Predictors of transitioning to adult mental health services and associated costs: a cross-country comparison

Rebecca Appleton*, Alastair Canaway, Helena Tuomainen, Gwen Dieleman, Suzanne Gerritsen, Mathilde Overbeek, Athanasios Maras, Larissa van Bodegom, Tomislav Franić, Giovanni de Girolamo, Jason Madan, Fiona McNicholas, Diane Purper-Ouakil, Ulrike M.E. Schulze, Sabine Tremmery, Swaran P. Singh

*Corresponding author for this work

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Young people are at risk of falling through the care gap after leaving child and adolescent mental health services (CAMHS) despite an ongoing need for mental health support. Currently, little is known about the predictors of transitioning to adult mental health services (AMHS), and associated healthcare and societal costs as young people cross the transition boundary. 


To conduct a secondary data analysis exploring predictors of transitioning or falling through the gap and associated costs. 


Data were used from a longitudinal study, which followed young people from seven European countries for 2 years after reaching their CAMHS boundary. Predictors of transitioning (including sociodemographic and clinical variables) and longitudinal resource use were compared for 488 young people who transitioned to AMHS versus those who fell through the gap. 


Young people were more likely to transition to AMHS if they were severely ill. Those from Italy, the Netherlands and the UK were more likely to fall through the gap than transition to AMHS. Healthcare costs fell for all young people over the study, with a sharper decrease for those who fell through the gap. 


Total healthcare costs fell for all participants, indicating that the intensity of mental health support reduces for all young people as they cross the CAMHS boundary, regardless of clinical need. 


It is important that alternative forms of mental health support are available for young people who do not meet the AMHS care threshold but still have mental health needs after leaving CAMHS.

Original languageEnglish
Article numbere300814
Number of pages9
JournalBMJ mental health
Issue number1
Early online date25 Oct 2023
Publication statusPublished - 25 Oct 2023

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