ADHD and transitions to adult mental health services

Author(s):  
Chris Hollis

Despite the recognition of ADHD as a lifespan neurodevelopmental disorder, the majority of young people with ADHD fail to transition successfully to adult services. Health service transition marks a particularly vulnerable time for young people with ADHD, as disengagement from services and untreated ADHD lead to serious adverse psychiatric and social outcomes. Barriers to successful transition include the lack of adult ADHD services, differences in acceptance thresholds, lack of knowledge and training among practitioners in adult services, and a less family-orientated culture in adult services that may exclude parents. Young people and parents should routinely be involved in the design and evaluation of services related to transition. The role of an ADHD transition worker and increased involvement of primary care in the management of ADHD is recommended to provide greater continuity and support before and after the transfer of care from child and adolescent to adult mental health services.

Author(s):  
Tamsin Ford

Abstract Increasing numbers of young adults need continued support for their attention deficit hyperactivity disorder (ADHD) beyond the age-boundary for children's services. The sparse literature on transition in general suggests patchy provision and huge gaps in transitional care, but also that young people with ADHD and other neurodevelopmental disorders fair particularly badly. Transition in health care coincides with many other important life-transitions while the difficulties associated with ADHD may make these challenges particularly hard to cope with. Parents or other advocates therefore often need to be involved, which can present problems in adult mental health services given that they tend to be less family oriented than children's services. Importantly, young people need help negotiating the transition from passive recipient of care to active self-management, and in building relationships with the adult team. In addition to patchy provision of adult ADHD services, transition is currently hampered by poor understanding of ADHD as a long term condition and uncertain knowledge of what services are available among young people and parents as well as the clinicians working with them. Guidelines recommend, and more importantly young people want, access to psycho-social interventions as well as medication. However, available evidence suggests poor quality transitional care and adult services that are highly focused on medication. Adult ADHD services need to undergo similar development to that experienced by Child and Adolescent Mental Health Services and community paediatrics over the last few decades. While we debate the relative merits of dedicated or specialist v. generic adult mental health services, for young adults with ADHD the training, experience and availability of professionals are more important than their qualifications or setting.


2013 ◽  
Vol 202 (s54) ◽  
pp. s41-s44 ◽  
Author(s):  
Clare Lamb ◽  
Margaret Murphy

SummaryThis discussion paper outlines our personal views for debate on some of the complexities inherent in the crucial task of improving mental health services for young people in the UK.


2014 ◽  
Vol 22 (6) ◽  
pp. 601-608 ◽  
Author(s):  
Laura Reale ◽  
Maria Antonella Costantino ◽  
Marco Sequi ◽  
Maurizio Bonati

Objective: To investigate the care management and continuity from child to adult mental health service for young adults with ADHD. Method: A questionnaire survey from 18 Regional ADHD Pediatric Centers (RAPC) in Lombardy, Italy, was used to collect data on transition protocols and population served, and to track the pathway of care of ADHD patients once they reached adulthood. Results: Twenty-eight percent of RAPC had transition protocols and 3% of the population annually served were potential referrals to adult service. Of 52 patients who turned 18 years, just over 70% were monitored by the general practitioner, of those 5 with RAPC support. One fifth of patients continued to use mental health services, the majority was still monitored by the RAPC, and only three by services for adult. Conclusion: Managing the process of transition to adult services in mental health care remains a need to be prioritized and better defined for ADHD patients.


2000 ◽  
Vol 6 (4) ◽  
pp. 287-294 ◽  
Author(s):  
Tami Kramer ◽  
M. Elena Garralda

Epidemiological research has revealed that psychiatric disorders in children and adolescents are common, persistent and handicapping. Only 1 in 10 of those with a disorder is seen in specialist mental health services. However, the majority of children and adolescents see their general practitioner (GP) every year. Although the majority present with physical complaints, there are indications that rates of psychiatric disorder in those attending are increased and that psychiatric disorder is associated with increased consulting. These findings raise questions about the role of primary care in the promotion and management of mental health in young people.


