Building bridges: Results from the milestone study investigating young people's transition from child to adult mental health care in Europe

Research output: Types of ThesisDoctoral ThesisInternal

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Abstract

The configuration of having separate mental health services by age, namely child and adolescent mental health services (CAMHS) and adult mental health services (AMHS), implies that CAMHS users who need ongoing treatment will have to ‘transition’ to AMHS when they reach the CAMHS’s upper age limit. This distinction could be an impediment to continuity of care and may cause young people to disengage from services, which may in turn negatively affect their mental health. To this date, however, how many young people experience discontinuity of care and how their mental health is consequently affected remains unclear. The series of studies described in this thesis aim to describe what care young people who reach the upper age limit of their CAMHS receive, what predictors and outcomes are associated with these pathways and young people’s, parents/carers’ and clinicians’ experiences with transition. The MILESTONE study was designed to describe associations between characteristics of CAMHS users, mental health care use after reaching the CAMHS upper age limit (care pathways) and outcomes that are associated with these pathways. MILESTONE is the first study to prospectively describe the mental health of an international cohort of 763 young people who reached the upper age limit of their CAMHS over a 2-year period and to use information on a wide range of predictors and outcomes from the perspective of young people, parents/carers and clinicians.

The mental health of young people in the cohort, reaching the upper age limit of their CAMHS, varied greatly in type and severity: only one in three young people reported clinical levels of self-reported problems. The heterogeneity of the CAMHS patient population in type and severity of mental health problems suggests not all young people need ongoing treatment. We found that the decision regarding continuity of treatment was mostly determined by a small set of clinical characteristics, including clinician-rated severity of psychopathology and self- and parent-reported need for ongoing treatment. Other indicators of severe and acute problems, such as a clinical classification of a severe mental disorder, suicidal thoughts/behaviours or self-harm and psychotic experiences, were not positively associated with a recommendation to continue treatment. This may be explained by the fact that just over half of CAMHS clinicians and parents were unaware of young people’s self-reported suicidal behaviour as they reached the CAMHS upper age limit, which was associated with a lower proportion of being recommended to continue treatment. However, we did not find differences in MHS use at nine months follow-up. Perhaps most importantly, we found that although approximately half of young people reaching the upper age limit of their CAMHS stop using mental health services, this was not associated with a deterioration in their mental health. Finally, our studies showed that although a third of all young people have negative experiences navigating the process of transition, most young people and parents were satisfied with the process of transition or care ending overall.

The findings described in this thesis give rise to optimism: many young people reaching the upper age limit of their CAMHS may not need continued treatment. Approximately half of all young people reaching the upper age limit of their CAMHS stop using mental health services, but this does not seem to jeopardize their mental health. If replicated, our findings suggest investments in improving transitional care for all CAMHS users may not be cost-effective in times of rising health care costs, but may be better targeted at a subgroup of young people with increasing mental health problems who do not receive continued treatment and young people with severe or acute mental health problems of which clinicians are unaware. In general, young people would benefit from implementation of a standardized assessment of self- and parent-reported mental health problems, including suicidality and psychotic experiences and the need for continued treatment, to guarantee an informed and collective transition decision.
Original languageEnglish
Awarding Institution
  • Erasmus University Rotterdam
Supervisors/Advisors
  • Hillegers, Manon, Supervisor
  • Dieleman, Gwen, Co-supervisor
  • Maras, Athanasios, Co-supervisor
Award date26 Mar 2024
Place of PublicationRotterdm
Print ISBNs978-94-6483-795-7
Publication statusPublished - 26 Mar 2024

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