Should We Still Care About the Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) Transition? Evidence From a Systematic Review and Meta-Analysis

Abstract

Objective Transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) represents a vulnerable period for transitional age youth (TAY), with high risk of disengagement and unmet needs. Evidence on effective transition models remains limited. This systematic review and meta-analysis aimed to quantify how many TAY achieved the CAMHS-AMHS transition, assess implementation of transition protocols, identify systemic barriers, and synthesize service improvements. Method Studies published between January 2013 and November 2025 were identified through PubMed, PsycINFO, Scopus, ProQuest, and Cochrane. Predefined inclusion criteria were applied, including youth aged 15-24, quantitative or mixed-methods designs, and studies describing mental health service models. Qualitative and non-psychiatric studies were excluded. Methodological quality was assessed using AMSTAR, the Newcastle-Ottawa Scale, RoB2, and SANRA, and transition proportions were pooled using a random-effects model. Results Forty-four quantitative or mixed-methods studies were included in the systematic review, and twenty-three contributed to the meta-analysis, encompassing 12,466 youth. The random-effects model estimated that 33% transitioned to AMHS (95% CI: 24-44), with substantial heterogeneity (I 2 = 97.9%). Duration of past care varied by diagnoses, from about 1 year for emotional conditions to over 5 years for neurodevelopmental disorders. Structured interventions, including transition coordinators, joint CAMHS-AMHS planning, and youth-specific clinics, were associated with higher engagement, shorter waiting times, and a greater proportion of completed handovers. However, guideline implementation was inconsistent, and barriers such as non-referral, strict diagnostic criteria, youth refusal, and fragmented services led to high disengagement rates, with up to 55% losing contact post-transition. TAY not referred often remained in CAMHS, were redirected to primary care, or disengaged entirely. Conclusion Although some progress has been made, organizational and clinical obstacles still appear to influence transition pathways more than TAY needs or developmental readiness. Concerning the limitations, the included studies varied widely in design, participant criteria, quality, and definition and measurement of transition outcomes, all contributing to heterogeneity and limiting direct comparability. Quantitative data on key aspects such as transition duration or past care were also limited, reducing the possibility of more detailed analyses. Learning from the marked variability across services, structured yet adaptive and collaborative frameworks may support improved continuity. Study registration information Transitional Age Youth Model Of Care (TAY-MOC) : metanalysis and systematic review about models of care in psychiatry; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024595896

The authors' abstract, as published at the source. JAACAP Open, 2026 · DOI ↗