Annex D
THE TRANSITION BETWEEN ADOLESCENT AND ADULT
MENTAL HEALTH SERVICES
D1. Adolescence as a transitional stage
between childhood and adulthood may mean that some young people
fail to receive mental health services appropriate to their age.
The need for better management of the interface, particularly
between adolescent and adult services, is widely recognised.
D2. The recent National Service Framework
for mental health, while focusing mainly on adult services, included
a number of standards and good practice models relevant across
whole populations, as well as guidance directed specifically to
the needs of young people at the adolescent/adult service interface.
Examples are the need for local inter-service arrangements to
be agreed covering the prompt assessment of serious mental illness
in young people; ensuring the safety and dignity of adolescents
where exceptional care is provided on an adult ward; and arranging
effective hand-over of care where a young person transfers to
mental health care for adults.
D3. The National Service Framework includes:
Assessment of serious mental illness
— prompt assessment is essential for
young people with the first signs of a psychotic illness, where
there is growing evidence that early assessment and treatment
can reduce level of morbidity. Clinical responsibility for the
mental health care of older adolescents can sometimes lead to
disagreements between child and adolescent mental health services
and adult services if working arrangements between the two services
have not been addressed. Variations exist for the "cut-off"
point for referral to adolescent services, for example, 16, 18
and 21 years or school leaving. Local arrangements should be agreed
to avoid confusion and possible delays.
In-patient beds
— if a bed in an adolescent unit cannot
be located for a young person, but admission is essential for
the safety and welfare of the service user or others, then care
may be provided on an adult ward for a short period. As a contingency
measure, NHS trusts should identify wards or settings that would
be better suited to meet the needs of young people. A protocol
must be agreed between the child and adolescent mental health
services, and adult services. Protocols should set out procedures
that safeguard the patient's safety and dignity.
Care planning and review
— When the mental health care of a
young person needs to transfer to services for working age adults,
a joint review of the young person's needs must be undertaken
to ensure that effective hand-over of care takes place. This should
be incorporated into a care plan under the Care Programme Approach
arrangements for adult services.
D4. These targets will be monitored as part
of arrangements for monitoring the implementation of the National
Service Framework.
9 March 2000
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