NIHR CLAHRC for

1
NIHR CLAHRC for Cambridgeshire Peterborough
Innovation by Design
Child Adolescent Theme
P.I. Professor Ian Goodyer
The Transfer of Care Project
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.

• Background
• The economic cost of mental health is high
• The total cost of mental illness in England is
  estimated to be 77.4 billion1 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 disorder2
• Five out of 10 of the leading causes of
  disability adjusted life years are mental
  disorders3
• 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 outcomes5
• Mental health problems for young people leaving
  social care may double in the first year6
• 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).

NIHR CLAHRC for
References 1 SCMH (2003). Economic and social
costs of mental health in England. London The
Sainsbury Centre for Mental Health and Kings
Fund (available from www.scmh.org.uk) 2Green H.,
McGinnity Á., Meltzer H., Ford T. Goodman R.
(2004). Mental health of children and young
people in Great Britain. Palgrave
Macmillan. 3Patel V., Flisher A., Hetrick S.
McGorry P. (2007). Mental health of young people
a global public-health challenge. The
Lancet369(9569)1302-13. 4 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 , 20359-364. 5Singh, S.P.
(2009). Transition of care from child to adult
mental health services the great divide. Current
Opinion in Psychiatry, 22(4) p. 386-90. 6 Dixon
J. (2008). Young people leaving care health,
well-being and outcomes. Child Family Social
Work, 2008. 13(2) p. 207-217. 7Akister 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 mo344_at_medschl.cam.ac.uk
Collaborations for Leadership in Applied Health
Research and Care