Lost in Transition - moving on smoothly from child to adult mental health of learning disability services  Sarah Bernard

Consultant Psychiatrist

Child and Adolescent Learning Disability

Overview Service provision Diagnosis Management The family Social care Occupation Placement Consent/capacity Other

Service Provision

CAMHS vs Adult LD Ref criteria “Proof of level of LD” “Proof of mental health issues” Do they have ASD Transitional services Why 18yrs?

Diagnosis

ICD-10 vs DSM IV How do childhood diagnoses change at

transition? Psychometry vs adaptive functioning

Management

Health vs Education vs Social Care (Funding!)

Community vs residential vs hospital Behavioural interventions – do they

change? Medication – how, why, when and what?

The Family

Changing role Inclusion vs exclusion Aging parents

Social Care

Referral criteria - conflicts Roles/Responsibilities Respite

Occupation

School…college…employment What has this got to do with psychiatry?

Placement

What is home? Moving on Catchment area

Consent and Capacity

Watch this space! MCA – how is it used? DoLs – 18 yrs+, but must be considered in

childhood MHA – when?

Other issues

Respecting each others services and expertise

Transitional planning – not an option!

Case

AA 17.5yrs Asylum seeker. Somalian. Previous history of abuse UK 2 yrs Probable sexual abuse Aggressive ++

Cont…

Breakdown of school placement Placed in respite unit – breakdown of

placement Witness in criminal proceedings Charged with assault

Diagnosis – ASD, MLD. Probable PTSD

Cont….

Options: move to adult placement? Move to residential school?

Fitness to plead assessment

Outcome…….to discuss

Conclusions

Transition from child to adult services requires planning and co-operation

Care pathways for transition should be established

Differences between child and adult services are inevitable

CAMHS – LD and Mental health of Adult LD should/must work together

A WISH LIST Respect on both sides Good child/adolescent services Sufficient funding (without arguments) Clear transition pathway (useful meetings!) Research