European Child & Adolescent Psychiatry

, Volume 27, Issue 4, pp 501–511 | Cite as

The interface between child/adolescent and adult mental health services: results from a European 28-country survey

  • Giulia SignoriniEmail author
  • Swaran P. Singh
  • Vlatka Boricevic Marsanic
  • Gwen Dieleman
  • Katarina Dodig-Ćurković
  • Tomislav Franic
  • Suzanne E. Gerritsen
  • James Griffin
  • Athanasios Maras
  • Fiona McNicholas
  • Lesley O’Hara
  • Diane Purper-Ouakil
  • Moli Paul
  • Frederick Russet
  • Paramala Santosh
  • Ulrike Schulze
  • Cathy Street
  • Sabine Tremmery
  • Helena Tuomainen
  • Frank Verhulst
  • Jane Warwick
  • Giovanni de Girolamo
  • for the MILESTONE Consortium
Original Contribution


Transition-related discontinuity of care is a major socioeconomic and societal challenge for the EU. The current service configuration, with distinct Child and Adolescent Mental Health (CAMHS) and Adult Mental Health Services (AMHS), is considered a weak link where the care pathway needs to be most robust. Our aim was to delineate transitional policies and care across Europe and to highlight current gaps in care provision at the service interface. An online mapping survey was conducted across all 28 European Countries using a bespoke instrument: The Standardized Assessment Tool for Mental Health Transition (SATMEHT). The survey was directed at expert(s) in each of the 28 EU countries. The response rate was 100%. Country experts commonly (12/28) reported that between 25 and 49% of CAMHS service users will need transitioning to AMHS. Estimates of the percentage of AMHS users aged under 30 years who had has previous contact with CAMHS were most commonly in the region 20–30% (33% on average).Written policies for managing the interface were available in only four countries and half (14/28) indicated that no transition support services were available. This is the first survey of CAMHS transitional policies and care carried out at a European level. Policymaking on transitional care clearly needs special attention and further elaboration. The Milestone Study on transition should provide much needed data on transition processes and outcomes that could form the basis for improving policy and practice in transitional care.


Child and adolescent mental health services Transition Youth mental health Europe 



The research leading to these results has received funding from the European Union’s Seventh Framework Programme for research, technological development and demonstration under Grant agreement no 602442. This paper reflects only the authors’ views and the European Union is not liable for any use that may be made of the information contained therein. This survey would have not been possible without the passionate and valuable collaboration of a large number of experts from all 28 European countries; they are listed here, while their full affiliation is shown in Online Resource 1: Bernardo Barahona-Corrêa, Nikita Bezborodovs, Niels Bilenberg, Vlatka Boricevic, Rosa Calvo, Nigel Camilleri, Antonella Costantino, Véronique De Roeck, Katarina Dodig Curkovic, Gwen Dieleman, Roberta Dochnal, Tomislav Franic, Suzanne E. Gerritsen, George Giannakopoulos, Michal Goetz, Alexandrina A. Grosen, Lars Joelsson, Matti Joukamaa, Nestor Kapusta, Anne Kleinberg, Gerasimos Kolaitis, Marianne Kryger, Sigita Lesinskiene, Athanasios Maras, Laura Mateescu, Fiona McNicholas, Jaroslav Matys, Katrien Moens, Lesley O’Hara, Kallistheni Pantelidou, Moli Paul, Eva Pollak, Diane Purper-Ouakil, Frédérick Russet, Per-Anders Rydelius, Aurelie Schandrin, Ulrike Schulze, Vaska Stancheva-Popkostadinova, Barbara Remberk, Marianne Schilling, Igor Skodacek, Andre Sourander, Cathy Street, Bie Tremmery, Petra Uhlikova, Therese van Amelsvoort, Frank Verhulst, Jean-Francois Vervier, Agnes Vetrò, Nora Wurth, Maja Zorko, Agata Zupančic, Concentris research management. Authors would also like to thank Myron Belfer and Matt Mujien for their support with questionnaire development and in the identification of country experts.

