Singh et al (Psychiatric Bulletin, August 2005, 29, 292-294) discuss the risk of disrupted care for young people who outgrow child and adolescent mental health services (CAMHS).

Lincolnshire Partnership NHS Trust has a protocol for good practice surrounding transfer of a young person's care from child to adult mental health services. However, in an audit of these procedures involving 82 young people aged 17 or 18 years who were discharged from three of our community CAMHS teams over a 2-year period, only seven were transferred to adult services. CAMHS clinicians identified 32 other young people who left the service with unresolved mental health problems: a suitable adult service could not be found for one young person, 21 young people dropped out of CAMHS and ten young people did not want to be referred to adult services.

The paucity of psychological therapies in adult mental health services created difficulties for CAMHS clinicians in finding suitable follow-on services. Perhaps the prospect of an inevitable ending with no further support contributed to the high drop-out rate of young people approaching the end of the service available to them in CAMHS? Some young people clearly said they did not want to have to ‘start from the beginning’ in establishing a therapeutic relationship with a new worker. Others were perhaps influenced in declining ongoing care by the perceived stigma of adult services.

Our audit findings add to the evidence that the current differing perspectives of CAMHS and adult mental health services create gaps in services through which vulnerable young people fall.