Transcript Slide 1

NIHR CLAHRC for
Cambridgeshire & Peterborough
Innovation by Design
Child & Adolescent Theme
P.I. Professor Ian Goodyer
The Transfer of Care Project
Background
Study Designs
The economic cost of mental health is high
An exploratory cross sectional study is underway that will gather information on
current and lifetime mental health and service use for the two groups of
adolescents on the cusp of a transition. This study will be used to test for
important predicting factors and inform our subsequent longitudinal studies.
Figure 1 shows the possible pathways post-transition for the CAMHS population.
• The total cost of mental illness in England is estimated to
be £77.4 billion1 and is comprised of:
• Human Costs (£41.8 billion) Health and social care
(£12.3billion) & Output losses (£23.1 billion)
Mental health problems are ubiquitous &
burdensome
CAMHS
•10% of children (5-16 years) are diagnosed with a mental
disorder2
•Five out of 10 of the leading causes of disability adjusted
life years are mental disorders3
Adolescence is a critical period of
vulnerability
Transitioning from services can be
problematic
referred to AMHS
mental health
service use?
•Half of all lifetime mental disorders begin in the middle
teenage years and three quarters by the mid twenties 4
not referred to
AMHS
other
service use?
mental health
service use?
other
service use?
Figure 1
Figure 2 shows the design for one of the longitudinal models (a cross-lagged panel
model) where we will test the progression of mental well-being for children
leaving care over a 6 month period during both transitional processes under
investigation.
NIHR CLAHRC for
•A poor transition from Child & adolescent mental health
services (CAMHS) to adult mental health services (AMHS)
can lead to discontinuity of care, disengagement from
services and poor clinical outcomes5
•Mental health problems for young people leaving social
care may double in the first year6
T1 well-being
T2 well-being
T3 well-being
T4 well-being
T1 service use
T2 service use
T3 service use
T4 service use
The current situation
There is a dearth of information on the characteristics and
pathways that young people follow when leaving CAMHS
and social care. Relatively little is known about who makes
successful transitions and what the crucial influencing
factors are. Research into the mental health and service
use of adolescence is timely given current political
discussion re-evaluating the form of mental health
services (e.g. New Horizons).
Aim
We aim to describe the mental health and service use of
adolescents going through two different transitions; one
from CAMHS, the other from social care. We will carry out
both cross-sectional & longitudinal studies, which are
needed in CAMHS and social care7.
Figure 2
As an example interpretation of the paths in such an analysis, the dashed line in
figure 2 from T2 service use to T3 well-being would provide information as to
whether service use at time 2 predicts mental well-being at time 3, controlling for
prior mental well-being. We will be able to tell whether higher levels of service use
at T2 are related to higher or lower mental well-being at T3.
References
1 SCMH (2003). Economic and social costs of mental health in England. London: The Sainsbury Centre for Mental Health and King’s Fund (available from www.scmh.org.uk)
2Green H., McGinnity Á., Meltzer H., Ford T. & Goodman R. (2004). Mental health of children and young people in Great Britain. Palgrave Macmillan.
3Patel V., Flisher A., Hetrick S. & McGorry P. (2007). Mental health of young people: a global public-health challenge. The Lancet;369(9569):1302-13.
4 Kessler R.C., Amminger G.P., Aguilar-Gaxiola S., Alonso J., Lee S. & Ustun T.B. (2007). Age of onset of mental disorders: a review of recent literature. Current Opinion in Psychiatry , 20:359-364.
5Singh, S.P. (2009). Transition of care from child to adult mental health services: the great divide. Current Opinion in Psychiatry, 22(4): p. 386-90.
6 Dixon J. (2008). Young people leaving care: health, well-being and outcomes. Child & Family Social Work, 2008. 13(2): p. 207-217.
7Akister J., Owens M. & Goodyer I.M. (in press). Leaving care and mental health: outcomes for children in out-of-home care during the transition to adulthood. Health Research Policy and
Systems.
For further information please contact Matthew Owens at the Department of Psychiatry, University of Cambridge [email protected]
Collaborations for Leadership in Applied Health Research and Care