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Discharge from Children’s Services: Experiences and Predictors of Mental Health Outcomes
Young people (YP) with mental health problems can get ‘lost’ following discharge from child and adolescent mental health services. Adult services may have different referral criteria or there may not be an appropriate service for young people to be referred to. This disruption of care may especially adversely affect the health, wellbeing and longer-term outcomes of YP on the autism spectrum. Mental healthcare transition occurs at approximately the same time as other developmentally appropriate transitions such as leaving school, moving to further education or employment, or seeking some degree of independence. For YP with ASD these transitions may be further complicated with a lack of support and post-education options.
Objectives:
The overall aim of this study was to describe the lived experience and outcomes for YP with ASD and an additional mental health problem leaving child and adolescent mental health services (CAMHS) and how this relates to their mental health and wellbeing.
Methods:
Participants were YP aged 14-18 years, with a diagnosis of ASD without additional intellectual impairment who were accessing CAMHS, from a 3-year longitudinal study. YP completed measures on their mental health (Hospital Anxiety and Depression Scale; HADS), wellbeing (Warwick and Edinburgh Mental Wellbeing Scale), and frequency of social participation. Additional qualitative contextual (clinical, family, social and education) information about the YP and their families was recorded by the research assistant. Qualitative and quantitative data were used to identify mental health outcomes and potential predictors of transfer locations (general practitioner or adult mental health services). Framework analysis was used to identify themes in the YP’s lived experiences over the course of the longitudinal study.
Results:
In total, 118 YP with ASD and additional mental health problems completed baseline measures (mean age= 16.1 yrs). 88 (74.6%) YP completed a final visit (either 3 or all four visits). By the final visit, 60 YP were in full time education, 5 YP were in full time employment, 1 in part time, 3 doing volunteer work, 3 in vocational training, 6 were looking for work, and 7 were unemployed and not looking for work (3 missing data). Only 24 YP (27.3%) transferred to adult mental health services, 44 (50%) were under general practitioner care and 20 (22.7%) remained in children’s mental health services. Predictors of transfer location will be reported.
Wellbeing was consistently below general population norms and the proportion of YP with an ‘abnormal’ HADS score on the ‘anxiety’ and ‘depression’ domains remained the same over the 4 visits. The qualitative themes allowed us to understand in more detail the YP lived experiences of transition and identify variables associated with ongoing problems or with positive outcomes.
Conclusions:
This study has identified the health and social factors that are relevant for young people with ASD as they are discharged from children’s services. For some young people adulthood is a new beginning. For others ongoing mental health difficulties, social needs and lack of access to adult services remain key risk factors for outcome in adulthood.