Healthcare costs for young people transitioning the boundary between child/adolescent and adult mental health services in seven European countries: results from the MILESTONE study

Alastair Canaway¹, Rebecca Appleton², Larissa van Bodegom³, Gwen Dieleman⁴, Tomislav Franić⁵, Suzanne Gerritsen⁴, Giovanni de Girolamo⁶, Athanasios Maras³, Fiona McNicholas⁷, Mathilde Overbeek⁸, Moli Paul⁹, Diane Purper-Ouakil¹⁰, Paramala Santosh¹¹, Ulrike Schulze¹², Swaran P Singh⁹, Cathy Street¹³, Priya Tah¹³, Bie Tremmery¹⁴, Helena Tuomainen¹³, Frank C Verhulst¹⁵, Dieter Wolke¹⁶, Jason Madan¹; MILESTONE Consortium

Affiliations

¹ Centre for Health Economics at Warwick, Warwick Medical School, University of Warwick, UK.
² NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK.
³ Yulius Academy, Yulius Mental Health Organization, The Netherlands; and Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands.
⁴ Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands.
⁵ Department of Psychiatry, University Hospital Split, Croatia; and School of Medicine, University of Split, Croatia.
⁶ Unit of Epidemiological Psychiatry and Evaluation, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Italy.
⁷ School of Medicine and Medical Science, University College Dublin, Republic of Ireland; and Lucena Child and Adolescent Mental Health Services, St. John of God Community Services, Republic of Ireland.
⁸ Yulius Academy, Yulius Mental Health Organization, The Netherlands and Clinical Child and Family Studies, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, The Netherlands.
⁹ Warwick Medical School, University of Warwick, UK and Children and Young People's Mental Health Service, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK.
¹⁰ Child and Adolescent Psychiatry Unit, Centre Hospitalier Universitaire de Montpellier, Saint Eloi Hospital, France; and Team PsyDev, CESP U1018, INSERM, Université de Versailles Saint-Quentin-en-Yvelines, University Paris Saclay, France.
¹¹ Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, UK; and HealthTracker Ltd, UK.
¹² Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Germany.
¹³ Warwick Medical School, University of Warwick, UK.
¹⁴ Department of Neurosciences, KU Leuven, Belgium.
¹⁵ Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands; and Department of Clinical Medicine, University of Copenhagen, Denmark.
¹⁶ Department of Psychology, University of Warwick, UK.

PMID: 37749976
PMCID: PMC10617498
DOI: 10.1192/bjo.2023.559

Healthcare costs for young people transitioning the boundary between child/adolescent and adult mental health services in seven European countries: results from the MILESTONE study

Alastair Canaway et al. BJPsych Open. 2023.

. 2023 Sep 26;9(5):e175.

doi: 10.1192/bjo.2023.559.

Authors

Affiliations

¹ Centre for Health Economics at Warwick, Warwick Medical School, University of Warwick, UK.
² NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK.
³ Yulius Academy, Yulius Mental Health Organization, The Netherlands; and Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands.
⁴ Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands.
⁵ Department of Psychiatry, University Hospital Split, Croatia; and School of Medicine, University of Split, Croatia.
⁶ Unit of Epidemiological Psychiatry and Evaluation, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Italy.
⁷ School of Medicine and Medical Science, University College Dublin, Republic of Ireland; and Lucena Child and Adolescent Mental Health Services, St. John of God Community Services, Republic of Ireland.
⁸ Yulius Academy, Yulius Mental Health Organization, The Netherlands and Clinical Child and Family Studies, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, The Netherlands.
⁹ Warwick Medical School, University of Warwick, UK and Children and Young People's Mental Health Service, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK.
¹⁰ Child and Adolescent Psychiatry Unit, Centre Hospitalier Universitaire de Montpellier, Saint Eloi Hospital, France; and Team PsyDev, CESP U1018, INSERM, Université de Versailles Saint-Quentin-en-Yvelines, University Paris Saclay, France.
¹¹ Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, UK; and HealthTracker Ltd, UK.
¹² Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Germany.
¹³ Warwick Medical School, University of Warwick, UK.
¹⁴ Department of Neurosciences, KU Leuven, Belgium.
¹⁵ Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands; and Department of Clinical Medicine, University of Copenhagen, Denmark.
¹⁶ Department of Psychology, University of Warwick, UK.

