According to the National Alliance on Mental Illness (NAMI), the onset of mental illness started by age 14 for 50 percent of presented cases. In other words, many children who are in need and receive mental health services now will continue to need or desire to engage in mental health services as adults. Therefore, a positive transition from child to adult mental health services is crucial to maintain continuity and quality of care. However, those aged 18 to 21 years old discontinue their services at higher rates than other age groups (Broad, Sandhu, Sunderji, & Charach, 2017). Understanding the transition process and how youth experience this transition can help support and minimize risk of disengagement during this vulnerable time.
Researchers have looked at reasons youth discontinue treatment when transitioning from child to adult services. To begin, youth are expected to transition to adult services between 18 and 21 years old, depending on the service and organization (Broad, Sandhu, Sunderji, & Charach, 2017). Aside from this major transition, youth undergo many others including graduation from school, moving out on their own, and joining the workforce. Therefore, this is an overwhelming time with the perception that their support system is decreasing (Broad, Sandhu, Sunderji, & Charach, 2017). In children services, there is usually an emphasis on the family unit and family involvement, but this is drastically different for youth once they transitioned to adult services, which can perpetuate the concern of dwindling supports (Broad, Sandhu, Sunderji, & Charach, 2017). Therefore, youth strive to create a balance between their independence and continued support. However, many youth struggle with the independence, because they feel that they do not have the necessary information to suddenly manage their healthcare (Broad, Sandhu, Sunderji, & Charach, 2017). Moreover, there can be little consideration for the perceived loss of an important relationship for youth and the associated fear or concern of having to start over with someone unfamiliar and/or again having less support (Broad, Sandhu, Sunderji, & Charach, 2017).
Suggestions to keep in mind:
Be informed and educate youth: It is important for caregivers and youth to know about and understand the process of transitioning from child services to adult services. With more knowledge youth and their support systems have a better opportunity to plan for a smoother transition and continue care.
Build skills: As mentioned, youth often do not learn about steps and skills needed to manage their physical and mental health care, and is, therefore, a barrier for them to continue care as a young adult. Ultimately, introducing youth to skills necessary to manage their physical and mental health care needs before this transition can be a protective factor and minimize healthcare related stressors in the future.
Create a plan: Youth, their caregivers, and other members of their treatment teams should create a plan to help youth prepare for transition. This could include knowing at what age youth will age out of their current services and/or organizations, what adult services are available, and what, if any, changes will occur regarding insurance. Once a timeframe is established, youth and their treatment team and can accordingly research and plan what and where services will be transferred. Of note, it is suggested to not wait until last minute.
Include youth in the transition process: Considering the amount of young adults that disengage from treatment during the transitional period, it is important to include them in this process. Youth are relied on to suddenly take care of their own health but are often not included in the planning, if any occurred. Incorporating youth in this process allows for their voice to be heard, which also encourages self-advocacy, as well as can prevent barriers to youth engaging in adult services in the future.
Author: Melanie Levitt, M.A.
Broad, K.L., Sandhu, V. K., Sunderji, N., & Charach, A. (2017). Youth experiences of transition from child mental health services to adult mental health services: a qualitative thematic synthesis. Biomed Central Psychiatry, 17(380).
Singh, S.P. & Tuomainen, H. (2015). Transition from child to adult mental health services: needs, barriers, experiences and new models of care. World Psychiatry, 14(3), 358-361.