Transition of Service Users from Child to Adult Mental Health Clinic in Lagos Nigeria

Abstract

Adolescence is a potentially stressful period characterised by various developmental changes. Disruption in provision and utilisation of mental health services during the transition from adolescence to adulthood has dire implications on clinical outcomes. There is dearth of data on the transition of service users from child to adult mental health services in Africa. This study determined the rate and correlates of drop out from treatment during the transition from child and adolescent clinic to the adult out-patient clinic at a public mental health care facility in Nigeria.  Using a retrospective cohort study design, clinical records of adolescent patients transferred to the adult clinic of a public psychiatric hospital after attaining adulthood were reviewed. Relevant clinical and socio-demographic data were documented in a pro-forma and analysed with SPSS 16.  More than a third (37.1%) of the cohort dropped out of treatment during transition from the child and adolescent clinic to the adult clinic.  Factors associated with disengagement from services during the transition period included male gender (p= 0.004), age <19 years at implementation of transfer (p<0.001) and previous traditional or spiritual treatment in the pathway to care (p= 0.015). On regression analysis, male gender (p=0.003), traditional or spiritual pathway to care (p=0.004) and transfer from child clinic before 19 years (p<0.001) were independently associated with drop-out from follow-up after transition to the adult clinic. The findings highlight the need for interventions targeted at minimising disruption in mental health service utilisation during transition from adolescence to adulthood. The transition process should be customised to address the specific and peculiar mental health needs of each adolescent.