Moving on from child and adolescent mental health services (CAMHS)

A child grows into a young person and soon starts their journey in the world as an 'adult'. This time of personal transition in a young person's life also becomes the time that a young person moves from one service to another. The services that have been a source of help and support will say that they can no longer continue.

This means that if the young person needs mental health services, they will need to be referred on to services for adults. This can be a very confusing time for young people and their parents.

This webpage provides some simple information about this period of transition.

For more detailed information, see the sources of information listed below.

Transition is a time of change from one place/service to another. In terms of mental health, this may mean the transfer of clinical care from child (CAMHS) to adult mental health services. It is also possible that a young person may no longer need the support of the CAMHS team, so they will be discharged and will continue to receive support from others, but is not referred on to adult mental health services.

For those young people who do continue to have severe mental health problems that require a transition to adult mental health services, this transition from one service to another should be a smooth process that offers uninterrupted continuity of care.

For parents/carers

As young people reach the later teenage years, this is the time when parents may no longer be the main carers. Young adults begin to take on the responsibility to make decisions about their own care.

Different young people take on this role at different times, but for parents who are used to being involved in the decision-making about their child's treatment, they may find themselves consulted less.

This can leave them feeling worried. This is especially so as many young people with mental health problems or disabilities will be vulnerable, and may lack the skills to survive independently or need longer to take on these responsibilities. For parents, it is important that they feel able to contribute to the decision about on-going and future care.

For young people

The transition from childhood to adulthood can be a difficult time in everybody's life. Taking responsibility for yourself and your treatment is something not all young people are able to do by a given age.

Below is some information to help with what you might need help with, including how the services available in your area can be accessed. This can then be thought about and discussed with family, your CAMHS professional, your teacher or your GP.

Many young people treated by professionals in CAMHS will not need to be referred on to adult mental health services. If further support is needed, other services may be able to provide more appropriate help and support.

The GP and the local primary care team may be the only service involved in taking care of their mental health needs. GPs can provide the continuity for a young person and their family. They can refer to specialist services if needed.

The primary care team may be able to continue with the management of some disorders such as anxiety, depression and eating disorders. The team may also be able to provide or refer to counselling or psychological treatments, such as Cognitive Behavioural Therapy (CBT). They can also refer to adult mental health services if appropriate.

In some local areas, there may be a 16-19 services or team which help adolescents with mental health problems move from CAMHS to adult mental health services.

Some young people may have mental illness that can be more severe (requiring hospital treatment or review of medications prescribed for mental illness). They may also have disabilitiies such as learning disabilities, along with the mental health problems. In this situation, the care and support is likely to be handed on to adult community mental health or adults with learning disability teams.

A young person can also have physical, social, emotional, educational and financial needs during this transition period. These needs may or may not be related to, or affected by, an underlying mental illness. 

When CAMHS are involved, it is possible that support was provided alongside other services, such as education and social care.

For adults (usually those 18 years and older), there may be different forms of support, and sometimes this can mean types of resources that were not previously available. Some of the services that can provide support are described below.

Education

Full-time education in a school setting is provided for some young people with special needs and those with significant learning difficulties up until the age of 19 years.

A transition plan should be started in year 9 and an appropriate provision identified. This process is led by the special educational needs co-ordinator, and an educational psychologist may be involved to support this process through further assessment, if necessary.

After leaving school, there is a range of provision for further education from colleges, which will have support in place for young people with special needs, to specialist day and residential colleges. It may be possible that education will plan and pay for post-16 education and training, especially for students with learning difficulties and disabilities.

Connexions

'Connexions' may be involved in helping young people, their families and other professionals to put together the transition plan that is developed in year 9. They may also support a young person to find a training course, apprenticeship or job after school or college.

Social care

In many local areas, for those young people with identified special care needs such as support with everyday living, housing or transport, the transition arrangements may be managed by a social worker based in adult services or a specialist transition support worker.

These professionals will talk to the young person and their family, as well as any relevant services already involved such as the children's disability team, the looked after children (children in local authority care) team and/or CAMHS to determine the care needs of the family and the young person. Any reassessment should be based on existing information such as the Common Assessment Framework (CAF).

