abstract: 'BackgroundPoor transitions to adult care from child and adolescent

  mental health services may increase the risk of disengagement and

  long-term negative outcomes. However, studies of transitions in mental

  health care are commonly difficult to administer and little is known

  about the determinants of successful transition. The persistence of

  health inequalities related to access, care, and outcome is now well

  accepted including the inverse care law which suggests that those most

  in need of services may be the least likely to obtain them. We sought to

  examine the pathways and determinants of transition, including the role

  of social class.MethodA retrospective systematic examination of

  electronic records and case notes of young people eligible to transition

  to adult care over a 4-year period across five Health and Social Care

  NHS Trusts in Northern Ireland.ResultsWe identified 373 service users

  eligible for transition. While a high proportion of eligible patients

  made the transition to adult services, very few received an optimal

  transition process and many dropped out of services or subsequently

  disengaged. Clinical factors, rather than social class, appear to be

  more influential in the transition pathway. However, those not in

  employment, education or training (NEET) were more likely (OR 3.04: 95\%

  CI 1.34, 6.91) to have been referred to Adult Mental Health Services

  (AMHS), as were those with a risk assessment or diagnosis (OR 4.89:

  2.45, 9.80 and OR 3.36: 1.78, 6.34), respectively.ConclusionsDespite the

  importance of a smoother transition to adult services, surprisingly, few

  patients experience this. There is a need for stronger standardised

  policies and guidelines to ensure optimal transitional care to AMHS. The

  barriers between different arms of psychiatry appear to persist. Joint

  working and shared arrangements between child and adolescent and adult

  mental health services should be fostered.'
affiliation: 'Leavey, G (Corresponding Author), Ulster Univ, Bamford Ctr Mental Hlth
  \& Wellbeing, Cromore Rd, Coleraine, Londonderry, North Ireland.

  Leavey, Gerard; McGrellis, Sheena; Forbes, Trisha; Rosato, Michael; Bunting, Brendan;
  Divin, Natalie; Hughes, Lynette, Ulster Univ, Bamford Ctr Mental Hlth \& Wellbeing,
  Cromore Rd, Coleraine, Londonderry, North Ireland.

  Thampi, Annette, Belfast Hlth \& Social Care Trust, Belfast, Antrim, North Ireland.

  Davidson, Gavin, Queens Univ Belfast, Belfast, Antrim, North Ireland.

  Toal, Alicia, Voices Young People Care, Belfast, Antrim, North Ireland.

  Paul, Moli; Singh, Swaran P., Univ Warwick, Coventry, W Midlands, England.'
author: Leavey, Gerard and McGrellis, Sheena and Forbes, Trisha and Thampi, Annette
  and Davidson, Gavin and Rosato, Michael and Bunting, Brendan and Divin, Natalie
  and Hughes, Lynette and Toal, Alicia and Paul, Moli and Singh, Swaran P.
author-email: g.leavey@ulster.ac.uk
author_list:
- family: Leavey
  given: Gerard
- family: McGrellis
  given: Sheena
- family: Forbes
  given: Trisha
- family: Thampi
  given: Annette
- family: Davidson
  given: Gavin
- family: Rosato
  given: Michael
- family: Bunting
  given: Brendan
- family: Divin
  given: Natalie
- family: Hughes
  given: Lynette
- family: Toal
  given: Alicia
- family: Paul
  given: Moli
- family: Singh
  given: Swaran P.
da: '2023-09-28'
doi: 10.1007/s00127-019-01684-z
eissn: 1433-9285
files: []
issn: 0933-7954
journal: SOCIAL PSYCHIATRY AND PSYCHIATRIC EPIDEMIOLOGY
keywords: 'Child and adolescent; Mental health; Inequalities; Service provision;

  Transition'
keywords-plus: CHILD; INEQUALITIES; GAP
language: English
month: AUG
number: '8'
number-of-cited-references: '25'
orcid-numbers: 'Leavey, Gerard/0000-0001-8411-8919

  Davidson, Gavin/0000-0001-6003-0170

  Forbes, Trisha/0000-0003-2047-2956'
pages: 955-963
papis_id: 061540f432e1f4aa9eccacecdce455d3
ref: Leavey2019improvingmental
researcherid-numbers: 'Leavey, Gerard/AAU-2912-2020

  Forbes, Trisha/ISB-5690-2023

  '
tags:
- review
times-cited: '14'
title: 'Improving mental health pathways and care for adolescents in transition to
  adult services (IMPACT): a retrospective case note review of social and clinical
  determinants of transition'
type: article
unique-id: WOS:000478101400008
usage-count-last-180-days: '3'
usage-count-since-2013: '12'
volume: '54'
web-of-science-categories: Psychiatry
year: '2019'