Open Access Open Badges Research article

‘Talking a different language’: an exploration of the influence of organizational cultures and working practices on transition from child to adult mental health services

Susan McLaren1, Ruth Belling1*, Moli Paul2, Tamsin Ford3, Tami Kramer4, Tim Weaver4, Kimberly Hovish5, Zoebia Islam6, Sarah White7 and Swaran P Singh2

Author Affiliations

1 Faculty of Health and Social Care, London South Bank University, London, United Kingdom

2 Division of Mental Health and Well Being, Warwick Medical School, The University of Warwick, Coventry, United Kingdom

3 Peninsula Medical School, University of Exeter, Exeter, United Kingdom

4 Faculty of Medicine, Imperial College, London, United Kingdom

5 Institute of Education, University of London, London, United Kingdom

6 Research and Innovation Department, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, United Kingdom

7 St. George’s University of London, London, United Kingdom

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BMC Health Services Research 2013, 13:254  doi:10.1186/1472-6963-13-254

Published: 3 July 2013



Organizational culture is manifest in patterns of behaviour underpinned by beliefs, values, attitudes and assumptions, which can influence working practices. Cultural factors and working practices have been suggested to influence the transition of young people moving from child to adult mental health services. Failure to manage and integrate transitional care effectively can lead to young people losing contact with health and social care systems, resulting in adverse effects on health, well-being and potential.


The study aim was to identify the organisational factors which facilitate or impede transition of young people from child and adolescent mental health services (CAMHS) to adult mental health services (AMHS) from the perspective of health professionals and representatives of voluntary organisations. Specific objectives were (i) to explore organizational cultures, structures, processes and resources which influence transition from child to adult mental health services; (ii) identify factors which constitute barriers and facilitators to transition and continuity of care and (iii) make recommendations for service improvements. Within an exploratory, qualitative design thirty four semi-structured interviews were conducted with health and social care professionals working in CAMHS and AMHS in four NHS Mental Health Trusts and four voluntary organizations, in England.


A cultural divide appears to exist between CAMHS and AMHS, characterized by different beliefs, attitudes, mutual misperceptions and a lack of understanding of different service structures. This is exacerbated by working practices relating to communication and information transfer which could impact negatively on transition, relational, informational and cross boundary continuity of care. There is also evidence of a cultural shift, with some positive approaches to collaborative working across services and agencies, involving joint posts, parallel working, shared clinics and joint meetings.


Cultural factors embodied in mutual misperceptions, attitudes, beliefs exist between CAMHS and AMHS. Working practices can exert either positive or negative effects on transition and continuity of care. Implementation of shared education and training, standardised approaches to record keeping and information transfer, supported by compatible IT resources are recommended, alongside management strategies which evaluate the achievement of outcomes related to transition and continuity of care.

Transition; Culture; Working practices; Care continuity; Mental health