Transition services in mental health — A suitable solution for young patients? A qualitative study of the opinions of adolescent and adult psychiatrists in Portugal

Abstract

Objectives

Transition from pediatric to adult health services is a difficult and common problem in many medical specialties, particularly in mental health, fraught with pitfalls that threaten its success and disrupt the continuity of care. However, there is a lack of research on this topic. The aim of this study was to characterize the perceptions of Portuguese physicians who are responsible for direct intervention in this process—child and adolescent psychiatrists (CAP) and adult psychiatrists (AP)—and to explore the possibilities for improvement.

Methods

A qualitative methodology was adopted, using thematic analysis to evaluate results, participants were selected using a convenience sampling of CAPs and APs in Lisbon area, 28 APs and 18 CAPs expressed interest in participating.

Saturation point was reached after interviewing eight CAPs and 13 APs, and the interviews were first listened to and transcribed, then NVivo software was used to facilitate coding of data.

Results

Many young people transition informally to adult services. Relying on the commitment of doctors, families, and patients is common in clinical discharge to general practitioners, who then make psychiatric referrals. A formal and standardized transition process was not found. Two-thirds of the respondents thought that transition services were useful, while others thought that such services were not needed and had no positive effect on the quality of care. However, all agreed that in the absence of transition protocols, informal transfers provided the best results.

Conclusions

All participants agreed on the importance of a seamless transition to ensure the continuity of care and that developing transition strategies to improve communication between pediatric and adult services would be beneficial. Some participants considered this issue for the first time. This suggests that the situation in Portugal is similar to that in other countries, highlighting a lack of awareness of the importance of transition process for patient outcomes.