Aging out of Child Mental Health into Adult Mental Health Services: Missed Opportunities for Engagement

Purpose. Each year, thousands age out of child mental health services across the U.S. These young people have the opportunity to enter adult community mental health services, however many do not for a myriad of personal, social, and system-related reasons. Negative child service experiences and stigma put young adults at risk for not accessing mental health services. Few have examined the actual processes of exiting child services and entering (or not-entering) adult service systems in real-time from the perspective of young people. This paper examines how young people experience the abrupt change of forced disconnection from mental health services at age 18.  

Methods: This study is longitudinal and qualitative. A convenience sample of 19 young adults who were preparing to age out of child services within the next six months or who had aged out within the last two years was sought from a community mental health provider in Austin, Texas. Participants had received serious emotional disturbance diagnoses while in child system services. The research team provided the participants a smartphone and service coverage for 12 months. Participants completed a series of three semi-structured interviews (every six months) exploring service experiences, barriers and facilitators to service engagement, perceived needs, and future plans. During months 2-5, and 7-11, we sent participants a Qualtrics survey link via text message to complete on their smartphone. A team of researchers analyzed interviews thematically, met regularly to discuss individually coded themes, and came to a consensus on both general and unique service experiences.  

 Results. The overarching theme of this study is the need for consistent, supportive relationships during a period of substantial life change. Many of the youth interviewed had long-term mental health service history, and talked about the impact of being forced to discontinue services with a trusted mental health provider at the age of 18. This was compounded by the additional life changes occurring such as moving out from their parents’ house, being expected to financially provide for themselves, or attending college. Echoing recent nationwide studies, all participants pointed to anxiety as their primary mental health challenge (no matter their documented diagnoses), and expressed a need for mental health services in order to support them being successful at work, school, and in their relationships. Over half of participants consistently completed monthly text message surveys reporting ongoing mental health needs, employment struggles, and immense substance use.

 Implications. This study provides a young adult perspective on the real gap between child and adult services within one community mental health agency. Traditional adult mental health services are neither designed nor equipped for transition-age youth who need comprehensive services to help them navigate the emerging responsibilities of young adulthood. The key to success in engaging this age group in mental health services is leveraging the relationship between two (or more) human beings. It is important to utilize near-age peer providers and to encourage traditional mental health providers to embrace “use of self” to connect with the young adults about their own experiences during the transition to adulthood.