A new report issued by the Consumer Quality Initiatives in Dorchester, MA, records the difficulties experienced by young adults who receive mental health treatment as adolescents and later transition to adult services. The group finds that eligibility for adult services is stricter, and Medicaid dollars primarily support short-term acute care services.
In addition, most of the service options for adults are not appropriate to the age of the newly transitioned young adults, as they are geared to older adults with more severe disorders. Finally, a legal guardian no longer is responsible for the basic needs of these individuals, meaning that homelessness and criminal justice involvement become real possibilities.
Principal investigator Jonathan Delman, an attorney who lives with manic depression, says, "[The news] is not all bad. The Department of Mental Health has made youth transition a priority. Two young adults who assisted on this project have co-chaired the department’s youth development committee that is charged with developing transition planning for the State Planning Council, and the department has provided us with seed money to develop a peer-mentoring project for youth in intensive residential treatment programs. We also are talking to MassHealth officials about the inclusion of a strong transition component in a family-focused program that will provide support to youth through age 22."
The report was drawn from 24 interviews with young adults 18 to 26 who had received adolescent public mental health services in the state. A large majority of the group was white and had been hospitalized and/or received therapy at some point during their adolescence. There was a median age of 21, and males and females were represented in equal numbers.
Twelve of the respondents reported they currently were living in a group home or supported housing for people with mental health and/or substance abuse difficulties, with nine of them living in programs that focused on young adult needs. Of the remainder, four were homeless, three were in a state hospital, three lived with family, and two lived with roommates.
One-third of the respondents were working part time. About 75% had been graduated from high school or obtained a GED. Three of the group had taken college courses but dropped them for psychiatric reasons. Five were currently taking college courses, with two attending full time.
Before aging out, just over one-third were living in a group residential setting and one-third were in a locked intensive residential treatment program, with the remainder at home with family or with a foster family. Those aging out of the group or residential setting were most commonly discharged to another group home or family, although some were moved to a state hospital.
When asked to describe the process of aging out, a majority used words like "scary," "stressful," "hard," "traumatizing," and "awful," reporting feelings of shock and helplessness. Five respondents reported positive experiences because they did not find adolescent services helpful or did not feel they were treated respectfully.
Themes emerging from those who found the experience difficult included:
- One-half of respondents said the process felt "unstable," as though the ground were moving out from under them. Several had little notice they were to be moved and didn’t have a chance to first visit their new adult setting and meet staff. Others found themselves homeless or in prison.
- One-third said they had an immediate loss of interpersonal support. Some no longer had substantial access to an adolescent case manager or therapist they had grown to know and trust. Others missed the general support they had as youth, such as being driven to movies and assistance with shopping.
- One-quarter commented on the shock of entering adult programs or hospitals with an older group of people with whom they did not identify.
When asked what types of help could have made the experience more positive, they usually mentioned adult independent skills training during the transition period such as money management, socialization skills, and job search skills; advanced planning for the transition; and involvement in planning for the transition.
Based on the interviews, Consumer Quality Initiatives makes the following recommendations to improve youth transition to adulthood:
- Start the transition planning process by at least age 16.
- Youth should not only be involved in planning their transition, but the process should be driven by their needs and desires, rather than the needs and desires of the system.
- There should be a consistent level of support for young people before and after they age out, with a strong independent living skills training component throughout.
- There should be age appropriate congregate living services for the youth in transition.
- A peer mentor program should be established with mentors who are young adults who have experienced mental illness and can help youth set goals, find resources that will move them toward their goals, and advise in a supportive and friendly way.
- A youth in transition citizenship web site should be developed so mentors and youth could collaboratively seek resources and navigate the health system and locate rehabilitative resources.
- A youth advocacy training curriculum should be established for those who have experienced the mental health system so they may develop a sustained and formalized voice to inform policy-makers about their needs and how the system can best respond to them.
(To download the report, go to: www.mass-cst.org.)
A new report issued by the Consumer Quality Initiatives in Dorchester, MA, records the difficulties experienced by young adults who receive mental health treatment as adolescents and later transition to adult services. The group finds that eligibility for adult services is stricter, and Medicaid dollars primarily support short-term acute care services.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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