Dr Faraz Mughal is a GP, an NIHR Research Fellow at Keele University, and is supported by the GM PSTRC. He has been working with Dr Rebecca Appleton, a Research Fellow from University College London (UCL) who led a research study, published in the British Journal of General Practice, called ‘Young people who have fallen through the mental health transition gap: a qualitative study on primary care support’.
Why was the research needed?
Young people who are no longer able to receive specialist mental health support after reaching the upper age limit of child and adolescent mental health services (CAMHS) may be able to access ongoing mental health support from their GP which could improve the safety of the transition.
This research enhances our understanding of how we can ensure safer transitions for young people with ongoing mental health needs.
Who was involved in the research?
This research included interviews with 14 young people and 13 parents of young people who had experienced poor continuity of care after reaching the point where they were too old to receive further support from CAMHS.
Participants were recruited from the West Midlands and London and were part of a larger study exploring the transition between child and adult mental health services across Europe (the MILESTONE project). A method called reflexive thematic analysis was used to analyse the data which helps to identify patterns or themes.
Young people and parents described frequently being discharged to their GP after reaching the upper age limit of CAMHS. Participants reflected on various experiences of accessing mental health support from their GP. Young people identified barriers including:
- Experiencing anxiety in the general practice environment (e.g., waiting room)
- The perception that GPs were unable to prescribe certain specialist medication
- Having to move to a new practice if they moved away from home for university.
Participants who reported positive experiences were more likely to have a long-term relationship with their GP and felt that their GP took the time to understand their needs and experiences.
What themes were uncovered?
Researchers identified that a major theme was ‘taking responsibility for the young person’s mental health care’. In some cases, participants said their GP took on responsibility for their care, as they were not eligible for support elsewhere. Parents described difficulties in trying to take responsibility for their child’s care if they were too unwell. This was because once that young person was over 18 it became more difficult for them to talk to services on their child’s behalf.
Young people reported having unmet mental health needs. In some cases, this was because referrals made by GPs to other services had been rejected, meaning their GP became the main provider of mental health care. However, some young people felt their GP did not have the necessary understanding of mental health problems to be able to offer appropriate support, which raises questions around GPs capability and training.
Disjointed care was also an important theme that was identified. Young people and their parents described having to navigate a complex health system, often with long waiting lists to access care. For example, some participants reported CAMHS discharging young people to their GP, and then the GP having to make an onward referral, which led to delays in accessing further mental health support. Disjointed care was also experienced by young people who had to change GP practices after moving away for university, as their new GP was often not aware of their previous mental health history.
What are the implications of this research?
Dr Rebecca Appleton, Research Fellow, Division of Psychiatry at UCL, and lead author of this research said: “Young people struggle to access support for their mental health once they reach the upper age boundary of CAMHS. This research indicates the need for improved communication between specialist services and GPs, to help GPs refer young people onwards, or to receive support to prescribe specialist medication.”
Dr Faraz Mughal, GP, NIHR Research Fellow, and affiliate of the NIHR GM PSTRC based in the School of Medicine, Keele University, said: “Our findings highlight the need for mental health and primary care services to work closer together for a safer transition process for young people who have ongoing mental health needs once reaching the upper boundary of CAMHS. Interventions should be tested to see how this process can be optimised.”
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