New models of care in general practice for the youth mental health transition boundary

Abstract

Setting the scene Mental illness represents the highest proportion of disease burden for children and young people in the UK.1 However, despite this, young people can struggle to access timely and appropriate mental health care. One particular barrier to continuity of care occurs when young people reach the upper age limit (usually 18 years) of child and adolescent mental health services (CAMHS). If they require ongoing specialist support, their care should be transferred to an adult mental health service (AMHS), through a purposeful and planned transfer of care known as ‘transition'. However, only around a quarter of young people transition to AMHS,2 and in the absence of specialist adult mental health care, GPs often become involved in the young person's care ‘by default'.3Although GPs become responsible for the young person's care after they leave CAMHS, they may not have the necessary skills and resources to manage complex mental health difficulties in young people. The role of the GP in transition The National Institute for Health and Care Excellence (NICE) transition guidance calls for a named GP to be part of the transition process, emphasising the role GPs can have in continuity of care.4 The guidance states that the person acting as the ‘named worker' (who is responsible for coordinating transition for the young person) should proactively engage GPs in transition planning, allowing GPs to be involved in the young person's mental health care at this crucial stage. At present, however, there is no known evidence to suggest that GPs are regularly involved in transition planning. This may be due to differing organisational cultures which prevent collaborative working; something which has been identified as a barrier to continuity of care between CAMHS and AMHS.5 Therefore, instead of a planned transfer of care, GPs become involved ‘by default' and become responsible for both monitoring and prescribing medication to young people once they are discharged from CAMHS, in some cases without specialist support.3 This can result in young people being unable to continue their medication after leaving CAMHS, or feeling as though their need for continued medication had not been sufficiently reviewed.6 If the transition to AMHS were to be properly planned, GPs would be well placed to provide ongoing care for young people when they are discharged from specialist mental health services, as they may have longstanding relationships with young people and their families.7 This relational continuity has been shown to help engagement for patients discharged from an early intervention in psychosis service.7 Patients valued the ability to access local primary care services, especially when they had a trusting relationship with their GP.7