Understanding Barriers in Personality Disorder Services During the Transition From CAMHS: A Service Evaluation

Around 25,000 young people (YP) transition to Adult Mental Health Services (AMHS) from Child and Adolescent Mental Health Services (CAMHS) annually in the United Kingdom. A small percentage experience all the key features of an effective transition-with suboptimal transitions potentially contributing to disengagement as YP approach or undergo the transition. Semistructured interviews were conducted with five YP, five CAMHS practitioners and seven AMHS practitioners working in the Personality Disorder Community Service (PDCS) to ascertain the barriers to engagement during the transition process. Transcripts were analysed using thematic analysis. Four themes were identified: Fragmented and Reactive Transitions, Relational Discontinuity, Systemic Rigidity and Alienation and Fragility of Autonomy. Findings indicated that unclear pathways, relational disruptions and mismatched expectations were key contributors to disengagement and negative perceptions of new services. No features of an optimum transition were being met consistently. Emotional dependency, lack of preparation and systemic rigidity further compounded difficulties for YP navigating the transition. CAMHS should prepare the YP prior to their referral and ensure that it is an informed decision. AMHS must clarify their service offer and provide accessible resources for CAMHS practitioners, YP and families to enable better management of expectations. Both services should collaborate throughout the transition, offer individualised plans and allow time for YP to adjust to the new service environment.