Transitions from child to adult mental health care: the evidence-base for ESCAP guidance for clinicians

The transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) presents significant challenges, underscoring the need for improved transitional care procedures. Few European countries have implemented national transition-related guidance, despite the potential of clinical guidance to support appropriate care decisions and practices. We conducted a literature review to inform the development of the European Society of Child and Adolescent Psychiatry (ESCAP) transition guidance for clinicians. Following systematic principles, four databases (Medline, Embase, PsychInfo, Web of Science) were searched to identify relevant international research published from January 1, 2019 to April 10, 2025, to build on existing evidence. Titles and abstracts were reviewed by two independent reviewers. We screened 12,595 records and included 149 reports published since 2019. Illness severity was the primary predictor of AMHS transition, with only 20–25% transitioning directly, challenging assumptions that only specific diagnostic groups warrant continuity. Among those reaching the upper age boundary, the majority (40–60%) discontinue specialist services rather than transitioning to AMHS. Longitudinal data from the MILESTONE study – though limited by recruitment bias towards less severe cases – show that most maintain stable mental health without ongoing specialist input, yet 25% experience deterioration and 13% require readmission within two years. Many studies reported shortcomings regarding transition experiences for young people and parents/caregivers. However, structured preparation and stakeholder involvement can improve outcomes regardless of service destination. Findings challenge deficit-focused perspectives by showing that discontinuation represents the appropriate pathway for about half of young people. Substantial cross-country variation, often resource driven, underscores the importance of individualised, developmentally appropriate approaches that respect young people’s autonomy while providing necessary support.