Should we still care about the CAMHS-AMHS transition? Evidence from a systematic review and meta-analysis

Background: 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 mental health 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. Methods: Studies published between January 2013 and November 2025 were identified through PubMed, PsycINFO, Scopus, ProQuest, and Cochrane. Results: Forty-four studies using quantitative or mixed methods were included in the systematic review, and twenty-three provided data for meta-analysis, which encompassed a total of 12,466 youth (mean = 542 ± 1.65). The random-effects model estimated that 33% of youth transitioned to AMHS (95% CI: 24-44). Duration of past care varied by condition, from 1 year for emotional conditions to over 5 years for neurodevelopmental conditions. Structured interventions, including transition coordinators, joint CAMHS-AMHS planning, and youth-specific clinics, improved engagement, reduced waiting times, and increased successful 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. Conclusions: Although some progress has been made, organizational and clinical obstacles still shape transition pathways more than TAY care needs or developmental readiness. Structured yet flexible frameworks are needed to improve continuity.