From the age of 18, a young person could also start preparing their own Personal Centre Plan which helps them access other available support.

If the young person has been 'looked after' by the local authority, they may be considered a "Care Leaver", and so may continue to be entitled to support from the local authority's leaving care service until the age of 21 years.

Those entering higher or further education may also access support until the age of 21 and, in the case of a young person with , they may be able to access support in education for a longer period.

It may also be possible to find voluntary organisations, like YoungMinds, that can provide a wide range of help and advice. The appropriate service will depend on the young person's particular skills and needs.

Physical health

Your GP usually takes care of this. If there is a need for specialist care, the GP should be able to refer you to an appropriate adult service. If was prescribed by a CAMHS professional, this could be reviewed by the GP or it might need to be reviewed by a specialist (such as a psychiatrist).

The key worker or doctor in CAMHS should make arrangements for this transfer of before the young person is discharged from CAMHS.

As a young person

The most important part of leaving CAMHS is to be able to talk about what you need.

This means understanding your illness, medication if prescribed, your skills, abilities and needs in everyday life. You may need to ask professionals and people, such as family or friends that you know well, for their opinions. This will help you to make decisions about what support you might benefit from. Even if no specific service is available for you, it is important to ask.

As a parent

The young person might want to involve their family, friends or partners in making decisions.

If the young person has a disability or illness affecting their capacity to make decisions, they may be officially treated as a 'vulnerable adult' with the parent taking on the role of 'formal carer'.

If at any point you or your family feel you have not been listened to, involved, or your questions have not been answered, you should not hesitate to express this and if needed even complain about this. As an adult and carer, it is important you are aware of your rights and what you are entitled to.

As a professional

It is important to give sufficient time for young people and families to move to their new roles and services. You may find the list of references below useful.

"I've had anxiety and depression since I was 13 years old. Sue, my mental health practitioner, taught me to use Cognitive Behavioural Therapy (CBT) which helps with my anxiety and also when my mood starts dipping. My CAMHS psychiatrist also prescribed medication that helped with my depression. Having stopped going to school completely for a while, I managed to go back and do my exams. I was doing really well and I didn't need to see the CAMHS team anymore.

A few months ago I was offered a place at the local college. I was really excited, but I was also worried about starting somewhere new and not knowing anyone. My anxiety got worse, and soon I could not face the world. My depression came back.

My mum spoke to our GP and contacted adult mental health services. Someone from a 'crisis team' came to the house. I couldn't be bothered. I didn't want to talk to them. We had a few visits over the week, but it was a different person every time. They said they were not the right people to help as I was eating OK - not doing any serious harm.

My parents panicked and called my old CAMHS practitioner Sue. She spoke to me, reassured me and agreed to speak to the community adult mental health team. A few days later, Sue visited me at home with my new care co-ordinator, Jan, from the adult community team. We had a long chat about my illness and Jan met my parents. She arranged some regular meetings and after a few months, I felt better. My medication was changed. Jan gave me a care plan, with helpful pointers and phone numbers on it should things get difficult for me again. I finally was able to attend an outpatient appointment with my new psychiatrist on my own.

Starting college and leaving CAMHS was hard. But I have learned I need to talk about my problems to get the right help. But when my illness takes over even that is difficult."

YoungMinds - UK's national charity working for mental health and emotional wellbeing of all children and young people and publishes useful information for young people, parents and professionals.

Social Care Institute for Excellence (SCIE) - this website has a section on transitions in mental health services along with lots of useful information.

References

• Department of Health website
• Moving on well: a practice guide for health professionals and their partners on transitions planning for young people with complex health needs and disability. Department of Health 2008.
• Adolescent transition care: Guidance for nursing staff. Royal College of Nursing 2004.

Credits

Revised by the Royal College of Psychiatrists’ Child and Family Public Education Editorial Board.

Series Editor: Dr Vasu Balaguru

Authors: Dr Margaret Bamforth, Dr Vasu Balaguru and Professor Ann Le Couteur

This leaflet reflects the best possible evidence at the time of writing.