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.
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Vander Stoep A, Beresford SA, Weiss NS et al (2000) Community-based study of the transition to adulthood for adolescents with psychiatric disorder. Am J Epidemiol 152:352–362
Davis M, Banks S, Fisher W et al (2004) Longitudinal patterns of offending during the transition to adulthood in youth from the mental health system. J Behav Health Serv Res 31:351–366
Davis M, Vander Stoep A (1997) The transition to adulthood for youth who have serious emotional disturbance: developmental transition and young adult outcomes. J Ment Health Adm 24:400–427
McGorry PD, Killackey E, Yung A (2008) Early intervention in psychosis: concepts, evidence and future directions. World Psychiatr 7(3):148–156
Chanen Andrew M, McCutcheon Louise (2013) Prevention and early intervention for borderline personality disorder: current status and recent evidence. Br J Psychiatr Suppl 202(s54):s24–s29
McGorry PD, Hickie IB, Yung AR et al (2006) Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective interventions. Aust N Z J Psychiatr 40(8):616–622
Pottick KJ, Bilder S, Vander Stoep A et al (2008) US patterns of mental health service utilization for transition-age youth and young adults. J Behav Health Serv Res 35:373–389
Lamb C, Murphy M (2013) The divide between child and adult mental health services: points for debate. Br J Psychiatr Suppl 54:s41–s44
Singh SP, Paul M, Ford T et al (2010) Process, outcome and experience of transition from child to adult mental healthcare: multiperspective study. Br J Psychiatry 197:305–312
McLaren S, Belling R, Paul M et al (2013) Talking a different language: an exploration of the influence of organizational cultures and working practices on transition from child to adult mental health services. BMC Health Serv Res 13:254. https://doi.org/10.1186/1472-6963-13-254
Singh S, Evans N, Sireling L et al (2005) Mind the gap: the interface between child and adult mental health services. Psychiatr Bull 29:292–294
Singh SP, Tuomainen H (2015) Transition from child to adult mental health services: needs, barriers, experiences and new models of care. World Psychiatr 14(3):358–361
Paul M, Ford T, Kramer T et al (2013) Transfers and transitions between child and adolescent and adult mental health services. Br J Psychiatr Suppl 202(S54):s36–s40
McGorry PD (2007) The specialist youth mental health model: strengthening the weakest link in the public mental health system. Med J Aust 187:S53–S56
National Institute of Health and Care Excellence (2016) NICE: Transition from children’s to adults’ services for young people using health or social care services. https://www.nice.org.uk/guidance/qs140 Accessed 12 June 2017
Gilmer TP, Ojeda VD, Fawley-King K et al (2012) Change in mental health service use after offering youth-specific versus adult programs to transition-age youths. Psychiatr Serv 63(6):592–596
McGorry P, Purcell R, Hickie I et al (2007) Investing in youth mental health is a best buy. Med J Aust 187(7):S5–S7
McNamara N, McNicholas F, Ford T et al (2014) Transition from child and adolescent to adult mental health services in the Republic of Ireland: an investigation of process and operational practice. Early Interv Psychiatr 8:291–297
McNicholas F, Adamson M, McNamara N et al (2015) Who is in the transition gap? Transition from CAMHS to AMHS in the Republic of Ireland. Irish J Psychol Med 32(1):61–69
World Health Organization. Atlas-Child and Adolescent Mental Health Resources-global concerns: implications for the future. 2005. https://www.who.int/mental_health/publications/atlas_child_ado/en/. Accessed on October 13 2015
Signorini G, Singh SP, Boricevic-Marsanic V et al (2017) Architecture and functioning of child and adolescent mental health services: a European 28-country survey. Lancet Psychiatr 4(9):715–724
Gillam T, Crofts M, Fadden G et al (2003) The interfaces project report—exploring the links between mental health services for children, adults and families. NHS, National Institute for Mental Health in England West Midlands Development Centre & The Meriden Programme
Pedrini L, Colasurdo G, Costa S et al (2012) The characteristics and activities of child and adolescent mental health services in Italy: a regional survey. BMC Psychiatr 30(12):7. https://doi.org/10.1186/1471-244x-12-7
Forbes A, While A, Ullman R et al. (2002) A multi-method review to identify components of practice which may promote continuity in the transition from child to adult care for young people with chronic illness or disability—report for the National Co-ordinating Centre for NHS Service Delivery and Organisation R & D (NCCSDO)
