1. Mental Health Support For Young People In Transition to Adult Services in North Somerset
Dr Fiona Barlow
Consultant Child and Adolescent Psychiatrist
North Somerset CAMHS

2. Overview Brief overview of mental health issues in late adolescence
Historical perspective of care provision for yr olds
Developments wrt service provision over past 7 years
Current transition forums
Current transition arrangements

3. Adolescence
Fascinating, critical complex stage of development with enormous changes
Physically ( pubertal changes, menarche)
Cognitively ( brain fine tuning,)
Emotionally ( personal identity, autonomy, coping strategies)
Socially ( peer groups, friendships, sexual identity)
Physical-growth spurt, secondary sexual characteristics, menarche
Cognitive-change in anatomy/function.Ability to weigh up risk, learn from experience, control impulse. Changes continue up to 25
Emotion-coping strategies for dealing with life events and challenges. Develop independence, taking more responsibility
Socially-peer groups and influence. Family relationships still important. But seek more relationships outside. Sexual identity

4. Adolescent Mental Health
Half of all life time psychiatric disorders start by age 14
Three quarters start by age 24 ( Kessler et al 2005)
16-18 yr olds experience a relatively high incidence of mental health problems.
Research indicates that yr olds are at additional risk of developing mental health problems cf pre-16 or post-18.
Less likely to seek professional help.

5. Adolescent Mental Health
Highest number of admissions to hospital for eating disorders is 15 yr old young people.
Majority of people who self-harm are between 11 and 25.(Association for Young People`s Health)
Completed suicide is rare. Rates for young men has fallen since 2011.
Source: Key Data for Adolescents 2013 Public Health England

6. Adolescent presentations within CAMHS/LD
Anxiety disorders
Depression/Self-Harm
Obsessive –Compulsive Disorder
Eating Disorders
ADHD
Autistic Spectrum Disorders/Asperger`s Syndrome
Emerging Personality Disorders
Psychosis
PTSD
Note that children with LD do access camhs. Specialist team who manage children with severe LD who are at high risk of having /developing serious mental illness

7. Historical perspective
2004 NSF for Children set out 10 yr plan to develop services around the needs of children.
Standard 9 The Mental Health and Psychological Well-being of Children and Young People
24 hour cover
Comprehensive service for children with LD and Mental Health problems
Access for all 16 and 17 year-olds, regardless of educational status
Since 2007 N Somerset CAMHS commissioned up to 18th birthday
Previously yr olds were seen in camhs if in full time education /college. Those who were not, living independently, not accessing education were seen within amhs.
Various indicators from NSF

8. Historical Perspective
TRACK study 2009 ( S Singh) national project looking at transition period between CAMHS and AMHS over 6 different mental health trusts.
Factors identified as important in making a transition inc: parental presence at appts, having serious mental illness, being on medication.
Successful transfer inc period of parallel care and good information transfer between services.
Highlighted that typical cases that fall through the gap inc neurodevelopmental disorders ( ADHD/ASD), emotional disorders and emerging personality disorders.
TRACK study national project funded by NIRH looking at transition period between CAMHS and AMHS and young people`s experience of this over 6 different mental health trusts across the UK.
Factors identified as being important wrt transition were: parental presence at appts, having serious mental illness, being on meds.
Factors identified in completing successful transfer inc period of parallel care, and good information transfer between services

9. Recommendations from TRACK Study
Implement clear transitions protocols
Audit protocols
Talk to colleagues across AMHS-CAMHS divide
Good Information transfer across services
Arrange joint meetings/assessments
Period of parallel care between services i.e. seamless
Transitions workers across teams
Extend adult services for adolescents who fall through the gap
Maximise key principles of good transition
Seamless
Continuity of care
Some flexibility of boundaries
Joint working

10. Local Developments
North Somerset AMHS-CAMHS working group was set up in 2007.
Members included reps from AMHS, CAMHS, NS PCT, EIPS, Adult Social Care, Crisis team, mental health liaison team, Area Services manager ,Consultant Psychiatrist from Riverside Adolescent Unit, transitions social worker for LD, BCH CAMHS

11. What has this Working Group achieved?
Establishment of ‘link’ relationships between adult and child teams
Regular advice/liaison with commissioners
Established clear protocols for transition to adult services which are now integral to multiagency transitions protocol.
Clear pathway agreed between AWP and WAHT for assessment of year olds with emergency presentations at WGH
Protocol is available to parents/carers as part of Multiagency transitions protocol ( available on LD4u website)

12. AMHS-CAMHS Working Group
Opportunity to discuss management of emergency presentations
Reflective learning from examples of poor transitions
Interface with many different agencies working with young people with mental health difficulties
Contribution towards establishment of new ADHD service for adults in 2010 with agreed transition protocol

13. Current Forums for Transition
AMHS-CAMHS Working Group meeting 6 monthly
Reps from CAMHS, EIPS, Access Services manager, manager of Mental Health Liaison Team, Primary Care Liaison Team and Intensive Support team and WGH ED
Focus on strategic/service development
Transitions Operations Group chaired by CTPLD manager meeting 2 monthly
Multiagency forum with reps form adult LDSWT, AMHS, CAMHS-LD, Housing, Weston College, Learning Partnership West, OT, Social Care, CCG
Aim is to identify and plan for those young people with complex needs who will need additional support in adulthood
Relevant service development from trans ops group is fed up to transitions governance group
CTPLD Community team for people with Learning Disabilities

14. Current Transition Arrangements
Any young person aged 17 and 6 months identified by team as requiring ongoing support for mental health needs
Refer to Primary Care Liaison Service who act as gateway into AMHS
Ideally if referral is accepted, we arrange a joint assessment between CAMHS-AMHS.
Aim to complete joint assessment and arrange handover meeting prior to young person`s 18th birthday

15. Transition Arrangements Contd
If following assessment, young person does not meet criteria for AMHS, they will be signposted to other possible avenues of support.
For those young people with ADHD, clear transitions referral pathway from 17 years to adult ADHD service based in Bristol. Ideally handover meeting is held locally to maximise engagement of young person.

16. Transition Arrangements for Children/adolescents with LD
Transition reviews start at 14 for children with SEN
Ideally families given Transitions Information Pack
All young people with additional needs referred to transitions social workers for FACS assessment
This determines eligibility for access to relevant adult services e.g. adult LD/social care
Parents can initiate this referral via LD4U website
Once referral received, information gathered from all agencies involved.
Multiagency pack
Fair Access to Care Assessment

17. Transition Arrangements for Children/adolescents with LD
If LD eligible, young person is allocated a transitions worker who links between both services and initiates transitions assessment.
This is a holistic assessment of the young person`s strengths and needs and identifies support post 18.
Where appropriate, there is a period of parallel care between child and adult services partic for those with complex health needs and/or challenging behaviour.
Families view are crucial and assessment includes family`s views and wishes.
Complex health needs e.g. lifetime service
CAMHS MAST liaising with intensive Support team in adult LD ( positive support plans and risk assessments)

18. Any Questions??