Transition from CAMHS to adult services — structured clinical viva

This is a dual-threshold care-gap scenario: too old for ongoing CAMHS soon, not accepted by adult CMHT for severe/enduring illness, with active self-harm risk and possible ADHD. TRACK literature shows emerging personality presentations and non-severe-enduring profiles often fall through; Appleton synthesis shows only about a quarter reach AMHS. Do not collude with pure rejection without alternatives.^[1][2][3]

Risk. Reassess current self-harm, intent, means, protective factors, and need for crisis/acute pathways independent of outpatient architecture. Name an interim risk owner until a receiving service engages.^[3]

Pathways. Map psychological therapies for emotion dysregulation (DBT/MBT-informed community options), adult ADHD assessment/shared care if indicated, youth 12–25 or NGO services, GP shared care with re-referral triggers, and specialist streams. Structural redesign arguments (McGorry) may be relevant regionally but do not invent local service existence.^[5][1]

Managed process. Early written plan, joint meetings if any receiving team exists, complete summary, young-person involvement, medication continuity if on psychotropics, follow-up of engagement. Cite MILESTONE as RCT evaluation of managed transition.^[4][1]

Family and capacity. Validate parental distress; assess young person's capacity for confidentiality preferences (Appelbaum); share information for serious harm risk under local law principles without invented sections.^[6]