From Adolescence to Adulthood: Understanding Care Trajectories in an Early Detection and Intervention Centre in France.
AMHS
CAMHS
at risk mental state
care pathway
early psychosis
Journal
Early intervention in psychiatry
ISSN: 1751-7893
Titre abrégé: Early Interv Psychiatry
Pays: Australia
ID NLM: 101320027
Informations de publication
Date de publication:
02 Sep 2024
02 Sep 2024
Historique:
revised:
08
07
2024
received:
01
04
2024
accepted:
27
07
2024
medline:
3
9
2024
pubmed:
3
9
2024
entrez:
3
9
2024
Statut:
aheadofprint
Résumé
Psychiatric disorders often emerge during adolescence or young adulthood, leading to significant disability among youth. The transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) is critical for individuals experiencing emerging psychopathology, with delayed access to care negatively impacting long-term outcomes. Accessing mental health services for adolescents and young adults is often complex and delayed due to challenges in service visibility, accessibility and appropriateness. This study examines the care trajectories of individuals consecutively accessing the early detection and intervention (EDI) centre C'JAAD (Evaluation Centre for Young Adults and Adolescents) in Paris (France) over the year 2021. The main goal was to clarify the role of this EDI centre in the continuity of care and transition to AMHS. Data about their history of care, hospitalisations and referral sources were collected retrospectively. The sample comprised 194 individuals, with 57.2% males and a median age of 20 years. Most patients (67.5%) were ≥18 years old upon arrival, with 31% in a situation of not being in education, employment, or training (NEET). Over one-third (35.2%) had prior psychiatric hospitalisations. Patients were mainly referred to our EDI centre from other hospital departments (42.3%). Regarding care in CAMHS, 50.3% of the total sample had medical follow-up during childhood, of whom 41.9% had discontinued care upon arrival at the EDI centre. The median onset age of care in CAMHS was 14, with a median duration of 12 months. Adult patients experienced an approximately 3-year gap between the end of CAMHS care and assessment at the EDI centre. The sample's characteristics resemble those of other EDI centres, but concerns persist regarding referral timing and the NEET status of many youths. Lack of prior medical follow-up and challenges in transitioning to AMHS underscore the need to enhance care continuity and address difficulties in accessing care during the transition to adulthood.
Sections du résumé
BACKGROUND
BACKGROUND
Psychiatric disorders often emerge during adolescence or young adulthood, leading to significant disability among youth. The transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) is critical for individuals experiencing emerging psychopathology, with delayed access to care negatively impacting long-term outcomes. Accessing mental health services for adolescents and young adults is often complex and delayed due to challenges in service visibility, accessibility and appropriateness.
METHODS
METHODS
This study examines the care trajectories of individuals consecutively accessing the early detection and intervention (EDI) centre C'JAAD (Evaluation Centre for Young Adults and Adolescents) in Paris (France) over the year 2021. The main goal was to clarify the role of this EDI centre in the continuity of care and transition to AMHS. Data about their history of care, hospitalisations and referral sources were collected retrospectively.
RESULTS
RESULTS
The sample comprised 194 individuals, with 57.2% males and a median age of 20 years. Most patients (67.5%) were ≥18 years old upon arrival, with 31% in a situation of not being in education, employment, or training (NEET). Over one-third (35.2%) had prior psychiatric hospitalisations. Patients were mainly referred to our EDI centre from other hospital departments (42.3%). Regarding care in CAMHS, 50.3% of the total sample had medical follow-up during childhood, of whom 41.9% had discontinued care upon arrival at the EDI centre. The median onset age of care in CAMHS was 14, with a median duration of 12 months. Adult patients experienced an approximately 3-year gap between the end of CAMHS care and assessment at the EDI centre.
