Having spent time on a mental health ward for a seven-week placement I had an insight into what inpatient care was like for our young people. There was 24-hour care, staff wherever and whenever they needed, bright colourful walls, freshly made meals from ingredients they bought the same day, games, TV’s and all the comfort and safety that young people need. It was apparent to me that this ward is a nice ward, a ward where many children feel safe for the first time. However, it quickly dawned on me as one young person was reaching her discharge date that she would be leaving and transitioning into adult services, a service that is very different and an adjustment young people may not feel comfortable with.

What is this transition and process like for these young people? How can we support their transition and prepare them for this change?

Faye Wake, one of the second year Mental Health Nurses can offer more insight into this, she reflects on a recent shift she has had with a young person transitioning to adult services.

“It is a hectic assessment day at the working age adult’s community mental health and recovery service (CMHRS). Two days a week professionals allocate their time to carry out initial assessments on people who are referred from GP services and occasionally Child and Adolescent Mental Health Services (CAMHS).

I start my day being greeted with a referral, which states about why the individual is referred, why they need your help and what they are hoping for. Some of these individuals are at risk of harm to themselves, at risk to others or from others. The young person I was going to assess today was an 18-year-old who has been under the care of CAMHS since they were four years old. They have a diagnosis of Autism (ASD), Depression, Eating Disorder Not Otherwise Specified (EDNOS) and Generalised Anxiety Disorder (GAD).

For a young adult with mental health needs, revisiting these experiences again after being involved with services for years can be traumatic. The pressure these assessments have on young people can make them focus on the negatives in their life, rather than the recovery that has been significant so far or what has previously worked for them.

These initial assessments can last between an 1-2 hours long and within this time you write an in-depth analysis of their personal history, their mental health history, family psychiatric history, pretty much their whole life in 2 hours. They are sat in a small room with one or two professionals who they are unfamiliar with. We must make decisions to determine someone’s risk level at present and in the past. These decisions to discharge or allocate can be lifechanging for individuals. Ultimately, I am a part of this decision and when someone does not meet the adult threshold for allocation but are desperate for help, I feel like I am declining them by offering recommendations which sometimes have waiting lists. This is what we had to do for this 18-year-old as they met the threshold for CAMHS in the past, but not for CMHRS.

This is all happening because of the underfunding of mental health services. As a student, I know the right thing to do and the risks we are taking as a team, but I’m often finding myself in a moral dilemma as the threshold for adult mental health services is high. However, mental health services have great support from charities and non-profit organisations, I am not sure what we would do without them. They are a big part of our recommendations to individuals who are not allocated in mental health services.

1 in 4 people will experience mental health issues in their lifetime, my question is, when will we see the resources available to support a society where mental health problems are more prevalent than ever before? Will we see staffing levels rise to accommodate the demand and need for services? I love being a student mental health nurse, it has its pros and cons but seeing individuals have stability and recovery in life makes it worthwhile for me. Nursing is a hard profession and to me, it is not for the faint hearted nor the empty of heart.”

Advice for how to prepare young people for transition:

• Ensure a transition of care is in place by contacting adult mental health teams and not just discharging from CAMHS

• Do not promise the patient that they will get the same level of care from adult services, the threshold is different, they may need another assessment of their needs, reassure the patient and their parent/Carers by explaining that you can advocate for them

• Be honest and say sometimes there may be a little wait for psychological interventions and appointments, offer organisations that can support such as crisis lines and using safe havens if the young person is ever in a crisis during transition

• Continue to monitor the patients mood/ risk during transition as this can be a very uncertain time for some young people

Author: Tia Dolphin, Year 3 Student and Faye Wake, Year 2 MH Student

Disclaimer: This blog contains personal opinions of students only and does not necessarily represent the views of the Children’s Nursing team, School of Health Sciences or the University of Surrey.

If you’re interested in writing a blog post for us – whether it’s a one-off about something in Nursing you’re passionate on, or as a regular contributor, please email Tia Dolphin (td00227@surrey.ac.uk) or Chloe Thomas (ct00633@surrey.ac.uk) – we’d love to hear from you!