Transitioning from child and adolescent mental health services with attention-deficit hyperactivity disorder in Ireland: Case note review

Abstract

Aim In a context of international concern about early adult mental health service provision, this study identifies characteristics and service outcomes of young people with attention-deficit hyperactivity disorder (ADHD) reaching the child and adolescent mental health service (CAMHS) transition boundary in Ireland. Methods The iTRACK study invited all 60 CAMHS teams in Ireland to participate; 8 teams retrospectively identified clinical case files for 62 eligible young people reaching the CAMHS transition boundary in all four Health Service Executive Regions. A secondary case note analysis identified characteristics, co-morbidities, referral and service outcomes for iTRACK cases with ADHD (n = 20). Results Two-thirds of young people with ADHD were on psychotropic medication and half had mental health co-morbidities, yet none was directly transferred to public adult mental health services (AMHS) at the transition boundary. Nearly half were retained in CAMHS, for an average of over a year; most either disengaged from services (40%) and/or actively refused transfer to AMHS (35%) at or after the transition boundary. There was a perception by CAMHS clinicians that adult services did not accept ADHD cases or lacked relevant service/expertise. Conclusions Despite high rates of medication use and comorbid mental health difficulties, there appears to be a complete absence of referral to publically available adult mental health services for ADHD youth transitioning from CAMHS in Ireland. More understanding of obstacles and optimum service configuration is essential to ensure that care is both available and accessible to young people with ADHD.