87 Patient cost-sharing, mental health care and inequalities APPENDIX A. YOUTH MENTAL HEALTH AND MENTAL HEALTH CARE Youth mental health and disorders Globally, about three-quarters of adult mental disorders have their onset during adolescence [1]. Mood disorders – namely depression and bipolar disorders – and psychotic disorders – namely schizophrenia – are the leading causes of disability amongst youth between 15 and 19 around the world [2]. In terms of prevalence/incidence, the range of diagnoses commonly found in youth is much broader, with childhood behavioural disorders (e.g. attention-deficit/hyperactivity disorder - ADHD, conduct disorder), anxiety disorders (including phobias) and eating disorders taking a large share [1]. Unfortunately, nationally representative and updated figures of mental health disorders in Dutch youth up to the age of 18 are lacking [3]. In a representative sample of 13 to 18 year-old adolescents from 1993 six-month prevalence of psychiatric disorders was about 22% for any disorder, with the most common disorders being simple phobia, social phobia, and conduct disorder [4]. An analysis of the TRacking Adolescents’ Individual Lives Survey (TRAILS) at the age of 19 between 2008 and 2010 reported 45% of all sample experiencing at least one disorder in their lifetime: 17% with mood disorders (of which 15% had criteria for major depression), 25% with anxiety disorders, and 16% with behavioural disorders (equal share for oppositional defiant and conduct disorders) [5]. More recent information can be obtained from the Health Behaviour in School-aged Children (HBSC) survey, for a more general characterization of Dutch adolescents´ mental wellbeing [6]. Results from 2017 reported high punctuations on the Strength and Difficulties Questionnaire (SDQ), suggesting that 22% of 16-years old had emotional problems, 12% had behavioural problems, 25% had hyperactivity and 13% had problems with their peers [6]. Transition between CAHMS and AMHS in the Netherlands In the Netherlands, the transitional boundary between Children and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS) is set at 18 years old [7, 8]. As in other countries, differences in service configuration and practices in the Dutch setting challenge the appropriate transition between CAMHS and AMHS.[8] A survey distributed in 2014 has enquired mental health care professionals about their experiences with transitional activities and process. Although the sample of respondents is not representative of the universe of practitioners in the Netherlands, findings suggest heterogeneity in the approaches around the transition. A considerable proportion of professionals reported not referring youth further to care when reaching adulthood (30.8%) or to do it after the age of 18 (42.7%). Responses suggest a lack of transitional policy, with 32.6% of professionals deciding based on own deliberation and just 11.2% according to service policies. Authors concluded that the “referral in the Netherlands does not seem to entail more than ending care at one service and starting at another”, and that further collaboration between CAMHS and AMHS – although deemed important by respondents – would be prevented by organizational and financial complications. 3
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