Transitions between child and adult mental health services: service design, philosophy and meaning at uncertain times

Accessible summary Failings in the transfer of care for young people requiring ongoing care within adult mental health services can have severe negative consequences. Adult and child services are often driven and designed in different ways. By looking at the way existing services are designed and the practices that drive them, this can then lead to the improvement of transitions of care. Consideration of the young person's needs and the relationships they have developed should be central to this process, with mental health nurses playing critical roles within this.Abstract A young person's transition of care from child and adolescent mental health services to adult mental health services can be an uncertain and distressing event that can have serious ramifications for their recovery. Recognition of this across many countries and recent UK media interest in the dangers of mental health services failing young people has led practitioners to question the existing processes. This paper reviews the current theories and research into potential failings of services and encourages exploration for a deeper understanding of when and how care should be managed in the transition process for young people. Mental health nurses can play a vital role in this process and, by adopting the assumptions of this paradigm, look at transition from this unique perspective. By reviewing the current ideas related to age boundaries, service thresholds, service philosophy and service design, it is argued that the importance of the therapeutic relationship, the understanding of the cultural context of the young person and the placing of the young person in a position of autonomy and control should be central to any decision and process of transfer between two mental health services.