NIHR CLAHRC for Cambridgeshire & Peterborough Innovation by Design Collaborations for Leadership in Applied Health Research and Care Background The economic cost of mental health is high The total cost of mental illness in England is estimated to be 77.4 billion 1 and is comprised of: Human Costs (41.8 billion) Health and social care (12.3billion) & Output losses (23.1 billion) Mental health problems are ubiquitous & burdensome 10% of children (5-16 years) are diagnosed with a mental disorder 2 Five out of 10 of the leading causes of disability adjusted life years are mental disorders 3 Adolescence is a critical period of vulnerability Half of all lifetime mental disorders begin in the middle teenage years and three quarters by the mid twenties 4 Transitioning from services can be problematic A poor transition from Child & adolescent mental health services (CAMHS) to adult mental health services (AMHS) can lead to discontinuity of care, disengagement from services and poor clinical outcomes 5 Mental health problems for young people leaving social care may double in the first year 6 The current situation There is a dearth of information on the characteristics and pathways that young people follow when leaving CAMHS and social care. Relatively little is known about who makes successful transitions and what the crucial influencing factors are. Research into the mental health and service use of adolescence is timely given current political discussion re-evaluating the form of mental health services (e.g. New Horizons). Aim We aim to describe the mental health and service use of adolescents going through two different transitions; one from CAMHS, the other from social care. We will carry out both cross-sectional & longitudinal studies, which are needed in CAMHS and social care 7. Study Designs An exploratory cross sectional study is underway that will gather information on current and lifetime mental health and service use for the two groups of adolescents on the cusp of a transition. This study will be used to test for important predicting factors and inform our subsequent longitudinal studies. Figure 1 shows the possible pathways post-transition for the CAMHS population. Figure 2 shows the design for one of the longitudinal models (a cross-lagged panel model) where we will test the progression of mental well-being for children leaving care over a 6 month period during both transitional processes under investigation. As an example interpretation of the paths in such an analysis, the dashed line in figure 2 from T2 service use to T3 well-being would provide information as to whether service use at time 2 predicts mental well-being at time 3, controlling for prior mental well-being. We will be able to tell whether higher levels of service use at T2 are related to higher or lower mental well-being at T3. Figure 1 T1 well-beingT2 well-beingT3 well-beingT4 well-being T1 service useT2 service useT3 service useT4 service use Figure 2 References 1 SCMH (2003). Economic and social costs of mental health in England. London: The Sainsbury Centre for Mental Health and Kings Fund (available from2 Green H., McGinnity ., Meltzer H., Ford T. & Goodman R. (2004). Mental health of children and young people in Great Britain. Palgrave Macmillan. 3 Patel V., Flisher A., Hetrick S. & McGorry P. (2007). Mental health of young people: a global public-health challenge. The Lancet;369(9569): Kessler R.C., Amminger G.P., Aguilar-Gaxiola S., Alonso J., Lee S. & Ustun T.B. (2007). Age of onset of mental disorders: a review of recent literature. Current Opinion in Psychiatry, 20: Singh, S.P. (2009). Transition of care from child to adult mental health services: the great divide. Current Opinion in Psychiatry, 22(4): p Dixon J. (2008). Young people leaving care: health, well-being and outcomes. Child & Family Social Work, (2): p Akister J., Owens M. & Goodyer I.M. (in press). Leaving care and mental health: outcomes for children in out-of-home care during the transition to adulthood. Health Research Policy and Systems. For further information please contact Matthew Owens at the Department of Psychiatry, University of Cambridge The Transfer of Care Project Child & Adolescent Theme P.I. Professor Ian Goodyer