DISCUSSION
CONCLUSIONS
The sample's characteristics resemble those of other EDI centres, but concerns persist regarding referral timing and the NEET status of many youths. Lack of prior medical follow-up and challenges in transitioning to AMHS underscore the need to enhance care continuity and address difficulties in accessing care during the transition to adulthood.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Koning Boudewijnstichting
ID : 2021-J5151410-223868
Organisme : Fondation Bettencourt-Schueller - Fondation Fondamental
Organisme : Agence Nationale pour la recherche
Organisme : Agence Nationale pour la recherche
ID : ANR 18-RHUS-0014
Informations de copyright
© 2024 The Author(s). Early Intervention in Psychiatry published by John Wiley & Sons Australia, Ltd.
Références
Amara, F., and P. Naves. 2013. Evaluation de la Mise en Place du Dispositif ‘Maison des Adolescents’ (MDA): Rapport. Paris, France: Membres de I'Inspection Generale des Affaires Sociales.
Appleton, R., A. Canaway, H. Tuomainen, et al. 2023. “Predictors of Transitioning to Adult Mental Health Services and Associated Costs: A Cross‐Country Comparison.” British Medical Jorunal Mental Health 26, no. 1: 1–9. https://doi.org/10.1136/bmjment‐2023‐300814.
Armando, M., P. Klauser, D. Anagnostopoulos, et al. 2020. “Clinical High Risk for Psychosis Model in Children and Adolescents: A Joint Position Statement of ESCAP Clinical Division and Research Academy.” European Child and Adolescent Psychiatry 29, no. 4: 413–416. https://doi.org/10.1007/s00787‐020‐01499‐3.
Benoit, L., P. Cottin, and M. R. Moro. 2018. “What Is a ‘Maison des Adolescents’? A History of Integrated Youth Health Care Services in France.” Early Intervention in Psychiatry 12, no. 5: 1000–1005. https://doi.org/10.1111/eip.12680.
Bertulies‐Esposito, B., A. Abdel‐Baki, P. Conus, and M. O. Krebs. 2021. “Strength in Numbers: Launching a National and International French‐Speaking Movement for the Implementation of Early Intervention Services.” Santé Mentale au Québec 46, no. 2: 365–389. https://doi.org/10.7202/1088189ar.
Bolhuis, K., L. Ghirardi, R. Kuja‐halkola, et al. 2024. “Risk of Psychosis Among Individuals Who Have Presented to Hospital With Self‐Harm: A Prospective Nationwide Register Study in Sweden.” Schizophrenia Bulletin 50, no. 4: 881–890.
Bolhuis, K., U. Lång, D. Gyllenberg, et al. 2021. “Hospital Presentation for Self‐Harm in Youth as a Risk Marker for Later Psychotic and Bipolar Disorders: A Cohort Study of 59 476 Finns.” Schizophrenia Bulletin 47, no. 6: 1685–1694. https://doi.org/10.1093/schbul/sbab061.
Boonstra, A., S. Leijdesdorff, C. Street, et al. 2024. “Turning 18 in Mental Health Services: A Multicountry Qualitative Study of Service User Experiences and Views.” Irish Journal of Psychological Medicine 1–9: 1–9. https://doi.org/10.1017/ipm.2024.5.
Boonstra, A., G. A. P. G. van Mastrigt, S. M. A. A. Evers, T. A. M. J. van Amelsvoort, and S. M. J. Leijdesdorff. 2023. “@Ease Peer‐To‐Peer Youth Walk‐In Centres in the Netherlands: A Protocol for Evaluating Longitudinal Outcomes, Follow‐Up Results and Cost‐of‐Illness.” Early Intervention in Psychiatry 17: 929–938. https://doi.org/10.1111/eip.13443.
Gerritsen, S. E., A. Maras, L. S. van Bodegom, et al. 2021. “Cohort Profile: Demographic and Clinical Characteristics of the MILESTONE Longitudinal Cohort of Young People Approaching the Upper Age Limit of Their Child Mental Health Care Service in Europe.” British Medical Jorunal Open 11, no. 12: e053373. https://doi.org/10.1136/bmjopen‐2021‐053373.
