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Understanding why young people fall through the gap between child and adult mental health services and the associated impact and costs for young people, society, and the health service
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Appleton, Rebecca (2020) Understanding why young people fall through the gap between child and adult mental health services and the associated impact and costs for young people, society, and the health service. PhD thesis, University of Warwick.
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Official URL: http://webcat.warwick.ac.uk/record=b3678223~S15
Abstract
This thesis explores the causes and effects of discontinuity of care at the upper age boundary of child and adolescent mental health services (CAMHS). We investigate why young people (YP) fall through the gap between child and adult services and the effect this has on their mental health, functioning, and associated healthcare and societal costs.
Mixed methods were used. A systematic review explored service use outcomes of young people after leaving CAMHS. Longitudinal data from 488 young people with an anxiety or depressive disorder, a neurodevelopmental disorder, or a personality disorder was analysed using multiple regression methods to examine predictors of transitioning, mental health and functioning outcomes, and resource use. Narrative interviews with thematic analysis was conducted with 15 YP and 15 parents of YP who fell through the gap. The results of all data analyses were synthesised using a Pillar Integration Process to generate new insights from the data.
The most common reason for falling through the gap was being deemed ‘not ill enough’ to access adult services. The current service structure does not meet the mental health needs of all YP, and several reported being unable to access mental health care or medication when needed. Falling through the gap caused frustration and anxiety for YP and parents, and some YPs struggled to manage without specialist mental health care. Those who were most ill typically used more health care resources.
This thesis sheds light on the causes and consequences of children falling through the gap between services. It concludes with seven recommendations for clinical practice and mental health policy to improve care for young people at the CAMHS transition boundary.
| Item Type: | Thesis (PhD) | ||||
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| Subjects: | R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RJ Pediatrics R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services |
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| Library of Congress Subject Headings (LCSH): | Child mental health services -- Great Britain, Youth -- Mental health services -- Great Britain, Health services -- Great Britain | ||||
| Official Date: | December 2020 | ||||
| Dates: |
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| Institution: | University of Warwick | ||||
| Theses Department: | Warwick Medical School | ||||
| Thesis Type: | PhD | ||||
| Publication Status: | Unpublished | ||||
| Supervisor(s)/Advisor: | Singh, Swaran P. ; Tuomainen, Helena ; Canaway, Alastair | ||||
| Sponsors: | Warwick Medical School | ||||
| Format of File: | |||||
| Extent: | 252 leaves : illustrations (some colour), colour map | ||||
| Language: | eng |
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