What does good look like?
The NHS Long Term Plan (2019) committed to extending service models to provide a ‘comprehensive offer’ of mental health support for 0- to 25-year-olds, that reaches across children and young people’s and adult mental health services. 0 – 25 models should provide an integrated approach across multiple services, including education, social care and the voluntary sector (NHS, 2019).
- Mental health support for 0- to 25-year-olds would align with other services for young people, including support for care leavers (Department for Education, 2018) and support for some young people with special educational needs and/or disabilities (SEND) (Department for Education, 2017).
- Evidence suggests that delaying transition at the age of 25 would benefit young people and ensure that the maximum period of risk would pass. This approach would require services to be available for young people who do not meet the criteria for traditional adult mental health services (Healthcare Safety Investigation Branch, 2018).
NICE guidelines (2016) highlight nine ‘overarching principles’ of good transition from children’s to adults’ services (NICE, 2016):
- Involving young people and their parents/carers in services design, delivery and evaluation related to transition.
- Ensuring transition support is developmentally appropriate.
- Ensuring transition support is strengths-based.
- Ensuring transition support is person-centred.
- Integrated working between service managers across children’s and young people’s health and social care services.
- Proactive identification and planning for young people with transition support needs by service managers.
- Every service taking responsibility for sharing safeguarding information with other organisations.
- Checking that the young person is registered with a GP.
- Consider ensuring that the young person has a named GP.
0 – 25 models for mental healthcare
- A report by the National Collaborating Centre for Mental Health assessed the evidence of how the needs of young adults can be meet within mental healthcare (National Collaborating Centre for Mental Health, 2023). It highlights that mental health services for young adults (18- to 25-year-olds) tend to work best where they have been co-produced with local young people and professionals and ran jointly with multiple providers.
- NHS East of England Regional Mental Health Team has produced a detailed report on what good looks like when designing services for young adults. They drew on international literature and 6 focus groups with different youth services across England, to identify key frameworks for these services (Hunn & Clarke, 2022).
- Young people have described the importance of ‘flexible’ and ‘gradual’ entry and exit points for mental health services. Instead of complex routes into treatment and long waiting times, this can provide personalised care in which they do not have to repeat their story multiple times (National Children’s Bureau, 2021).
- The 2018 Care Quality Commission review highlighted that ‘commissioners and service planners across health, social care, education and the criminal justice system must plan and commission services jointly, pooling their resources where necessary, so that services can work flexibly across organisational boundaries to provide person-centred care built around each child or young person and their parents, families and carers – rather than expecting children and young people to work around the complexities of the system’ (Care Quality Commission, 2018b).
Improving transitions between services
There is a range of guidance for services that support young people transitioning from children and young people’s mental health services (Healthcare Safety Investigation Branch, 2018). Key elements are flexible, managed transitions that involve shared decision making with the young person; continuity of care; and follow-up after transition (Healthcare Safety Investigation Branch, 2018).
- NHS England guidance (2015) states that ‘whatever the age at which a young person leaves one mental health system for another, the transition must be carefully planned with the young person and, where appropriate, their family’ (NHS England, 2015). It also states that commissioners may need to ‘look to other services’ to support young people who are not eligible for adult mental health services (NHS England, 2015).
- The NHS East of England team produced ‘Transition Standards for Eating Disorder Services in the East of England’ in June 2022, which includes a self-assessment checklist for implementing these standards.
- NHS England Commissioning for Quality and Innovation (QUIN) payments in 2017-19 incentivised providers to improve transitions. They required services to have a transition plan which included personal transition goals agreed with the young person; and that young people approaching the age of transition should have a meeting to prepare at least 6 months beforehand (Healthcare Safety Investigation Branch, 2018)
- The Care Quality Commission (CQC) has produced a guide which highlights what good looks like for inpatient transition (Care Quality Commission, 2018c).
- There may be benefits to using specific tools to empower young people in their transition planning (Healthcare Safety Investigation Branch, 2018). Many acute NHS trusts use the ‘Ready Steady Go’ toolkit for empowering young people and improving transitions (TIER, 2023). This tool has been recommended by NICE (NICE, 2017b).
- However, only a few interventions aimed at improving transitions have been evaluated (Embrett et al., 2016).
- Transforming mental health services from 0-25: A case for change
- Joint Commissioning Panel for Mental Health’s Guidance for commissioners of mental health services for young people making the transition from child and adolescent to adult services
- NHS England’s Commissioning for Quality and Innovation National Scheme 2017 to 2019and model service specification for transitions from child and adolescent mental health services
- NICE guidance Transition from children’s to adults’ services for young people using health or social care services
- Social Care Institute for Excellenceguidance, research and case studies on moving from adolescent to adult mental health services.
- Improving transition from children to adult mental health services
- Core components of successful transitions from child to adult mental health care (as decided by a national survey with youth, caregivers, and health professionals)
- Joining up the commissioning of young people’s services across health, social care, housing and youth services
- Building Bridges: Developing a Needs Led Transition Pathway Between Child and Adult Mental Health Services
Full list of references is included at the end of this chapter.