Gerritsen, S. E., L. S. van Bodegom, G. C. Dieleman, et al. 2022. “Demographic, Clinical, and Service‐Use Characteristics Related to the Clinician's Recommendation to Transition From Child to Adult Mental Health Services.” Social Psychiatry and Psychiatric Epidemiology 57, no. 5: 973–991. https://doi.org/10.1007/s00127‐022‐02238‐6.
Gerritsen, S. E., L. S. van Bodegom, M. M. Overbeek, et al. 2022. “Leaving Child and Adolescent Mental Health Services in the MILESTONE Cohort: A Longitudinal Cohort Study on Young people's Mental Health Indicators, Care Pathways, and Outcomes in Europe.” Lancet Psychiatry 9, no. 12: 944–956. https://doi.org/10.1016/S2215‐0366(22)00310‐8.
Goldman, H. H., A. E. Skodol, and T. R. Lave. 1992. “Revising Axis V for DSM‐IV: A Review of Measures of Social Functioning.” American Journal of Psychiatry 149, no. 9: 1148–1156. https://doi.org/10.1176/ajp.149.9.1148.
Iorfino, F., E. M. Scott, J. S. Carpenter, et al. 2019. “Clinical Stage Transitions in Persons Aged 12 to 25 Years Presenting to Early Intervention Mental Health Services With Anxiety, Mood, and Psychotic Disorders.” Jorunal of the American Medical Association Psychiatry 76, no. 11: 1167–1175. https://doi.org/10.1001/jamapsychiatry.2019.2360.
Krebs, M.‐O. 2019. “Le Réseau Transition: A National Initiative to Promote Early Intervention in Early Psychosis in Adolescents and Young Adults.” L'Information Psychiatrique 95, no. 8: 667–671. https://doi.org/10.1684/ipe.2019.2011.
Lång, U., H. Ramsay, K. Yates, et al. 2022. “Potential for Prediction of Psychosis and Bipolar Disorder in Child and Adolescent Mental Health Services: A Longitudinal Register Study of All People Born in Finland in 1987.” World Psychiatry 21, no. 3: 436–443. https://doi.org/10.1002/wps.21009.
Léger, M., V. Wolff, B. Kabuth, E. Albuisson, and F. Ligier. 2022. “The Mood Disorder Spectrum vs. Schizophrenia Decision Tree: EDIPHAS Research Into the Childhood and Adolescence of 205 Patients.” BioMed Central Psychiatry 22, no. 1: 1–13. https://doi.org/10.1186/s12888‐022‐03835‐0.
Malla, A., S. Iyer, P. McGorry, et al. 2016. “From Early Intervention in Psychosis to Youth Mental Health Reform: A Review of the Evolution and Transformation of Mental Health Services for Young People.” Social Psychiatry and Psychiatric Epidemiology 51, no. 3: 319–326. https://doi.org/10.1007/s00127‐015‐1165‐4.
Marchini, S., J. Reis, I. Hussein, and V. Delvenne. 2021. “Outpatient Care in Psychiatry for Transitional Age Youth (16 to 24 Years Old): Which Trajectories of Psychiatric Care in French‐Speaking Belgium?” Psychiatria Danubina 33, no. Suppl 9: 55–62.
McGorry, P., T. Bates, and M. Birchwood. 2013. “Designing Youth Mental Health Services for the 21st Century: Examples From Australia, Ireland and the UK.” British Journal of Psychiatry. Supplement 54, no. s54: s30–s35. https://doi.org/10.1192/bjp.bp.112.119214.
McGorry, P. D., and I. B. Hickie. 2019. Clinical Staging in Psychiatry. Cambridge, UK: Cambridge University Press. https://doi.org/10.1017/9781139839518.