Davis M, Sondheimer DL (2005) State child mental health efforts to support youth in transition to Adulthood. J Behav Health Serv Res 32(1):27–42
Herrman H, Purcell R, Goldstone S et al (2012) Improving mental health in young people. Psychiatr Danub 24:S285–S290
Belling R, McLaren S, Paul M et al (2014) Slipping through the net: the impact of organisational resources and eligibility issues on transition from child and adolescent to adult mental health services. J Health Serv Res Policy 19(3):169–176
da Pinto Costa M, Moscoso A, de Girolamo G (2016) Psychiatry in practice, education, experience, and expertise. In: Fiorillo A, Volpe U, Bhugra D (eds) Mental healthcare in the transition from child and adolescent to adult psychiatry: what a psychiatrist cannot ignore, 1st edn. Oxford University Press, Oxford, pp 295–305
Tatlow-Golden M, Gavin B, McNamara N et al (2017) Transitioning from child and adolescent mental health services with attention-deficit hyperactivity disorder in Ireland: case note review. Early Interv Psychiatr. https://doi.org/10.1111/eip.12408
Vloet M, Davidson S, Capelli M (2011) We suffer from being lost formulating policies to reclaim youth. Health Q 14(2):32–38
Kennedy P, Pugh R, Millar E (2005) Towards managing the whole system of care and improving continuity of care. Psychiatr Bull 29(7):252–254
McGorry P, Bates T, Birchwood M (2013) Designing youth mental health services for the 21st century: examples from Australia, Ireland and the UK. Br J Psychiatr Suppl 54:s30–s35
McGorry PD, Goldstone SD, Parker AG et al (2014) Cultures for mental health care of young people: an Australian blueprint for reform. Lancet Psychiatr 1(7):559–568
Rickwood DJ, Mazzer KR, Telford NR et al (2015) Changes in psychological distress and psychosocial functioning in young people visiting headspace centres for mental health problems. Med J Aust 202(10):537–542
Paul M (2014) Adolescents’ rights: better for promoting individual rights or public health? Adolesc Psychiatr 4(4):216–224
Racine E, Bell E, Yan A et al (2014) Ethics challenges of transition from paediatric to adult health care services for young adults with neurodevelopmental disabilities. Paediatr Child Health 19(2):65–68
Dean K, Stevens H, Mortensen PB et al (2010) Full spectrum of psychiatric outcomes among offspring with parental history of mental disorder. Arch Gen Psychiatr 67:822–829
Ranning A, Munk Laursen T, Thorup A et al (2015) Serious mental illness and disrupted caregiving for children: a nationwide, register-based cohort study. J Clin Psychiatr 76(8):e1006–e1014. https://doi.org/10.4088/jcp.13m08931
Siegenthaler E, Munder T, Egger M (2012) Effects of preventive interventions in mentally ill parents on the mental health of the mental health of offspring: systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatr 51(1):8–17
Reupert AE, Cuff R, Drost L et al (2013) Intervention programs for children whose parents have a mental illness: a review. Med J Aust 199((3 Suppl)):S18–S22
Muñoz-Solomando A, Townley M, Williams R (2010) Improving transitions for young people who move from child and adolescent mental health services to mental health services for adults: lessons from research and young people’s and practitioners’ experiences. Curr Opin Psychiatr 23(4):311–317
Singh SP, Tuomainen H, Warwick J et al (2017) Protocol for a cohort study of adolescent mental health service users with a nested cluster-randomised controlled trial to assess the clinical and cost effectiveness of managed transition in improving transitions from child to adult mental health services (The MILESTONE study). BMJ Open 7(10):e016055
Patton GC, Sawyer SM, Santelli JS et al (2016) Our future: a lancet commission on adolescent health and wellbeing. Lancet 387:2423–2478
Blum RW, Bastos FI, Kabiru W et al (2012) Adolescent health in the 21st century. Lancet 28(379(9826)):1567–1568
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).
Conflict of interest
The authors declare no conflicts of interest in the submitted work.
The original version of this article was revised: The original version of this article contained an error in Table 1. The correct table is presented below.
The members of the the MILESTONE Consortium are listed in acknowledgements section.
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Signorini, G., Singh, S.P., Marsanic, V.B. et al. The interface between child/adolescent and adult mental health services: results from a European 28-country survey. Eur Child Adolesc Psychiatry 27, 501–511 (2018). https://doi.org/10.1007/s00787-018-1112-5