Behandlungsangebote der Adoleszenzpsychiatrie – Ergebnisse einer deutschlandweiten Erhebung

Zusammenfassung

Ziel der Studie war es, deutschlandweit adoleszenzspezifische Behandlungsmodelle zu untersuchen, die Umsetzung transitionspsychiatrischer Versorgung darzustellen und relevante Problembereiche in der Versorgung für Heranwachsende mit psychischen Erkrankungen zu identifizieren.

Methodik Es erfolgte eine fragebogenbasierte Querschnittserhebung (N = 26) krankenhausbasierter adoleszenzpsychiatrischer Behandlungsmodelle. Anhand von 28 Items wurden Daten zur Versorgungsstruktur, Zielgruppe und Therapieangeboten sowie spezifische Anforderungen der Adoleszenzpsychiatrie untersucht und deskriptiv ausgewertet.

Ergebnisse Es zeigt sich eine Zunahme adoleszenzspezifischer krankenhausbasierter Angebote in Deutschland. Diese sind durch diagnoseübergreifende und adoleszenzspezifische Therapieansätze und multiprofessionelle Arbeit gekennzeichnet. Überwiegend besteht ein Behandlungsangebot erst ab Volljährigkeit. Eine Minderheit der Therapieangebote ist in fachübergreifenden Kooperationsmodellen organisiert. Es werden strukturelle Defizite hinsichtlich Akut- und Krisenbehandlungen, sektorenübergreifender Zusammenarbeit und systematischer Transition berichtet.

Schlussfolgerungen Es besteht deutschlandweit ein wachsendes Interesse an der Entwicklung adoleszenzpsychiatrischer Behandlungsangebote. Die enge fachübergreifende Zusammenarbeit von Kinder- und Jugendpsychiatrie und Erwachsenenpsychiatrie ist zur Überwindung von Schnittstellenproblemen mit dem Ziel einer gelungenen Transition notwendig, aber bisher nicht flächendeckend implementiert. Um die Weiterentwicklung von Kooperationsprojekten zu ermöglichen, sollten strukturelle Hürden verringert werden.

Abstract

Introduction The aim of the study was to examine adolescence-specific treatment models throughout Germany, to describe the implementation process of transition psychiatric care and to identify relevant health care problem areas for adolescents with mental disorders.

Methodology A questionnaire-based cross-sectional survey (N = 26) of hospital-based adolescent psychiatric treatment models was conducted. Service structures, treatment groups and interventions were investigated by the 28-item questionnaire.

Results There is an increase in adolescence-specific hospital-based services in Germany. These are characterized by multi-professional team work in diagnosis and adolescence-specific therapy approaches. Most of the treatment available is for young adults only (>18 years). Some of the services are organized in interdisciplinary cooperation models. Structural deficits in acute and crisis treatment, cross-sectoral cooperation and systematic transition are reported. Conclusions There is growing interest throughout Germany in the development of adolescent psychiatric treatment. Close interdisciplinary cooperation between child and adolescent psychiatry and adult psychiatry is necessary to overcome interface problems with the aim of a successful transition, but has not yet been implemented. Structural problems should be reduced in order to facilitate further development in transition psychiatry.

Schlüsselwörter

Adoleszenzpsychiatrie - Transitionspsychiatrie - Erwachsenenpsychiatrie - Kinder- und Jugendpsychiatrie - Transition

Key words

transition medicine - mental health care - adult psychiatry - child and adolescent psychiatry - adolescent psychiatry

