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Every year, thousands of young people with mental illness find that the help they receive stops abruptly when they reach a significant birthday.
In Europe, this is a point reached between 16 and 21 years, marking the moment when the end of the care of services to the child.
A significant proportion need ongoing support and treatment, but many of those who are reorienting to adult care report feeling abandoned, neglected or poorly cared for.
Many others do not get any support from adult services – their care reaching a very real cliff edge.
This difficult time often comes with other rapid changes such as leaving home, going to university, starting to work or building new relationships.
What can be done to improve things for them?
"Not sick enough"
The experiences of 1,000 young people leaving child and adolescent mental health services (Camhs) and entering adult mental health services (Amhs) are tracked in eight European countries: United Kingdom, Ireland, Belgium, the Netherlands , France, Germany, Italy and Croatia. .
Their stories are striking and often have common traits:
- Young people having decisions made about them, without being involved
- Be released suddenly around the age of 18 and not be informed of their options
- Be told that they are not "sick enough" for adult services
- Having to convince adult services that they need help
- Having to tell their story several times due to staff changes and insufficient information sharing
Some young people can not go to school, see their friends or even get out of their room.
It is not uncommon for them to wait for appointments with adult services for at least a year – and then be told that the service will not accept them, announced the MILESTONE project. It is led by the University of Warwick, which collaborates with researchers from other countries studied.
Common problems
In the United Kingdom, as in many other European countries, the mental health problems of children and young people are increasing and affect about one in ten children aged 5 to 16 years.
Anxiety and depression are among the most common ailments, with girls ages 14 and older being more likely than boys to be affected by these problems. Growing up in a poor household increases the risk of mental illness by three.
In the United Kingdom, less than half of young people with mental health problems are supported by their Camhs service.
In Europe, the supply of Camhs varies considerably – from 12.9 per 100,000 young aid recipients in Finland to 0.5 per cent in Bulgaria.
Being unable to find help can be catastrophic. Nearly one in five deaths among young people aged 15 to 19 in the EU is caused by intentional self-harm – just behind deaths from transport.
The story of Emma
In my adolescence, I suffered depression, anxiety and self-harm. At worst, I felt that there was absolutely no hope in the world and that there was no room for me anymore.
I had help with mental health services for children from the age of 15 and the plan was to leave at 18 years old. I was so worried that my problems were getting worse. The university was delayed – I could not get on a bus, let alone move.
A year later, I started my studies, but leaving the service literally gave me grief. Having benefited from support for most of my teenage years, the idea of having no one even scared me a lot. Where can I turn?
Two or three months later, my difficulties returned and I began to hurt myself again. A tutor led me to university counseling services and finally saw a support worker who understood my difficulties.
My problems worsened and years after leaving the children's services, I was finally sent to adult services. I've told my story for what seemed like the hundredth time, to more people than I can count. It was horrible.
- For mental health help and support, visit the BBC's tips pages.
An end to care
In most European countries, support for childcare ends at 18 years old. In some places it is lower, especially in Cyprus (aged 15 to 19), Malta (aged 16) and France (aged 16 to 18). In the UK, Camh support continues normally until 18 years of age.
At least 75% of Britons and an average of 33% of Europe would need additional treatment.
In the absence of treatment, the long-term risks for these young people are: poor school performance, increased risk of drug and alcohol abuse, contact with the criminal justice system and unemployment .
However, the transition to adult services is often difficult. There are different methods of caring for adults with mental illness and it is a distinct specialty.
In the UK, one in three young people who attended Camhs and who needed continued support failed to relocate.
People suffering from depression and / or anxiety, or suffering from a neurodevelopmental disorder such as attention deficit hyperactivity disorder (ADHD), are among the people most affected.
- Children's mental health: Camhs "do not fit"
- Mental health: children have failed at the vulnerable point
What could help?
Across Europe, improving access to treatment and support for young people with mental health issues is becoming a top priority.
In some parts of the United Kingdom, for example, services are reorganizing. There are now a number of mental health services providing support, care and treatment to people under 25 years of age.
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In other areas, efforts are underway to develop new support in schools and colleges. Some British universities are taking steps to improve mental health care for students following concerns about the number of suicides.
The first steps are also underway in several other countries.
In Germany, a "working group" has been set up to improve cooperation in the care of young people on the move.
A similar program is also under way in the Netherlands, while France has recently set up specific facilities for adolescents and hospitalized patients, called "House of Adolescents".
More like this
Understanding what could help young people with mental illness is at the heart of the MILESTONE project.
Seeing what works – and does not work – for them will help to understand how care could be provided in the future.
Since about 50% of mental health problems have appeared at age 14 and 75% at age 24, it is a lesson that deserves to be learned.
About this piece
This analysis document was commissioned by the BBC to an expert working for an outside organization.
Helena Tuomainen is a research fellow at Warwick Medical School and director of scientific research for the MILESTONE project.
The MILESTONE project is an EU-funded international research project that focuses on the transition of care from child mental health services to adult care. It is led by the University of Warwick, in partnership with seven other European research centers in the study countries.
Published by Duncan Walker
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