The MILESTONE Consortium: members and partner institutions

Swaran Singh, Helena Tuomainen, Jason Madan, Moli Paul, Cathy Street, Dieter Wolke, Jane Warwick, Priya Tah, Alastair Canaway, James Griffin, Rebecca Appleton, Amanda Tuffrey, Anna Wilson, Charlotte Gatherer, Leanne Walker (University of Warwick, UK); Giovanni de Girolamo, Giulia Signorini, Alessandro Ferrari, Elisa Gheza, Cecilia Ferrari, Laura Rivolta, Flavia Levi, Maria Cataldo, Lidia Manenti, Giorgia Morini, Adriana Pastore, Cecilia Toselli, Pamela Varvara (Saint John of God Clinical Research Center, Italy); Paramala Santosh, Natalie Heaney, Jatinder Singh (Kings College London, UK); Diane Purper-Ouakil, Frédérick Russet, Virginie Maurice, Véronique Humbertclaude (Centre Hospitalier Universitaire de Montpellier, France); Athanasios Maras, Larissa van Bodegom, Mathilde Overbeek (Yulius Academy, Netherlands); Ulrike Schulze, Jörg M. Fegert, Paul Plener, Melanie Saam, Ulrike Breuninger, Renate Schepker, Michele Noterdaeme (University of Ulm, Germany); Sabine Tremmery, Gaëlle Hendrickx (Katholieke Universiteit Leuven, Belgium); Fiona McNicholas, Aleksandra Gronostaj, Rachael McKenna (University College Dublin, Republic of Ireland); Tomislav Franić, Nikolina Davidović (University Hospital Split, Croatia); Kate Lievesley, Federico Fiori (HealthTracker Ltd, UK); Frank Verhulst, Gwen C. Dieleman, Suzanne Gerritsen (Erasmus Medical Centre, Netherlands); Andrea Wohner (concentris research management GmbH, Germany).

Author contributions

GS and GdG wrote the manuscript; JW and JG supervised data quality control and analysis, interpreted results and assisted in the writing of the manuscript; SS, GD, TF, SG, AM, FMN, LOH, DPO, MP, FR, PS, US, CS, ST, HT, KDC, VB and FV provided substantial contribution to the conception of the work, revising it critically for important intellectual content, approved the final version and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The corresponding author confirms that she had full access to all data in the study and had final responsibility for the decision to submit for publication.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest in the submitted work.

Supplementary material

787_2018_1112_MOESM1_ESM.pdf (82 kb)
Supplementary material 1 (PDF 82 kb)
787_2018_1112_MOESM2_ESM.pdf (257 kb)
Supplementary material 2 (PDF 257 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018
corrected publication [March/2018]

Authors and Affiliations

  • Giulia Signorini
    • 1
    Email author
  • Swaran P. Singh
    • 2
  • Vlatka Boricevic Marsanic
    • 3
  • Gwen Dieleman
    • 4
  • Katarina Dodig-Ćurković
    • 5
  • Tomislav Franic
    • 6
  • Suzanne E. Gerritsen
    • 4
  • James Griffin
    • 7
  • Athanasios Maras
    • 4
    • 8
  • Fiona McNicholas
    • 9
    • 10
    • 11
    • 12
  • Lesley O’Hara
    • 13
  • Diane Purper-Ouakil
    • 14
  • Moli Paul
    • 2
  • Frederick Russet
    • 14
  • Paramala Santosh
    • 15
    • 16
    • 17
  • Ulrike Schulze
    • 18
  • Cathy Street
    • 2
  • Sabine Tremmery
    • 19
    • 20
  • Helena Tuomainen
    • 2
  • Frank Verhulst
    • 4
  • Jane Warwick
    • 7
  • Giovanni de Girolamo
    • 1
  • for the MILESTONE Consortium
  1. 1.Psychiatric Epidemiology and Evaluation UnitSaint John of God Clinical Research CentreBresciaItaly
  2. 2.Mental Health and Wellbeing, Warwick Medical SchoolUniversity of WarwickCoventryUK
  3. 3.Psychiatric Hospital for Children and Youth ZagrebZagrebCroatia
  4. 4.Erasmus University Medical CentreRotterdamNetherlands
  5. 5.Unit for Child and Adolescent Psychiatry, School of medicineUniversity Health Center in OsijekOsijekCroatia
  6. 6.Department of PsychiatryClinical Hospital Center SplitSplitCroatia
  7. 7.Warwick Clinical Trials Unit, Warwick Medical SchoolUniversity of WarwickCoventryUK
  8. 8.Yulius AcademyRotterdamNetherlands
  9. 9.Department of Child and Adolescent PsychiatrySMMS UCDDublin 4Ireland
  10. 10.Geary InstituteUniversity College DublinDublin 4Ireland
  11. 11.Department of Child PsychiatryOur Lady’s Hospital for Sick ChildrenDublin 12Ireland
  12. 12.Lucena Clinic SJOGDublin 6Ireland
  13. 13.Saint John of God Research FoundationCo. DublinIreland
  14. 14.Child and Adolescent Psychiatry Unit (MPEA1)CHU Montpellier-St Eloi HospitalMontpellierFrance
  15. 15.Department of Child and Adolescent Psychiatry, King’s College LondonInstitute of Psychiatry, Psychology and NeuroscienceLondonUK
  16. 16.National and Specialist Child and Adolescent Mental Health Services, Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD)Maudsley HospitalLondonUK
  17. 17.HealthTracker LtdGillinghamUK
  18. 18.Department of Child and Adolescent Psychiatry/PsychotherapyUniversity of UlmUlmGermany
  19. 19.Department of Neurosciences, Child and Adolescent PsychiatryUniversity of LeuvenLeuvenBelgium
  20. 20.Department of Child and Adolescent PsychiatryUniversity Hospitals LeuvenLeuvenBelgium

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