1992 ◽  
Vol 20 (2) ◽  
pp. 207-242 ◽  
Author(s):  
Michael J. Leiber

Although a number of studies have evaluated reform in commitment proceedings, these have been subject to criticism for failing to conduct a comprehensive examination and/or allow for a reasonable amount of time for the reform to be implemented. The objective of this study was to address these concerns by examining the patterns and trends of a J 975 reform on civil commitment in Dane County, Wisconsin. Utilizing a “before and after” research design, the findings suggest that the implementation of reform is specific to certain areas and varies by the year(s) assessed. The role of the mental health network and the restructuring of the financial responsibility for mental health services are seen as pivotal in why reform was more or less successful.


2013 ◽  
Vol 13 (1) ◽  
Author(s):  
Charlotte L Hall ◽  
Karen Newell ◽  
John Taylor ◽  
Kapil Sayal ◽  
Katie D Swift ◽  
...  

2020 ◽  
Vol 44 (4) ◽  
pp. 163-168 ◽  
Author(s):  
Gaelle Hendrickx ◽  
Veronique De Roeck ◽  
Athanasios Maras ◽  
Gwen Dieleman ◽  
Suzanne Gerritsen ◽  
...  

The transition from child and adolescent to adult mental health services for young people with mental health problems is of international concern. Despite the high prevalence of mental disorders during adolescence and their tendency to continue during adulthood, the majority of young people do not experience continuity of care. The aim of this review paper is to unravel the complexity of transitional mental healthcare to clinicians, policy makers and mental health service managers, and to address challenges to a smooth transition process at all levels.


2017 ◽  
Vol 41 (S1) ◽  
pp. S153-S153
Author(s):  
M. Livanou ◽  
V. Furtado ◽  
S. Singh

IntroductionTransitions from child and adolescent mental health services to adult mental health services have been quite troublesome for young people in the UK. There is strong evidence throughout the literature that long waiting lists and rigid adult services criteria hamper dramatically transitions across services. Little knowledge exists about transitions from forensic adolescent services to adult services.ObjectivesTo interview health-care professionals and young offenders in transition of care from forensic child and adolescent mental health services in England.AimsThis study aimed to bridge the current literature gap in regards to transitions across forensic services and the complexities resulting from disruptive care.MethodsThis study adopted a prospective design to identify young offenders referred to adult services over a six-month period. We utilized semi-structured interviews. Health-care professionals were interviewed about their transition views and perspectives. Young offenders were followed-up within a month of their transition and were interviewed.ResultsThe numbers of transitions within forensic settings are much lower compared to those of general transitions across mental health services in England. Transition delays were a repetitive theme across interviews due to lack of bed availability, especially in medium secure hospitals, and poor multi-agency communication. Commissioning determines age boundaries along with transfer destination for each service.ConclusionsIneffective liaison among different sectors might impact adversely young people and hallmark their long-stay in the system. Therefore, continuity of care within forensic services should be looked warily along with the role of policy shaped by commissioning. Multiple transitions can repeatedly traumatize young people moving across services.


1996 ◽  
Vol 30 (6) ◽  
pp. 805-812 ◽  
Author(s):  
Peter Birleson

Objectives: The aim of the paper is to clarify the legal rights of adolescent patients, guardians and staff in Victorian Child and Adolescent Mental Health Services (CAMHS). Victorian CAMHS have now been ‘gazetted’ and can admit patients on an involuntary basis under the amended Mental Health Act 1986 (MHA). The MHA applies equally to young people under the age of 18 years, which has raised some confusion about who has the right to consent to treatment. Method: Staff of CAMHS inpatient units have recently posed questions to the Victorian chief psychiatrist. These have included clarification of when the MHA may be appropriately used for adolescents, what is the clinician's duty of care, how to assess young people's capacity to consent to treatment, how to manage some patient groups, and what is the role of the courts in treatment decisions. The author provides a view on each of these matters, based on recent literature and confirmed by legal opinion. Results: Some matters of fact are presented and advice is provided. Conclusions: Services must seek the informed consent of guardians and adolescents and, for those young people with major psychiatric disorders who require treatment and are unable to consent, the amended MHA provides clearer direction for the use of involuntary treatment. Where units offer admission to provide assessment and stabilisation, a clear explanation about the treatment goals, and the role of restraint and medication in managing behaviour is essential at the outset of the admission process.


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