Transitioning from child to adult healthcare is common for young people with health problems. They grow and reach the age boundary between services. Transition is distinct from transfer since it is more than a complete administrative event. A smooth transition should be a coordinated, purposeful, planned and patient-centred process. It ensures they will receive optimised health, minimises adverse events, and continuity in care. It also helps the young person attain his/her maximum ability.
The transition starts with preparing a service user to leave a child-centred healthcare setting. It ends when that person is received and properly engaged with the adult healthcare provider. The transition became a clinical and research priority as an increasing number of young people with physical disorders. It helps them survive these life-threatening conditions into adulthood and get the ongoing care they need. However, it also gives therapeutic opportunities to ensure good outcomes in adult life.
Transition In Mental Health
Transition in mental health is equally important as the physical healthcare received in care settings. A seamless transition from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) is not usual. However, young people with mental health problems find themselves without professional support or a referral to an adult service. They may be referred, but the adult services are ill-equipped to meet their needs.
Studies from the UK and the US show that when young people reach 16 years of age, they decline drastically (by 24% and 45%) to use mental health services and even more at the age of 18 (over 60% in the UK). Young people with serious mental health disorders such as psychosis easily go through a transition to adult services. However, young people with emotional/neurotic, neurodevelopmental, and personality disorders may struggle with transition and are less likely to cross the boundary.
In the UK, only about 15% of young people with ADHD (attention deficit hyperactivity disorder) make a transition. In Ireland, this figure is only 7%. In the US, there is a lack of or inconsistent health insurance coverage for ADHD, which makes the transition more difficult. In recent years, some key findings have changed the understanding of developmental psychopathology and the age of onset of adult mental disorders.
The National Comorbidity Survey Replication from the US has found the age of onset of different mental disorders. This large data shows that all lifetime cases started by age 14, three-quarters by age 24, with later onset usually being comorbid conditions. Many adult mental health disorders are extensions of juvenile disorders now. This means they can be traced back to childhood conditions.
Mental Health Transition And Young People’s Preferences
Studies show that young people do not engage well with adult services worldwide. Young people may not be aware of what is available to help them or refrain from seeking help because of unhelpful beliefs about autonomy and stigma. Young people with two or more chronic health conditions find it difficult to find the right services. They may face developmental and situational transitions along with healthcare transitions, such as changes in housing and relationships, moving on to adult roles and gaining greater independence.
Parents and young people find services unhelpful during transition. Young people do not feel adequately prepared or supported during the transition, feel insecure at the loss of the familiar, lack understanding of adult services, and are afraid of the unfamiliar. Both young people and their families feel their voices are not heard during the transition process. The unplanned transition is like “having to move house due to a flood”. The child/adult may confused between mental health services, and that causes a lack of care pathway where it should be most robust.
Why Do You Need To Switch?
As you get older, your psychiatric needs change. Once you have completed puberty, your body and brain will fully develop. Adult psychiatric treatment plans can be different than those for children. A psychiatrist specialising in helping adults can benefit you as you enter adulthood. This transition usually does not have to occur on your 18th birthday. It is recommended to make the transition before you turn 19. Sometimes, the health plan will help you keep your psychiatrist until you turn 21. Here are a few tips to make this process easy.
Start Early
Discussing the change with your child psychiatrist well in advance, a year or more before you plan the transition, is ideal. Do not wait until the last minute to start the transition process.
Ask for Recommendations
You can ask for recommendations from your child’s psychiatrist. They can help you as they likely know trusted adult psychiatrists. They refer you to someone who will fit your needs well. You can also get recommendations from your primary care physician, trusted friends, or family.
Involve Parents or Guardians
Parents or guardians can provide emotional support and help manage the transition logistics. So, if you are comfortable, involve your parents or guardians. You become more independent as you blow out the candles on your 18th birthday cake. Complete independence does not have to end as you involve them. However, trusted adults can offer excellent advice and support if needed.
Understand Your Diagnosis and Treatment
Make sure you have a clear understanding of your diagnosis, treatment plan, and medications before you transition. Ask your child psychiatrist to explain anything you are unclear about.
Get Copies of Your Medical Records
Request a copy of your medical records, including mental health diagnoses, treatment plans, and medication histories. Provide these to your new psychiatrist to ensure continuity of care.
Prepare for Your First Appointment
Before your first appointment with your new psychiatrist, list questions, concerns, and any symptoms you want to discuss. Compiling a list of questions is always a good idea when meeting with any healthcare provider. Try to take some notes during your appointment.
Be Open & Honest
Be open and honest as possible about your feelings, symptoms, and concerns during your initial appointments. This will help your new psychiatrist understand your situation and provide the best care.
Be Patient
Building a new relationship takes time. It might take a few sessions to feel comfortable with your new psychiatrist. Your physical body changes as you move from adolescence to adulthood, and this can necessitate changes in your psychiatric care. It is also wise to remember, when trying out new treatment options that it does take time to work. So try to be patient with this process as well.
Stay Consistent
Consistency is key to managing mental health conditions. Try to keep up with regular appointments and follow the treatment plan set down by your new psychiatrist. Also, stay consistent with taking your medications. Changing your dosage on your own or stopping taking medications can produce serious consequences. If you have medication concerns, schedule an appointment with your doctor.
Advocate for Yourself
You know yourself best and must be active in your treatment plan. So, if something does not feel right, speak up. This can be tough for young adults, but remember that this is your life and health. You have a right to proper care, to ask questions, and to voice concerns.
