Case Studies

Bridging The Gap: Teen to Adult Personal Advisors (TAPAS)

Bridging the Gap is a clinical mental health service provided by the Sussex Partnership NHS Trust, for young people aged 14-25 with mental health needs. Though it is a clinical service, Bridging the Gap has strong links with Brighton’s Integrated Youth Support Service and the voluntary sector. The aim of the Bridging the Gap service is to develop better access to services and earlier intervention for young people with mental health problems, particularly those who will likely move into adulthood under the treatment of a mental health service.

The service operates through five qualified mental health workers called TAPAs (Teen to Adult Personal Advisors), two of which specialise in working with specific groups of young people - those from BME (black or minority ethnic) groups and those who are LGBT (lesbian, gay, bisexual or transgender). The TAPAs are based in various Youth Hubs across Brighton, though their work also involves outreach into other areas of the community. There are a range of professionals working out of the hubs including Connexions PAs, sexual health workers, and LGBT support workers. The TAPAs location in the hubs is particularly beneficial as part of their role is to link young people up to other services.

The TAPAs team work with young people through tailored, one-to-one sessions. The period of time each TAPAs team member works with a young person is dependent on the individual needs of that person. The service links in with specialist Child and Adolescent Mental Health Services (CAMHS), Early Intervention in Psychosis (EIP), the Adult Mental Health Service (AMHS) and substance misuse services.

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As part of the redesign of Brighton and Hove CAMHS, it was decided that a new service was needed in order to cater for young people with mental health needs who, for whatever reason, were not currently accessing services. Through research conducted by a range of people, including service providers, voluntary sector organisations and the young people themselves, it was found that mental health services were frequently losing young people in the transition to adulthood as they passed the 18 cut off age of the CAMHS service.

This was particularly the case for young people with behavioural and developmental disorders e.g. autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). The project was named ‘Bridging the Gap’ by the young people that took part in the research in recognition of the many challenges presented by the move from child to adult services.

Bridging the Gap is funded through Brighton and Hove CAMHS. It is linked to the Right Here project (www.right-here.org.uk), which is funded by the Paul Hamlyn Foundation and the Mental Health Fund. Right Here aims to change the way in which the mental health of young people aged 16-25 is addressed in the UK. Right Here Brighton and Hove is one of the project’s four pilot sites.

“Post 18, a lot of those young people find it difficult getting in to the adult services, and they are almost falling in to this black hole really... The way that CAMHS deals with that group, up until 18, is very different than adult services, and so when they go through adult services they find it very, very difficult to engage... CAMHS treat a lot of developmental/ behavioural conditions but the adult services, well it’s almost like, well they’ve become 18, they haven’t got it anymore.” (TAPAS)

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Referrals to the TAPAs team come from a wide range of other services, for example: CAMHS; AMHS; Connexions; GPs; YOTs and probation services. Because of the TAPAs placement in the youth service hubs, a number of young people make it on to the TAPAs caseload just by walking in to the centre. Importantly, one of the marked differences with the TAPAs service is in the speed of the response to referrals. Whereas the wait for an NHS appointment might be up to four weeks, TAPAs try and see young people within a week of them being referred.

Numbers accessing the service are lower than the average mental health worker, but the level and intensity of support given to each young person is considerably higher. Also, because of their location in the hubs, TAPAs frequently offer ‘on the spot’ support and advice, both to professionals working in different spheres and to young people who have just dropped in to the youth centre for that day only.

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Mainstream services tend not to wrap around the person. They have allotted slots where support and/or psychiatric help is administered. They deal only with the key issue and not with the person as a whole.

This is where TAPAs feel their service is different. Some of the ways they work innovatively with young adults are listed below.

Flexible and responsive working: The TAPAs team understand that young people may need more flexibility and effort to engage with a service than adults.

“When a young person becomes 18 and they have to go to the adult services, the leniency that they would have had certainly with CAMHS, literally stops... we are better able to offer them a flexible service that caters for their presentation and need. For example, they might have missed two or more appointments and you ring them, text them, you might write to them, speak to their parents. You do everything you can. So there is a big difference from what they would get from [adult services] and what they get from us.” (TAPA)

Using the ‘one-stop-shop’ approach or ‘no wrong door’:

Young adults can have all their needs met in one place. The hubs house multi- disciplinary professionals, and so a young person can benefit from a range of services that they might well have not accessed independently.

