Researchers have examined the ethical values that people expect to underpin the transition from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS). Lesley O’Hara and colleagues studied focus groups in Croatia, Ireland and the UK that involved a total of 111 participants aged from 16 to 60 years. Most of the participants had experience of mental health problems, either personally or involving a family member or close friend. The participants contributed to discussions on the ethical principles and challenges underlying this critical healthcare transition.
The issues that emerged broadly fell under the categories of: (a) desired practice, (b) who should decide, (c) the process of decision-making and (d) potential harm(s). In terms of desired practice, all groups clearly expressed the view that all young people should have equal access to mental health services. The discussions held on who should decide on the mental health care pathway were more complex: some believed that young adults should decide on their own mental health care, while others felt that experienced clinicians were better placed to make these decisions. The participants favoured a collaborative approach to the decision-making process – promoting the young person’s autonomy, providing information, and supporting parents – which should take place ahead of time. Finally, all groups raised concerns about the potential harm of stigma about attending AMHS.
Overall, the researchers believe that engaging with young people early in the decision-making process will likely improve the trust between the practitioner and the patient. They propose that alternatives to AMHS should be identified if the young person is concerned about the stigma associated with adult mental health care.
O’Hara, L., Holme, I, Tah, P., Franic, T., Vrljičak Davidović, N., Paul, M., Preet Singh, S., Street, C., Tuomainen, H., Schulze, U., McNicholas, F. & the MILESTONE Consortium. (2020), A cross-cultural qualitative study of the ethical aspects in the transition from child mental health services to adult mental health services. Child Adolesc. Ment. Health. doi: 10.1111/camh.12377.