Cinderella finally felt like she was growing into her glass slippers. She had found her diagnosis, a psychiatrist who ‘got’ her and she was awaiting therapy. The beautiful recovery she dreamed of was on the horizon.
The clock stuck twelve and before cinderella knew it she was different. She didn’t look it and she didn’t feel it, but according to everyone else she was. Cinderella had turned 18 years old and now legally an adult she was told to battle her illness alone. Her mental health team disappeared overnight- replaced with a harsher adult services team. They couldn’t see Cinders as regularly and had even longer waiting lists for therapy than CAMHS did. Things that she was encouraged to do in CAMHS she got angry letters about from adult services. Suddenly Cinderella was lost. She was just as ill as before the clock struck 12- she had the same symptoms and felt the same- but suddenly she had no help. She had to get a grip but she was slipping. She was now on her own.
This is the story that many young people find themselves protagonist to when they turn 18 within children’s mental health services. The handover to adult services can be baffling, abrupt and overall more harmful than helpful. As it is Children’s Mental Health Week I wanted to talk about this issue as not everyone has the happily ever after of walking away from CAMHS and never looking back. For those left in the system the transfer can make them feel lost and abandoned.
There is a growing campaign for an 18-25s transitional period between the two services. What a dedicated service in this area could achieve would be phenomenal. Young people could have their appointments grow slowly further apart to avoid sudden changes and subsequent feelings of abandonment. The responsibility in care could shift slowly to the young person when they are post-18. This transition stage could also be really valuable for learning necessary skills for adult life in a way that is conducive to mental wellbeing as a whole. In the transition young people could move care team one practitioner at a time- first key worker, then psychiatrist and therapists so that the process is gradual. A more in depth series of Care Plan Approach meetings could take place with both adults and children’s services to discuss what the young person found useful in CAMHS and how that can be carried over for the future. Medication could be altered during the transition by both psychiatrists. Particularly if a young person has been with CAMHS for quite some time the psychiatrist-patient relationship is infinitely valuable. Young people with mental health problems don’t all send out the same red flares therefore longstanding professionals who can smell the smoke make all the difference. Changes to medication should be made subtly and with respect to the young person and the lifestyle they need to uphold whilst dealing with possible side affects. Being 18 is stressful enough with exams and uni approaching and all the responsibilities that becoming an adult brings. It seems counterproductive and cruel to change an 18 year old’s care so dramatically at such a challenging age.
When I moved from Children’s to Adult care I found the difference in practice frightening and it led me to wanting to discharge myself from the service altogether. I was told that I was the only person that could make myself better and all carers were instructed to blank out my symptoms until I pulled myself together. Not only is this upsetting but it is dangerous. The work CAMHS had done to slowly build my trust in professionals was gone within a few dreadful meetings with the Community Mental Health Team. Young people turn 18 and drop out of the system, not because the system has cured them but because it has broken them too badly. This is not good enough.
Cinderella could have gone to A&E six hours before she became an adult with self injury and depression. As a seventeen year old she would likely have been admitted. Six hours after turning eighteen she would be sent home. Do we really believe that a magical chemistry takes place on an eighteenth birthday- rendering a child able to take on all their struggles alone? I don’t think so. It’s important that there is a true transitional phase so that this problem doesn’t occur in 25 year olds instead. It’s not that young people are not responsible- it’s that the difference in practice is so dramatic there is a canyon between the two providers.