“When a young person comes to the service, they can get their housing sorted out, their benefits, Connexions and so on... If they have to leave from one place to another, they won’t get there.” (TAPA)

Linking in with other services:

In addition, the TAPAs team links young people in with other services that may affect their lives, for example: YOTs (youth offending teams); CAMHS; adult mental health services; Connexions; substance misuse services; LGBT services.

Supporting positives in young people’s lives:

The TAPAs help young people recognise the positive things in their life, and actively support them in reaching their goals.

“She gives me job things like a booklet of jobs I can look through. She’s very interested in my college. She wants me to finish. ‘Cause two months ago I didn’t care. [Other mainstream services] focus on the bad things and not on the good things, ‘how do you feel, do you feel bad’. It’s not talking just about how you feel that helps, it’s talking about all the other things. Like what you’ve achieved and what you’re doing with yourself. It’s not just the bad things.” (Gemma, 20)

Helping them develop life skills: Alongside the key area of mental health support, the TAPAs team also help young adults develop life skills. For example, getting their benefits, form filling, child care advice, financial and legal advice, paying bills and even setting up mobile phone accounts.

“They find it really difficult and stressful to fill in the application, whatever, and I’ve done quite a lot of support with that, helped them fill the forms in and go through it with them. It’s quite time-consuming but it’s important to them.” (TAPA)

Accompanying to other appointments: Where needed, TAPAs will also go with the young person to other important appointments they may have. This helps the young people feel secure, supported and able to talk through their feelings about their experience with that professional.

“[C] came to a CAMHS meeting with me last week to see if there’s any help or anything else they could offer. That really helped me there. I liked it because it gave both of the people different points of view. [C] knew what was happening and what they were talking to me about at CAMHS, and CAMHS knew I was [with the TAPAs team] and getting help there too. I haven’t seen the CAMHS lady for about six months, and a lot has happened since then, a lot. [C] just helped me sum it up really.” (Hannah, 15)

“She comes down to my psychiatrist appointments to support me. After it’s finished she’ll ask me how I feel about it, and how I think it went. It’s nice to know it’s not just me going through it. Someone else actually cares apart from my family.” (Gemma, 20)

Being a positive role model: The service recognises that some young people may not have benefited from having a significant adult in their lives, so in turn may not have experienced the boundaries, structure and guidance needed to make successful transitions to adulthood. The TAPAs therefore do a lot of work around stress management, and advice and guidance on lifestyles.

Link in with families: If possible, TAPAs will involve parents, other relatives and partners, but the involvement of family is always led by the young person. TAPAs also forge relationships with families when other issues are at play, for example, a young person going into custody.

“We try to involve their family as much as possible. When you go to an adult service, you will be dealt with as an individual, on your own. There’s none of that systemic approach. You’ll be dealt with as an adult, ‘this is what’s wrong with you, forget your parents’. And that’s the big difference. You can’t within this day and age, cut people off like that, because all the other bits within their life have some bearing on the way they actually present it.” (TAPA)

Finishing treatment when the young person is ready: Leaving the service is a mutual process decided between the TAPA worker and the young person. Sometimes a young adult will feel they are ready to leave, sometimes the TAPA worker will raise the topic. The young person will always be a key part of that decision-making though.

“Young people often dip in and out of treatment. You won’t discharge them as in three months they’ll come back and get a little boost and then go away again. You have to allow to that. That’s the way they want to use the service.” (TAPA)

Making access easier:

And as part of their outreach role, TAPAs will always make the effort to work with the young person at a place that suits them. This may mean home appointments, meeting in the hubs or it may be somewhere completely different.

“We have a young man, who is 20. He is up for sentencing and chances are he will go to prison. I will try to work out a programme that will work for him whilst he’s in the prison, so he doesn’t come back to what he has faced in the past, the behaviour, then get back in to prison.” (TAPA)

“[P] has said I can call him anytime I want. If you wanna chat or something, or if anything’s getting you down, or playing on your mind. We talk on the phone about twice a week.” (Mike, 22)

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• The TAPAs are currently providing training for non mental health staff in the hubs, so they can recognise mental health problems and refer if necessary.
• Making links with other services, such as social exclusion outreach workers and local GPs, and particularly statutory services.
• Implement a system which reviews all areas and issues impacting on a young person’s life and plots ‘distance travelled’, so young people will be able to see for themselves where they were and how far they have come.
• Ultimately, to replicate the ‘one stop shop’ approach to service delivery in other areas of Sussex.

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