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 or feel it, but everyone else said 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 harsher adult services who expected a lot of her. 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, like reach out for help when she needed it, she got angry letters about from adult services. Suddenly Cinderella was lost. She was just as ill as when 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 a protagonist in 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.
When I moved from Children’s to Adult care I found the difference in practice frightening and it led me to want to discharge myself from services altogether, despite the risks. I was told that I was the only person that could make myself better and the strategy from the adult team appeared to be that I should be ignored until I presumably got bored of being mentally ill and found a less destructive hobby. Not only was this deeply upsetting, but it was dangerous and ultimately made me worse. Within a few dreadful meetings with the Community Mental Health Team all the coaxing my CAMHS team had done to make me choose recovery was obliterated. In fact hope in general was obliterated. Talking to other young women who I shared time with at the CAMHS unit, many when they turned 18, voluntarily or involuntarily, dropped out of the system. Not because the system had cured them but because it had broken them too badly to continue. This is not good enough.
There is a growing campaign for an 18-25s transitional period between adult and CAMHS 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. The responsibility in care could shift slowly to the young person when they are post-18. This transition stage could 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 into their future care. 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. It seems counterproductive and cruel to change an 18 year old’s care so dramatically at such a challenging age.
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 and she would be sent home and told to deal with it herself. Do services truly believe that a magical spell occurs at the strike of midnight when a child turns 18? That they will suddenly have a zen-like wisdom about them and gain all the effective coping skills they have severely lacked? There needs to be a bridge over the canyon between services.