The Bridge Between Child and Adolescent and Adult Services

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Emerging adulthood  – the transition from childhood or adolescence to adulthood – is often a challenging and unstable time. Young people may be undergoing physical, psychological, and social changes and exploring their identity and place in their communities. 

For young people who are supported by child and adolescent mental health services (CAMHS), the move to adult mental health services (AMHS) often coincides with these challenges.

Navigating the transition can be very difficult, especially for young people who find change scary, stressful, or overwhelming. AMHS can look quite different from CAMHS, and while some of these differences may be positive, others may be harder to cope with.

While the bridge between child and adolescent and adult mental health services can be hard, effective preparation and care can make the journey smoother and easier.

This blog explores some of the challenges young people may face during the transition and what mental health services and parents can do to support the process.

Coping with Change

Emerging adulthood is a time of change. Young people’s brains are still developing, as are their bodies. They may be exploring aspects of their identity, such as their gender, sexuality, or religion. 

At the same time, emerging adults may undertake increasing responsibilities in their communities and wider society. They may be considering the roles they want to take and how they fit into with other people around them. Some emerging adults may experience a conflict between staying true to who they are and belonging to a community.

Alongside developmental changes, young people also experience institutional changes. This might mean moving from school to further education or starting a full-time job. The transition from CAMHS to AMHS also usually coincides with these changes.

These changes may be stressful or overwhelming for any young person, but for late adolescents with mental health concerns, they can be especially difficult. Young people with eating disorders often find change hard to manage and may use disordered eating behaviours to try to cope. Neurodiverse young people with mental health disorders also often struggle with change and a lack of routine.

Supported and Planned Transitions

While the change from CAMHS to AMHS may be inevitably challenging for many young people with mental health concerns, there are some steps that services can take to help emerging adults make effective transitions without harming their recovery.

A 2010 study that interviewed young people about the bridge between child and adult services found that a good transition process involved effective transition planning, communication and information transfer between teams, and continuity of care following transition.

These steps may help young people to continue their treatment into adulthood, avoid relapses, and continue to make improvements in their mental health.

Preparation and Expectations

Change is usually more scary when you don’t know what to expect. Young people have said that understanding what AMHS will look like – and learning details about the services – helps to make the transition easier. Having clear expectations can take some of the anxiety away from the transition and allow young people to prepare for what is coming next.

Flexible and Gradual Transition Times

Having flexible transition times is often important for young people crossing the bridge between CAMHS and AMHS. Some young people find that their transition time (between the ages of 16-18) is arbitrary and coincides with other stressful events like starting college, conflicts with parents, or other aspects of their life. This can make both the transition and other events much harder to cope with.

Other young people may have only recently started treatment and not yet be fully engaged in treatment, giving them less motivation to continue through a change in service.

On the other hand, flexible transition times would allow young people to choose to make the transition at a time that suits them. This might be during a calmer or more stable period or when they feel like they have made significant progress and can cope with the change.

Young people also usually prefer a gradual transition process where the two services overlap for some time. This means that young people can still feel supported by CAMHS, which they know and trust until they feel comfortable with AMHS. It also allows their previous service to provide support with the transition and any challenges they face during the process.

Active Involvement in the Transition Process

It’s important for young people to be treated like people and not ‘patients’. This means that adolescents should have a say in their transition process. They may decide when to make the transition, how much involvement their parents should have, and when to start seeing new therapists and move on from previous relationships. 

Giving a young person ownership over the process helps make the transition feel less overwhelming and scary. They’re also more likely to be satisfied with the process and less likely to feel disillusioned, unimportant or neglected, encouraging them to stay in treatment and avoiding drop-outs.

Understanding young people as partners in their mental health treatment also paves the way for independence, self-confidence, and self-efficacy without withdrawing support or care.

Attachments to Therapists

One of the most difficult things about the move from CAMHS to AMHS is having to leave secure therapeutic relationships and form new ones. During their time with CAMHS, young people often build strong and trusting relationships with their therapists.

Ending these relationships can cause feelings of abandonment, anxiety, or distress. This may be particularly true for young people with insecure attachment styles or personality disorders like BPD, where adolescents often experience a fear of abandonment.

Young people may also take time to build an effective relationship with a new therapist from AMHS and especially to form a trusting connection. Without proper planning, young people risk experiencing a gap in treatment without a therapist that they trust and can be open with.

Young people, parents, and clinicians have all highlighted the importance of a gradual and collaborative transition process that makes leaving previous relationships and forming new ones easier. This might mean getting to know their therapist from AMHS several months before they finish sessions with their CAMHS therapist.

It could also involve having continued, less frequent appointments with their CAMHS once they have started sessions with a new one, to avoid a sudden break or feelings of abandonment. 

Balancing Autonomy with Support

One key part of adolescent healthcare is balancing young people’s need for independence with that of support and parental involvement. As adolescents grow older, they tend to become more independent – but this change is gradual, and some young people want and need more autonomy than others.

CAMHS and AMHS usually have different care philosophies surrounding independence. While CAMHS services often emphasise the family unit, fully involving parents and other close figures in the treatment process, AMHS tend to limit family involvement and consider young people as autonomous adults. 

However, although some young people do value independence, others prefer parental involvement and support, and the sudden shift can cause them to feel overwhelmed and alone.

This can feel particularly challenging when young people may already be experiencing changes in their support system, such as shifting friend groups or moving to further education.

Moreover, some young people may experience these changes as a reduction in care and try to change their behaviours to feel more dependent and cared for.

Adolescents with eating disorders and borderline personality disorder may feel discouraged from recovery and instead maintain unhealthy behaviours in an effort to receive more support.

For young people struggling to cope with a reduction in parental support, there are some steps that can be taken. Young people can ask their adult mental health service to continue to include their parents or other family members in their treatment.

Parents and other close adults can also take steps to offer support independently to their children and ensure they still feel loved and cared for. Gradual transition processes can also make things easier, preventing a sudden shift in the philosophy of care.

The Wave Clinic: Dedicated Recovery Programs for Young People

The Wave Clinic offers specialist recovery programs for young people, making a difference in the lives of teenagers and adolescents around the world. Our seven core elements of treatment support young people to learn life skills, build plans for the future, heal from trauma, experience new and exciting adventures, and achieve lasting and meaningful recovery.

We combine clinical excellence with education, community work, and a gap year experience, helping young people develop a secure and confident sense of self and building a resilient foundation.

Our program is led by experts specialising in young people’s mental health care, who understand the unique needs of teenagers and adolescents. We work closely with every young person to design individualised treatment plan, listening to what they have to say every step of the way.

We also involve parents in our recovery programs, helping families to build scaffolding that supports recovery and healing.

If you would like to find out more about our programs, get in touch today. We’re here to support you.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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