Lost in Transition - moving on smoothly from child to adult mental health of learning disability services Sarah Bernard Consultant Psychiatrist Child and Adolescent Learning Disability

Overview  Service provision  Diagnosis  Management  The family  Social care  Occupation  Placement  Consent/capacity  Other

Service Provision  CAMHS vs Adult LD  Ref criteria  “Proof of level of LD”  “Proof of mental health issues”  Do they have ASD  Transitional services  Why 18yrs?

Diagnosis  ICD-10 vs DSM IV  How do childhood diagnoses change at transition?  Psychometry vs adaptive functioning

Management  Health vs Education vs Social Care (Funding!)  Community vs residential vs hospital  Behavioural interventions – do they change?  Medication – how, why, when and what?

The Family  Changing role  Inclusion vs exclusion  Aging parents

Social Care  Referral criteria - conflicts  Roles/Responsibilities  Respite

Occupation  School…college…employment  What has this got to do with psychiatry?

Placement  What is home?  Moving on  Catchment area

Consent and Capacity  Watch this space!  MCA – how is it used?  DoLs – 18 yrs+, but must be considered in childhood  MHA – when?

Other issues  Respecting each others services and expertise  Transitional planning – not an option!

Case  AA  17.5yrs  Asylum seeker. Somalian.  Previous history of abuse  UK 2 yrs  Probable sexual abuse  Aggressive ++

Cont…  Breakdown of school placement  Placed in respite unit – breakdown of placement  Witness in criminal proceedings  Charged with assault  Diagnosis – ASD, MLD. Probable PTSD

Cont….  Options: move to adult placement? Move to residential school?  Fitness to plead assessment  Outcome…….to discuss

Conclusions  Transition from child to adult services requires planning and co-operation  Care pathways for transition should be established  Differences between child and adult services are inevitable  CAMHS – LD and Mental health of Adult LD should/must work together

A WISH LIST  Respect on both sides  Good child/adolescent services  Sufficient funding (without arguments)  Clear transition pathway (useful meetings!)  Research