A study into young people who have fallen through the mental health transition gap after reaching the upper boundary of CAMHS has found ‘GPs can provide good continuity of care,’ but there is ‘a need for comprehensive handover care from CAMHS.’
The study, published in the BJGP and called Young People who have Fallen through the Mental Health Transition Gap: a Qualitative Study on Primary Care Support, was supported by the National Institute for Health Research and focused on 15 young people aged 17 to 21 – and their parents – belonging to eight different NHS Mental Health Trusts and having diagnoses including anxiety, personality disorder or depression.
Three themes were identified – unmet mental health needs, disjointed care, and taking responsibility for the young person’s mental health care.
It found that there needed to be a more managed transition of care for young people, if they are to be transferred to their GP after leaving CAMHS.
This could include a ‘full handover’ of the young person’s notes by CAMHS, including any required actions by the GP and ‘potentially a pre-arranged GP appointment’ to ensure that the young person gets the care they need.
The report said: ‘The scarcity of available services, high eligibility thresholds, and long waiting lists contribute to difficulties in referring young people to AMHS.
‘Young people are often discharged to their GP when they reach the upper boundary of CAMHS.
‘GPs can provide good continuity of care, as they often make the initial CAMHS referral and can have long-term relationships with young people and their families.’
However, the report said: ‘The process is far from being standardised, with GPs reporting the absence of a handover and little communication from mental health services.’
The study is, to the authors’ knowledge, the first to explore the experiences of young people and their parents who accessed mental health support from primary care after falling through the gap post-CAMHS.
Continuity of care
The authors added: ‘Young people’s positive experiences were more likely to include having a long-term relationship with their GP and finding that their GP made time to understand their needs and experiences.’
The study pointed to ‘disjointed services’ leading to ‘poor continuity of care for young people,’ in some cases.
For example, when the young people did not meet the threshold for continued care at AMHS, CAMHS often discharged them to their GP for the GP to make a referral elsewhere.
‘This process was not always managed well,’ the authors said, ‘and creates another step in the care pathway and, in some cases, lengthy delays.’
It identified ‘barriers also included the perception that GPs couldn’t prescribe certain medication, anxiety caused by the general practice environment, and having to move to a new practice at university.’
The transition study concluded: ‘There needs to be improved communication between GPs and specialist care,’ and ‘GPs should be aware of the challenges and needs of this population group and attempt to be proactive and make time to assess young people’s mental health needs if they take responsibility of care. This could be facilitated through further training for GPs to increase their knowledge of the mental health needs of transition-aged young people.’
The study also called for more research into ‘interventions which improve continuity of care for young people after leaving CAMHS, and collaborative working across community mental health services.’
GPs providing care beyond their competence
It comes after a separate survey of over 500 GPs found that two thirds felt NHS pressures meant they were having to provide specialist mental health support beyond their competence.
Management in Practice’s sister title Pulse asked GPs about the impact of the Covid-19 pandemic on mental health services.
The types of support GPs said they had to provide included:
- Dealing with suicidal ideation in adults (86%).
- Dealing with mental health crises in adult patients (81%).
- Monitoring patients who should be monitored by a specialist team (70%).
- Diagnosing children and adolescents with mental health issues (69%).
- Dealing with suicidal ideation in children (66%).
Dr Paul Evans, Gateshead and South Tyneside LMC chair, told Pulse his practice was currently managing six or seven patients with eating disorders while they wait for specialist input.
He said: ‘We are an area that has an incredibly limited eating disorder anyway and while we have not seen any change in that service… in the pandemic, we have seen people with eating disorders deteriorate in terms of their symptoms and eating behaviours.’
According to Dr Evans, there have been ‘absolutely loads’ of situations over the last two years where secondary mental health services have tried to pass work over to GPs.
Another respondent commented on the Pulse survey that: ‘CAMHS reject every single referral, even in children presenting to hospital with overdose.’
Earlier this year, NHS England said it would begin work on an ‘implementation plan’ for new mental health waiting time standards, which include a 24-hour target for urgent mental health care.