PMID: 37749976
PMCID: PMC10617498
DOI: 10.1192/bjo.2023.559

Abstract

Background: The boundary between services for children and adolescents and adults has been identified as problematic for young people with mental health problems.

Aims: To examine the use and cost of healthcare for young people engaged in mental healthcare before and after the child/adolescent and adult service boundary.

Method: Data from 772 young people in seven European countries participating in the MILESTONE trial were analysed. We analysed and costed healthcare resources used in the 6-month period before and after the service boundary.

Results: The proportion of young people engaging with healthcare services fell substantially after crossing the service boundary (associated costs €7761 pre-boundary v. €3376 post-boundary). Pre-boundary, the main cost driver was in-patient care (approximately 50%), whereas post-boundary costs were more evenly spread between services; cost reductions were correlated with pre-boundary in-patient care. Severity was associated with substantially higher costs pre- and post-boundary, and those who were engaged specifically with mental health services after the service boundary accrued the greatest healthcare costs post-service boundary.

Conclusions: Costs of healthcare are large in this population, but fall considerably after transition, particularly for those who were most severely ill. In part, this is likely to reflect improvement in the mental health of young people. However, qualitative evidence from the MILESTONE study suggests that lack of capacity in adult services and young people's disengagement with formal mental health services post-transition are contributing factors. Long-term data are needed to assess the adverse long-term effects on costs and health of this unmet need and disengagement.

Keywords: Europe; Mental health services; cost of illness; randomised controlled trial; transition.

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Conflict of interest statement

S.P.S. is part-funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care West Midlands, now recommissioned as NIHR Applied Research Collaboration West Midlands. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. P.J.S. is the co-inventor of the HealthTracker™, and is the Chief Executive Officer and shareholder in HealthTracker Ltd. F.C.V. publishes the Dutch translations of the Achenbach System of Empirically-Based Assessment, from which he receives remuneration. A.M. was a speaker and advisor for Neurim, Shire, Infectopharm and Lilly (all not related to transition research). All remaining authors have no conflicts of interest to declare.

Figures

**Fig. 1**
HoNOSCA scores pre- and post-boundary. HoNOSCA, Health of the Nation Outcome Scales for Children and Adolescents.

**Fig. 2**
Cost component before and after the service boundary.

**Fig. 3**
Mean costs by severity tertile.

**Fig. 4**
Cost by severity status and mental health engagement post-boundary (engagement data were not collected in Italy).

See this image and copyright information in PMC

References

1. Singh SP, Tuomainen H. Transition from child to adult mental health services: needs, barriers, experiences and new models of care. World Psychiatry 2015; 14(3): 358–61. - PMC - PubMed
1. Appleton R, Elahi F, Tuomainen H, Canaway A, Singh SP. “I'm just a long history of people rejecting referrals” experiences of young people who fell through the gap between child and adult mental health services. Eur Child Adolesc Psychiatry 2021; 30(3): 401–13. - PMC - PubMed
1. Butterworth S, Singh SP, Birchwood M, Islam Z, Munro ER, Vostanis P, et al. Transitioning care-leavers with mental health needs: ‘they set you up to fail!’. Child Adolesc Ment Health 2017; 22(3): 138–47. - PubMed
1. Singh SP, Paul M, Ford T, Kramer T, Weaver T, McLaren S, et al. Process, outcome and experience of transition from child to adult mental healthcare: multiperspective study. Br J Psychiatry 2010; 197(4): 305–12. - PubMed
1. Singh SP, Tuomainen H, Bouliotis G, Canaway A, Girolamo GD, Dieleman GC, et al. Effect of managed transition on mental health outcomes for young people at the child–adult mental health service boundary: a randomised clinical trial. Psychol Med 2023; 53(6): 2193–204. - PMC - PubMed

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Healthcare costs for young people transitioning the boundary between child/adolescent and adult mental health services in seven European countries: results from the MILESTONE study

Affiliations

Healthcare costs for young people transitioning the boundary between child/adolescent and adult mental health services in seven European countries: results from the MILESTONE study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Grants and funding

LinkOut - more resources

Full Text Sources