This was one of the key messages to emerge from a recent event in the European Parliament organised by GAMIAN-Europe and the European Brain Council. The debate on 21 November heard from several healthcare professionals and experts on the issues around what is known as the “transition of care.”
This is the process of planning, preparing and moving a patient with a mental health condition, from child to adult mental health services, a process seen as vitally important for those su¬ffering from a mental health condition or disorder.
Opening and moderating the event, Executive Director of the European Brain Council Frédéric Destrébecq, noted that it is widely recognised that the transition of care in mental health services can be problematic for patients and is an area requiring improvement.
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One of the event’s keynote speakers, Professor Swaran Singh, of the University of Warwick in the UK, said that studies had shown that “poor transition” can lead to “disengagement” from services.
While there was no single solution to the problem, he said that MILESTONE, an EU-funded project which aims to identify service gaps in current mental healthcare systems, was a step in the right direction.
He told the packed meeting, “Some of the assumptions about mental healthcare have been turned on their head in recent years.” It was important, he added, to make the distinction between child and adult mental health issues.
“Transitioning from one to the other can be very difficult whether it is a physical or mental disorder but what we now know is that it is hardest for people with mental health problems.”
He said the five-year MILESTONE project will conclude in January 2019 and seeks to develop a standardised, best practice model.
Dolores Gauci, of mental illness advocacy campaigners GAMIAN-Europe, said that it was important to bring together stakeholders to address important issues such as the transition of care from child to adult services.
Gauci said, “The transition from child to adult services is of great importance to us because it is about ensuring the best possible care for all who need it, irrespective of age or condition. The lack of a smooth transition into adult services leads to great risks, including lack of progress or stopping follow up, with all the negative consequences on the individual, their family and society as a whole.”
She added, “This holds true for all conditions be they physical or mental. Yet for physical illness, for example, cancer, cardiovascular disease or diabetes, transition and continuity of care is taken as a given. Yet within the mental health field it is another story. We strongly believe that what is accepted as best practice in physical health should apply also to mental health. Unfortunately, we are far from this reality.”
Gauci said that stigma is a “major barrier” to improving services and access to mental health services.
“Stigma is pervasive and people affected by such issues and their families encounter it every day. To address stigma effectively we need to develop and grow a mindset that looks at mental health as an integral part of health and for this to happen, better information and education is required across society, across governments and across all educational institutions,” she added.
“Immediate cooperation across the board and a more integrated approach towards mental health between the various medical professionals and services involved would be of great help.”
Professor Geert Dom, of the European Psychiatric Association, presented the findings of a group of experts, led by the European Brain Council and GAMIAN-Europe and developed with support from Shire.
Entitled, “Bridging the Gap: Optimising transition from child to adult mental healthcare”, the expert policy paper which discusses mental health and transition of care, is the outcome of a collaboration that was jointly initiated by Shire, GAMIAN-Europe and the European Brain Council.
Dom spoke of the risks associated with falling through the care gap during transition arguing that, “At present, there is a terrible gap between the transition from child to adult mental healthcare services and there needs to be greater awareness of this. I have seen lots of cases where children of 12 and 13 have good contact with mental healthcare services but by the time they reach 17 and 18, this contact falls away and they drop out.”
He added, “The problems associated with transition from child to adult services applies to all mental health disorders and so much more needs to be done to tackle this issue.”
Both the expert policy paper and the event focused in part on the mental health disorder, attention deficit hyperactivity disorder - ADHD - which is estimated to a¬ffect around 1 in 20 children and adolescents in Europe.
This neurodevelopmental disorder can a¬ffect people throughout their lives and may be under-recognised or misunderstood. The expert policy paper highlights that adolescents with ADHD who are transferring to adult services can experience patchy or inadequate support and struggle to access services.
European Brain Council president Professor David Nutt of Imperial College London, said, “As a clinician I have seen the huge problems that face young people with ADHD when moving into adulthood. This period is difficult enough anyway and made much harder if one has a psychiatric diagnosis. Today’s expert policy paper will help all involved in care of this disadvantaged group make the transition in a more stable and secure fashion.”
Andrea Bilbow, the president of ADHD-Europe, welcomed the findings.
The 27-page report provides an overall assessment of the problem, and suggests that adolescents have a greater tendency for “risky behaviour” and may become lost in the system between child and adult mental health services.
The expert policy paper recommends simple measures, such as ensuring awareness and improving the education of healthcare professionals, improving the management and planning of the transition process, and promoting long-term continuity of care after the transition has been made to adult services, to ensure that youngsters who may require continued care receive the support they need.
Czech MEP Tomas Zdechovsky, who hosted the event, said the meeting was “particularly timely and important”. “We need to encourage further open debate on mental health. Things need to change and this is one way of doing it.”
Nutt meanwhile argued that, “By establishing a cohesive infrastructure to support transition for people living with mental health conditions, we can e¬ffect real, measurable change for future generations, for example, by enabling people to more e¬ffectively engage in long-term employment, and by reducing overall long-term healthcare costs.”
He then called on “Stakeholders across Europe to support and implement the recommendations set out in this expert policy paper and to help establish a best practice transition pathway across all European member states.”