Continuity of care from child and adolescent to adult mental health services: evidence from a regional survey in Northern Italy

Paolo Stagi, Simona Galeotti, Stefano Mimmi, Fabrizio Starace, Augusto C. Castagnini

To examine clinical and demographic factors associated with continuity of care from child-adolescent (CAMHS) to adult mental health services (AMHS), we undertook a record-linkage study to the Adult Mental Health Information System including all those 16 years old and over who were listed between 2010 and 2013 in the Child and Adolescent Neuropsychiatry Information System in Emilia-Romagna, an Italian region of nearly 4.5 million residents. From a cohort of 8239 adolescents attending CAMHS (population at risk about 144,000), 821 (19.4 %) moved to AMHS, excluding cases with specific developmental disorders, whose conditions were not managed by adult psychiatrists, and those with mental retardation who attended usually social services. Young people referred for treatment to AMHS were more likely to receive a discharge diagnosis of schizophrenia and related disorders (Odds Ratio [OR] 3.92; 95 % confidence interval [CI] 2.17-7.08), personality disorders (OR 2.69; 95 % CI 1.89-3.83), and pervasive developmental disorders (OR 2.13; 95 % CI 1.51-2.99). Further factors predicting transfer to AMHS were not living with parents, inpatient psychiatric admission, and being on medication in the previous 24 months. These findings suggest that a relatively small number of adolescents moved to AMHS and are likely to reflect the configuration of local mental health services and alternative care available, mainly for those with less-severe mental disorders.