We are excited to share a powerful case study highlighting the importance of collaboration and co-production in improving mental health services for young adults. At Scale successfully bid and were commissioned by North East London NHS Trust to undertake a review of their Adult Mental Health Service (AMHS) offer for individuals aged 18-25, specifically focusing on the transition process from Children and Adolescent Mental Health Services (CAHMS). This review encompassed four London Boroughs: Barking and Dagenham, Havering, Redbridge, and Waltham Forest.

As the lead consultants for this transformative review, our mission was to identify strategies for enhancing engagement and better supporting the transition from child to adult mental health services, particularly for individuals from diverse communities. Also, was the current service provision what service users needed and or wanted? How could the engagement process influence and promote collaborative working to develop services models and how could this be delivered to support service transformation. We focused on two critical areas:

1. The 'transition' process: We developed and delivered an engagement model that provided qualitative data and real-life experiences of young people when approaching the age of 17 and 3 months, as they moved from CYP services to adult services. We also examined the experiences of those who entered adult services as new service users at this age, without prior access to CAMHS.

2. The service offer itself: We examined the existing service provisions and explored what the client provided for young people between the ages of 18 and 25 within the adult service specifically.

 

Young people entering adulthood today face new emotional demands, including pressures from competition in education, accessing employment, increased concerns about their future, living arrangements and financial instability. These pressures are accompanied by the increased fear of violence and gang culture and the impact of technology and social media on self-perception, relationships, and their privacy.

 

Throughout this review, it was crucial for us to understand the perspectives of young people, their parent/carers, families, and staff members who utilised these services. Our goal was to gain valuable insights into their lived experiences during the transition process and within the service itself, with a focus on identifying areas for improvement. We prioritised aspects such as continuity, coordination, timeliness, transparency, and seamlessness of care for individuals within this age group. We also paid special attention to how well the transition process and service provision aligned with the unique needs of young adults.

 

To ensure the success of our consultation process, we emphasised active engagement and sought meaningful contributions from service users, staff partners, parent/carers, and other stakeholders. We were committed to directly hearing the voices of young adults, adopting a genuinely open and listening approach. Our proactive approach ensured that we reached out to those young adults who may have been less likely to respond, recognising the importance of including diverse perspectives across a wide range of demographics.

During the consultation process, we identified specific priority groups whose experiences in accessing mental health services are often more challenging. These groups included; looked after children (LAC), care leavers, individuals on the edge of youth justice/under youth justice services, those with special educational needs and disabilities (SEND), young carers, and young asylum seekers.

 

From the outset, we were determined to embrace co-production principles in our approach to consulting and involving young adults in this review. We engaged in meaningful conversations, seeking to understand their lived experiences and encouraging dialogue that would facilitate their active participation in co-designing service changes that directly impacted them and improved services for other young adults.

 

The review provided us with profound insights into the intricacies of AMHS and the current service offer for young adults. As a result, we formulated a total of 16 recommendations across four key themes. These recommendations were adopted in principle, reflecting the commitment of the Trust to deliver services that truly address the needs of young adults.

 

Young adult user feedback is sometimes heard; however, they are not consistently engaged in helping to shape and/or implement service improvements and this review identified that service user groups across the Trust had no young adult representation and many young adults chose not to participate in group activities due to their mental health.

 

However, young adults interviewed as part of this review welcomed the opportunity to participate and to engage in future co-production opportunities but felt there were some local opportunities to engage and consult with young adults, using a variety engagement methods, but these were not consistent across the Trust.

Young adults felt that going forward there was a need to better and more practically demonstrate the commitment to co-production. For example, by more actively involving young adults as equal partners in the development of the Trust’s Transformation Programme.

We also explored the issues relating to young adults transitioning to AMHS by listening to the experiences of young people in this process. What we heard was that as young people approach 18, they are expected to make important life decisions on their education, family relationships and housing. In particular, LAC young adults who are also required to leave care at 18 and make the transition from being cared for to becoming independent and entering adulthood. 

 

Nationally, LAC young people are more likely to have high level therapeutic needs and receive care from CAMHS. Traumatic experiences during childhood are common for care-experienced young adults. This often leads to chronic mental health conditions, such as PTSD if they do not have access to effective evidenced based therapies at an early stage. Consequently, young people can experience several transitions at the same time, creating a greater challenge and anxiety about the prospect of adulthood. For young people with complex mental health needs, the transition from CAMHS to AMHS is critical. 

 

Young adults fedback the importance of developing positive, professional relationships with them as part of their care. This is a key aspect to young adult engagement with services, having staff that care and who spend time during sessions to deliver meaningful interventions, which in turn, supports the development of trusted relationships and continued service user engagement.

Co-production is imperative to the success of any offer for young adults. The need to listen to young adults and their families with lived experience is key to gain insight into their needs and how services can best meet them.

Effective communication and joint working between professional services, particularly between CAMHS and AMHS, Health, Local Authority and the VCS is key to improving the offer to young adults. This has been emphasised by The National Collaborating Centre for Mental Health, who found that all models of mental health care for young adults identify partnership and integrated working as part of their service design processes. 

Forward Thinking Birmingham (2015) for 0–25-year-olds is an ambitious, whole system change, which replaces existing services.   They highlighted in their impact and process evaluation (2018) the need to:

• Include VCS partners in the development of the services access and assessment process to promote better management of demand across the network

• Establish a clear protocol for sharing information across the network of partners

• Where possible VCS partners should be commissioned for more than a year at a time to foster long -term sustainability. 

Our findings were in line with principles outlined in the National Collaborating Centre for Mental Health Research.

This case study underscores the fundamental importance of collaboration, co-production, and meaningful engagement in developing mental health services for young adults. Co-production, should be young adult focused, flexible, ensure effective management of transitions and be rooted in the community - locally based in line with PCN localities.

By valuing the voices of service users and involving them in the design and improvement process, we can lay the foundation for services that meet their unique requirements. At Scale is proud to have played a part in this transformative journey, and we remain committed to driving positive change in mental health services through collaborative efforts and a focus on the voices of those we serve.