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,
Rebecca Appleton,
Larissa van Bodegom,
Gwen Dieleman,
Tomislav Franić,
Suzanne Gerritsen,
Giovanni de Girolamo,
Athanasios Maras,
Fiona McNicholas,
Mathilde Overbeek,
Moli Paul,
Diane Purper-Ouakil,
Paramala Santosh,
Ulrike Schulze,
Swaran P. Singh,
Cathy Street,
Priya Tah,
Bie Tremmery,
Helena Tuomainen,
Frank C. Verhulst,
Dieter Wolke,
Jason Madan,
for the MILESTONE Consortium
Affiliations
Alastair Canaway
Centre for Health Economics at Warwick, Warwick Medical School, University of Warwick, UK
Rebecca Appleton
NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
Larissa van Bodegom
Yulius Academy, Yulius Mental Health Organization, The Netherlands; and Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands
Gwen Dieleman
Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands
Tomislav Franić
Department of Psychiatry, University Hospital Split, Croatia; and School of Medicine, University of Split, Croatia
Suzanne Gerritsen
Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands
Unit of Epidemiological Psychiatry and Evaluation, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Italy
Athanasios Maras
Yulius Academy, Yulius Mental Health Organization, The Netherlands; and Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands
Fiona McNicholas
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
Mathilde Overbeek
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
Moli Paul
Warwick Medical School, University of Warwick, UK and Children and Young People’s Mental Health Service, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
Diane Purper-Ouakil
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
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
Ulrike Schulze
Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Germany
Warwick Medical School, University of Warwick, UK and Children and Young People’s Mental Health Service, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands; and Department of Clinical Medicine, University of Copenhagen, Denmark
Dieter Wolke
Department of Psychology, University of Warwick, UK
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.