• Literatur

• 1 Patton GC, Olsson CA, Skirbekk V. et al. Adolescence and the next generation. Nature 2018; 554: 458-466
• 2 Patton GC, Sawyer SM, Santelli JS. et al. Our future: A Lancet commission on adolescent health and wellbeing. Lancet 2016; 387: 2423-2478
• 3 McLaren S, Belling R, Paul M. et al. ‘Talking a different language’: An exploration of the influence of organizational cultures and working practices on transition from child to adult mental health services. BMC Health Serv Res 2013; 13: 254
• 4 Mulvale GM, Nguyen TD, Miatello AM. et al. Lost in transition or translation? Care philosophies and transitions between child and youth and adult mental health services: A systematic review. J Ment Health 2016 1–10.
• 5 Tuomainen H, Schulze U, Warwick J. et al. Managing the link and strengthening transition from child to adult mental health Care in Europe (MILESTONE): Background, rationale and methodology. BMC Psychiatry 2018; 18: 167
• 6 Zachrisson H, Rödje K, Mykletun A. et al. Utilization of health services in relation to mental health problems in adolescents: A population based survey. BMC Public Health 2006; 6: 34 Published 2006 Feb 16.
• 7 de Haan AM, Boon AE, de Jong JT. et al. A meta-analytic review on treatment dropout in child and adolescent outpatient mental health care. Clin Psychol Rev 2013; 33: 698-711
• 8 Crowley R, Wolfe I, Lock K. et al. Improving the transition between paediatric and adult healthcare: A systematic review. Arch Dis Child 2011; 96: 548-553
• 9 Arnett JJ. Padilla-Walker LM: Brief report: Danish emerging adults’ conceptions of adulthood. J Adolesc 2015; 38: 39-44
• 10 McNicholas F, Adamson M, McNamara N. et al. Who is in the transition gap? Transition from CAMHS to AMHS in the Republic of Ireland. Ir J Psychol Med 2015; 32: 61-69
• 11 Singh SP, Tuomainen H. Transition from child to adult mental health services: Needs, barriers, experiences and new models of care. World Psychiatry 2015; 14: 358-361
• 12 Signorini G, Singh SP, Marsanic VB. et al. The interface between child / adolescent and adult mental health services: Results from a European 28-country survey. Eur Child Adolesc Psychiatry 2018; 27: 501-511
• 13 Kessler RC, Avenevoli S, Costello EJ. et al. Prevalence, persistence, and sociodemographic correlates of DSM-IV disorders in the National Comorbidity Survey Replication Adolescent Supplement. Arch Gen Psychiatry 2012; 69: 372-380
• 14 Blum RW, Garell D, Hodgman CH. et al. Transition from child-centered to adult health-care systems for adolescents with chronic conditions. A position paper of the Society for Adolescent Medicine. J Adolesc Health 1993; 14: 570-576
• 15 Gutierrez-Colosia MR, Salvador-Carulla L, Salinas-Perez JA. et al. Standard comparison of local mental health care systems in eight European countries.Epidemiol Psychiatr Sci 2017: 1-14
• 16 Paul M, Street C, Wheeler N. et al. Transition to adult services for young people with mental health needs: A systematic review. Clin Child Psychol Psychiatry 2015; 20: 436-457
• 17 Karow A, Lipp M, Schweigert E. et al. Alters-, diagnose- und fachübergreifende stationäre Behandlung für Jugendliche und junge Erwachsene (16–25 Jahre) in der Adoleszenzpsychiatrie. Psych Prax Press 2017
• 18 Rickwood D, Telford N, Mazzer K. et al. The services provided to young people through the headspace centres across Australia. Med J Aust 2015; 202 (10) : 533-536
• 19 Singh SP, Paul M, Ford T. et al. Process, outcome and experience of transition from child to adult mental healthcare: Multiperspective study. Br J Psychiatry 2010; 197: 305-312
• 20 Bechdolf A, Wagner M, Ruhrmann S. et al. Preventing progression to first-episode psychosis in early initial prodromal states. Br J Psychiatry 2012; 200: 22-29
• 21 Chanen A, Sharp C, Hoffman P. et al. Prevention and early intervention for borderline personality disorder: A novel public health priority. World Psychiatry 2017; 16: 215-216
• 22 Hovish K, Weaver T, Islam Z. et al. Transition experiences of mental health service users, parents, and professionals in the United Kingdom: A qualitative study. Psychiatr Rehabil J 2012; 35: 251-257
• 23 McGorry PD. The specialist youth mental health model: Strengthening the weakest link in the public mental health system. Med J Aust 2007; 187: S53-6
• 24 Henderson JL, Cheung A, Cleverley K. et al. Integrated collaborative care teams to enhance service delivery to youth with mental health and substance use challenges: Protocol for a pragmatic randomised controlled trial. BMJ Open 2017; 7: e014080
• 25 Cappelli M, Davidson S, Racek J. et al. Transitioning Youth into Adult Mental Health and Addiction Services: An Outcomes Evaluation of the Youth Transition Project. J Behav Health Serv Res 2016; 43: 597-610
• 26 Ruggeri M, Leese M, Thornicroft G. et al. Definition and prevalence of severe and persistent mental illness. Br J Psychiatry 2000; 177: 149-155
• 27 National Institute for Health and Care Excellence. Transition from children’s to adults’ services for young people using health or social care services. NICE guideline [NG43], 2017
• 28 Karow A, Bock T, Naber D. et al. Die psychische Gesundheit von Kindern, Jugendlichen und jungen Erwachsenen – Teil 2: Krankheitslast, Defizite des deutschen Versorgungssystems, Effektivität und Effizienz von „Early Intervention Services”. Fortschr Neurol Psychiatr 2013; 81: 628-638