Young people need care services that carry on consistently through the transitions between childhood and adulthood. Kadra Abdinasir, Strategic Lead at the Children and Young People’s Mental Health Coalition (CYPMHC), makes the case, and welcomes recent Government initiatives in this direction
The transition into adulthood can be a daunting and difficult time for most young people, characterised by both excitement and uncertainty. It is a time when young people are presented with decisions about their future, including choices about their education and career.
For young people with emotional or mental health needs, this can be a particularly difficult period. The needs of this group may worsen without the right support in place, leading them to fall through the cracks of services.
The issues surrounding transitions have been widely documented nationally and even internationally. This problem is not unique to mental health services but one observed across health, education and children’s services. However, continuity of care in relation to mental health is imperative.
There are lifelong consequences associated with poorly managed transitions for young people with mental health needs. Indeed, research has shown that half of mental health problems emerge before the age of 14 and around three-quarters are established by the age of 24. Early identification and intervention during this period are therefore key.
What do young people say they want and need?
Young people’s views on what would make the transition from child to adult services a more positive experience have been consistent. They want services that are designed with them in mind and are accessible, flexible and non-stigmatising.
“I felt stigmatised, so I disengaged.” – Stephen*, 19 (young person supported by CYPMHC member)
Furthermore, young people want to be taken more seriously and have access to information and advice to allow them to have a greater say in their care. They also demand compassion and respect, regardless of their age.
“Thinking about the service from a young person’s perspective and what their needs are/what would be helpful.” – Jenny*, 20 (young person supported by CYPMHC member)
A transition plan should be developed in partnership with young people and their families to ensure a seamless transfer. Many young people tell us they often recount their stories to multiple professionals and want their details to be shared with all those involved in their care.
What the evidence shows
It is well established that the brain does not fully mature until about age 25. The time up until this point can be regarded as a period of heightened vulnerability and opportunity, if only we identify and respond to young people’s needs effectively.
The latest prevalence study in England published by NHS Digital reveals that one in eight of 5–19 year-olds had a mental disorder at the time of the survey. Worryingly, the rate of mental disorders increases with age, with one in six (16.9%) 17–19 year-olds experiencing a mental health problem. One in sixteen of these young people experience more than one diagnosable problem.
The study also reveals stark differences between older girls and boys. Girls aged 17–19 were more than twice as likely as boys that age to have a disorder. It is also concerning that one in four girls within this age group experience emotional disorders compared to nearly one in twelve boys. Girls within this age group were also at greater risk of self-harming or attempting suicide. These findings are in line with the Adult Psychiatric Morbidity Survey for England which reported young women aged 16–25 being the highest risk group for mental health problems.
We must pay close attention to the needs of this cohort, including those from vulnerable backgrounds, such as those leaving care, LGBT+ or with special educational needs or disabilities.
The policy response
Difficulties in transitioning young people from child to adult mental health services was identified as an area of national concern over a decade ago in a national review of services. It concluded that “chronological age is not the best determinant for appropriate service provision.” The government’s landmark Future in Mind 2015 report on children and young people’s mental health also recommended that “transitions from children’s services [should be] based on the needs of the young person, rather than a particular age.” Despite this acknowledgement, we are yet to see widespread improvements in the provision offered to young people.
“Maintaining strong relationships with practitioners – want to continue with them, even when you move location.” – Mariam*, 21 (young person supporter by CYPMHC member)
Improving transitions continues to be a government priority with the current Green Paper on children’s mental health seeking to establish a national group to examine the mental health needs of 16–25 year-olds. The recently announced NHS Long Term Plan commits to creating a service offer that caters across the 0–25 year-olds. This is a step in the right direction and will bring this important provision in line with other services for vulnerable young people, such as leaving care support and special educational needs and disabilities services where there is a statutory duty to offer support until age 25.
Putting rhetoric into practice
The Children and Young People’s Mental Health Coalition has long been calling for change to help improve transitions for young people. Collectively, we want to see a more flexible approach to transitions from children and young people’s to adult mental health services.
We welcome the Government’s commitment to creating a 0–25 service model. There have already been a number of such services set up across the country by both the statutory and voluntary sector to address issues surrounding transitions. These approaches need to be robustly evaluated to ensure they work for children and young people.
Commissioners of children and adult services must also work closely together to plan and appropriately resource services to address this issue. Greater coordination is also needed between mental health service providers and key agencies such as education, social care and substance misuse services.
As awareness of young people’s mental health continues to rise, it is vital we provide the help they need to overcome barriers and navigate this critical period in life.
*Names have been changed to preserve the identity of young people.
About the Children and Young People’s Mental Health Coalition
The Coalition is open to all those working to improve infant, children and young people’s mental health. Our current membership comprises over 180 organisations from across the charitable sector. Through our collective voice, we influence and shape policy, systems and practice by listening to, and learning from our members, supporters, children, young people and families. Further information can be found here: http://cypmhc.org.uk/