Skip to main content

06.03.2019 | Original Paper Open Access

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

Social Psychiatry and Psychiatric Epidemiology
Gerard Leavey, Sheena McGrellis, Trisha Forbes, Annette Thampi, Gavin Davidson, Michael Rosato, Brendan Bunting, Natalie Divin, Lynette Hughes, Alicia Toal, Moli Paul, Swaran P. Singh



Poor 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.


A 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.


We 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.


Despite 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.

Unsere Produktempfehlungen

Neuer Inhalt


e.Med Interdisziplinär


Mit e.Med Interdisziplinär erhalten Sie Zugang zu allen CME-Fortbildungen und Fachzeitschriften auf Zusätzlich können Sie eine Zeitschrift Ihrer Wahl in gedruckter Form beziehen – ohne Aufpreis.

e.Med Neurologie & Psychiatrie


Mit e.Med Neurologie & Psychiatrie erhalten Sie Zugang zu CME-Fortbildungen der Fachgebiete, den Premium-Inhalten der dazugehörigen Fachzeitschriften, inklusive einer gedruckten Zeitschrift Ihrer Wahl.

Weitere Produktempfehlungen anzeigen
Über diesen Artikel

Neu im Fachgebiet Psychiatrie

Meistgelesene Bücher aus dem Fachgebiet

2017 | Buch

Pocket Guide Psychopharmaka von A bis Z

Im Pocket Guide finden Sie von A bis Z schnell und übersichtlich die "Erste-Hilfe"-Information rund um alle Psychopharmaka, die Sie auf Station und im Praxisalltag brauchen. Das Pocket-Buch passt bestens in die Kitteltasche. Auf eine ausführliche Darstellung der Störungen wurde bewusst verzichtet.

Prof. Dr. med. Otto Benkert, Prof. Dr. med. I.-G. Anghelescu, Prof. Dr. med. G. Gründer, Prof. Dr. med. P. Heiser, Prof. Dr. rer. Nat. C. Hiemke, Prof. Dr. med. H. Himmerich, Prof. Dr. med. F. Kiefer, Prof. Dr. med. C. Lange-Asschenfeldt, Prof. Dr. med., Dr. rer. nat., Dipl.-Psych. M.J. Müller, Dr. med., Dipl.-Kfm. M. Paulzen, Dr. med. F. Regen, Prof. Dr. med. A. Steiger, Prof. Dr. med. F. Weber

2016 | Buch

Klinikmanual Psychiatrie, Psychosomatik und Psychotherapie

Dieses Kitteltaschenbuch enthält übersichtlich und systematisch alle notwendigen Informationen zum schnellen Nachschlagen auf Station, in der Ambulanz oder im Konsildienst: Klare Handlungsanweisungen, Therapieempfehlungen und die notwendigen rechtlichen Hintergründe.

Prof. Dr. Dr. Frank Schneider

Mail Icon II Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Psychiatrie und bleiben Sie gut informiert – ganz bequem per eMail.