McGorry, P. D., C. Mei, A. Chanen, C. Hodges, M. Alvarez‐Jimenez, and E. Killackey. 2022. “Designing and Scaling Up Integrated Youth Mental Health Care.” World Psychiatry 21, no. 1: 61–76. https://doi.org/10.1002/wps.20938.
O'Hara, L., I. Holme, P. Tah, et al. 2020. “A Cross‐Cultural Qualitative Study of the Ethical Aspects in the Transition From Child Mental Health Services to Adult Mental Health Services.” Child and Adolescent Mental Health 25, no. 3: 143–149. https://doi.org/10.1111/camh.12377.
Oppetit, A., J. Bourgin, G. Martinez, et al. 2018. “The C'JAAD: A French Team for Early Intervention in Psychosis in Paris.” Early Intervention in Psychiatry 12, no. 2: 243–249. https://doi.org/10.1111/eip.12376.
R Core Team. 2013. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing. http://www.R‐project.org/.
Rickwood, D., M. Paraskakis, D. Quin, et al. 2019. “Australia's Innovation in Youth Mental Health Care: The Headspace Centre Model.” Early Intervention in Psychiatry 13, no. 1: 159–166. https://doi.org/10.1111/eip.12740.
Russet, F., V. Humbertclaude, N. Davidovic Vrljicak, et al. 2022. “Are Psychiatrists Trained to Address the Mental Health Needs of Young People Transitioning From Child to Adult Services? Insights From a European Survey.” Frontiers in Psychiatry 12. https://doi.org/10.3389/fpsyt.2021.768206.
Signorini, G., S. P. Singh, V. B. Marsanic, et al. 2018. “The Interface Between Child/Adolescent and Adult Mental Health Services: Results From a European 28‐Country Survey.” European Child and Adolescent Psychiatry 27, no. 4: 501–511. https://doi.org/10.1007/s00787‐018‐1112‐5.
Singh, S. P., M. Paul, T. Ford, T. Kramer, and T. Weaver. 2008. “Transitions of Care From Child and Adolescent Mental Health Services to Adult Mental Health Services (TRACK Study): A Study of Protocols in Greater London.” BioMed Central Health Services Research 8: 135. https://doi.org/10.1186/1472‐6963‐8‐135.
Singh, S. P., and H. Tuomainen. 2015. “Transition From Child to Adult Mental Health Services: Needs, Barriers, Experiences and New Models of Care.” World Psychiatry: Official Journal of the World Psychiatric Association 14, no. 3: 358–361. https://doi.org/10.1002/wps.20266.
Singh, S. P., H. Tuomainen, G. De Girolamo, et al. 2017. “Protocol for a Cohort Study of Adolescent Mental Health Service Users With a Nested Cluster Randomised Controlled Trial to Assess the Clinical and Cost‐Effectiveness of Managed Transition in Improving Transitions From Child to Adult Mental Health Services.” British Medical Journal Open 7, no. 10: e016055. https://doi.org/10.1136/bmjopen‐2017‐016055.
Solmi, M., J. Radua, M. Olivola, et al. 2022. “Age at Onset of Mental Disorders Worldwide: Large‐Scale Meta‐Analysis of 192 Epidemiological Studies.” Molecular Psychiatry 27, no. 1: 281–295. https://doi.org/10.1038/s41380‐021‐01161‐7.
Vyas, N. S., M. Birchwood, and S. P. Singh. 2014. “Youth Services: Meeting the Mental Health Needs of Adolescents.” Irish Journal of Psychological Medicine 32, no. 1: 13–19. https://doi.org/10.1017/ipm.2014.73.
Yung, A. R., A. R. Yung, H. Pan Yuen, et al. 2005. “Mapping the Onset of Psychosis: The Comprehensive Assessment of At‐Risk Mental States.” Australian and New Zealand Journal of Psychiatry 39, no. 11–12: 964–971. https://doi.org/10.1080/j.1440‐1614.2005.01714.x.