School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
Department of Psychology, Nottingham Trent University, Nottingham, UK.
Early Interv Psychiatry. 2018 Jun;12(3):505-512. doi: 10.1111/eip.12408. Epub 2017 May 10.
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 (TB) in Ireland. 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 TB in all 4 Health Service Executive Regions. A secondary case note analysis identified characteristics, co-morbidities, referral and service outcomes for iTRACK cases with ADHD (n = 20). 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 TB. 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 TB. There was a perception by CAMHS clinicians that adult services did not accept ADHD cases or lacked relevant service/expertise. Despite high rates of medication use and co-morbid mental health difficulties, there appears to be a complete absence of referral to publicly available AMHS 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.
在国际关注早期成年心理健康服务提供的背景下，本研究确定了爱尔兰达到儿童和青少年心理健康服务（CAMHS）过渡边界（TB）的注意力缺陷多动障碍（ADHD）年轻人的特征和服务结果。iTRACK 研究邀请爱尔兰所有 60 个 CAMHS 团队参加；8 个团队回顾性地为所有 4 个卫生服务行政区域的 62 名符合条件的年轻人确定了临床病例档案，这些年轻人达到了 CAMHS TB。二次病例记录分析确定了 iTRACK 病例中 ADHD（n=20）的特征、合并症、转诊和服务结果。三分之二的 ADHD 年轻人正在服用精神药物，一半有心理健康合并症，但没有人在 TB 时直接转至公共成人心理健康服务（AMHS）。近一半人留在 CAMHS 中，平均超过一年；大多数人在 TB 时或之后要么不再接受服务（40%），要么积极拒绝转至 AMHS（35%）。CAMHS 临床医生认为成人服务不接受 ADHD 病例或缺乏相关服务/专业知识。尽管药物治疗和合并心理健康问题的比例很高，但爱尔兰从 CAMHS 过渡的 ADHD 青年似乎完全没有被转介到公共可用的 AMHS。更深入地了解障碍和最佳服务配置对于确保 ADHD 年轻人获得可及的护理至关重要。
