Young People & Transitions

Coherent services for adolescents and young adults with severe psychological disturbances

Young people with severe and co-morbid presentations may require a range of interventions over an extended period and therefore can use a significant amount of resources within both CAMHS and adult services post-18.  There is a group of adolescents and young adults with severe psychological, emotional and behavioural disturbances who have traits consistent with aspects of adult axis II psychiatric diagnoses such as borderline personality disorder. 

Young people who experience a problematic personality development trajectory place an undue burden on health, social care, education and justice services.  Their presentation is high risk both in terms of the risk of harm suffered by these individuals, and also the difficulties and risks that manifest through their often dysfunctional social relationships with others. 

These young people are likely to have a range of co-morbid problems such as:

• Self Harm
• Suicidal thoughts and behaviours
• Depression and mood disorders
• Eating Disorders
• Alcohol and substance misuse
• Effects of trauma and abuse
• Relationship problems and social dysfunction
• Forensic presentations
• Breakdown of everyday functioning
• Transient psychotic states
• Extensive use of health and social services

It is accepted that outcomes for young people with problematic personality development trajectories are poor and their care pathways ill defined, with long term or repeated detention in either mental health or forensic settings representing common endpoints.

Currently, there is limited availability of intensive time-defined interventions that can improve long-term outcomes and prevent a worsening of the condition that may in turn result in expensive use of out-of-district placements, secure settings, repeat in-patient stays, acute episodes and contact with criminal justice. A proposed manualised brief adolescent psychodynamic therapy at step three of IAPT might help with some of these young people. Moreover, there remain significant concerns at a policy level regarding the adequacy of transitions from CAMHS to AMHS, and hence a coherent treatment model specifically delivered for adolescents is timely. A model including the importance of continuity of staff and thinking, which includes the importance of reciprocal emotional relationships in healthy development and good mental health has a lot to offer here.

The move between child and adolescent to adult services is a gap many adolescents fall through.  We aim to work with child and adolescent, as well as adult services, in thinking about the complications of transitions and the specific needs of adolescents.

For further information about NSCAP's work in this area please contact our Young People Lead, Jason Kaushal.