Young people let down by transition to adult mental health services

The report is the third from the HSSIB investigation into mental health hospital services in England.

“Evidence shows that a more flexible approach to transition is much safer and more therapeutic for young people"

Craig Hadley

The latest report summarises the investigation by HSSIB into the transition from inpatient children and young people’s mental health services to adult mental health services.

The investigation identified an “inconsistent approach” to transitions across England.

The investigation found that many young people were being discharged from inpatient mental health care because they had reached the “transition age” of 18, and not because their mental health needs had changed.

This is despite national guidance that states that the point of transition should not be based on a rigid age threshold and evidence that more flexible, developmentally appropriate and needs-led transitions have more positive patient outcomes.

Providers told the investigation that inpatient children and young people’s mental health services were “stretched” meaning that patients needed to be transitioned to adult services at age 18 to “prevent bed blocking” and “maintain flow”.

However, the investigation also found that many people who reach the age of 18 in an inpatient mental health setting do not meet the criteria for ongoing inpatient care as an adult.

In these cases, patients were discharged into a setting that frequently did not meet their care needs, such as supported living.

The investigation found examples of young people discharged from inpatient children and young people’s mental health services to bed and breakfast hostels and to caravans on holiday sites.

Although community mental health support was put in place, families and carers described these situations as falling “far below what was suitable to meet young people’s ongoing mental health care needs”.

In many cases this led to poor outcomes, including instances of suicide, the investigation found.

The investigation found that young people discharged from inpatient children and young people’s mental health services had to navigate many services across “a complex system” with separate legislation, funding lines, responsibilities and agendas.

It found that support was made available to patients discharged from inpatient children and young people’s mental health services if they fell into certain categories.

These included patients who had been detained under sections of the Mental Health Act, those who had been a “child in care” and those with a learning disability, autism or special educational needs.

Patients discharged from inpatient children and young people’s mental health services who did not fall into these categories could be discharged without appropriate support for their ongoing needs, in some case leaving them homeless.

The report recommended “closer cooperation” between local government, education and health systems for the safe and effective transition of young patients into adulthood.

It also recommended better aligned thresholds and criteria for access to care between children and young people’s mental health services and adult mental health services, to ensure more seamless care pathways from childhood to adulthood.

Senior safety investigator at the HSSIB, Craig Hadley, acknowledged that the delivery of mental health care was complex and that services were routinely experiencing high demand.

But he added that an inconsistent approach to transitions, compounded by a lack of integration between health, social care and education, was putting the “safety and wellbeing of vulnerable young people at risk”.

"Trust leaders and their teams will welcome calls for more joined up thinking"

Saffron Cordery

“Evidence shows that a more flexible approach to transition is much safer and more therapeutic for young people,” he said.

“There are examples of organisations taking this type of approach, but they are not underpinned by a system that supports this overall.

"We heard from providers and commissioners that to achieve flexibility they were pushing the boundaries of how inpatient care had been delivered in the past."

He added: “The move from inpatient children and young people’s services to adult services currently happens at an already challenging time of life for young people and it should not be made harder for them, and their families.”

Interim chief executive of NHS Providers, Saffron Cordery, responded to the report.

She said: “This report confirms there is much more to do to bridge the gap in supporting children and young people as they make the transition from inpatient children and young people’s mental health services to accessing adult mental health services.

“Against a mismatch of soaring and often more complex demand for mental health services and hugely stretched capacity, trust leaders and their teams will welcome calls for more joined up thinking across education, health, and social care to ensure children and young people can transition into adulthood safely and effectively.

“They will also back calls for mental health services to be better designed and commissioned to help children and young people as they move to adult services and for this to be supported by adequate funding.”

She said investment was also needed in wider public services to prevent young people becoming mentally unwell in the first place.