

Care leavers’ views about transition: a literature review

“…All seven studies considered particular aspects of leaving care, namely: the emotional support available to care leavers (Adley & Jupp Kina, 2014); factors motivating care leavers to engage with services (Amaral, 2011); care leavers' experience of transition between child and adult health care services (Butterworth et al, 2016); health priorities of care leavers (Matthews & Sykes, 2012); and care leavers' transition trajectories and access to support (Rogers, 2011). Two papers viewed care leavers' experiences from the theoretical lenses: of resilience (Driscoll, 2013) and life-course theory (Horrocks, 2002) respectively.…”

“…Additional inconsistencies were highlighted for those who had experienced transition between child and adult mental health services (Butterworth et al, 2016;Horrocks, 2002). All but one participant reported poor coordination, with some placed on long waiting lists before moving to a new team where they were expected to forge relationships with other professionals.…”

“…Others wanted offers of support from social care to be renewed several times (Adley & Jupp Kina, 2014;Rogers, 2011). Flexibility extended to wanting the choice to change aftercare advisors if the relationship was poor (Butterworth et al, 2016).…”