“It’s all about survival” : Young adults’ transitions within psychiatric care from the perspective of young adults, relatives, and professionals

Sammanfattning: Aim:The overall aim of this thesis was to explore young adults’ transitions within psychiatric care from the perspective of young adults, relatives, and professionals. Method: The thesis includes four studies (I–IV) with a qualitative approach. Data for study I were collected through focus group discussionswith professionals of child and adolescent psychiatry (CAP) and general psychiatry (GenP), and analyzed using deductive content analysisbased on Meleis’s theory of transition. Data for studies II–IVwere collected from individualinterviews with young adults and relatives withexpectations and experiences of transfer from CAP to GenP (II), from young adults with experiences of care in both CAP and GenP (III), andfrom relatives with experiences of parenting young adults with mental illness (IV). The data from studies II–IV were analyzed using grounded theory(GT) as described by Corbin and Strauss.Results:The synthesis of the four studies (I–IV) resulted in a grounded theory, “Support and intrinsic motivation as prerequisites for transition and recovery,” describing young adults’ transitions within psychiatric care. The result shows that young adults with mental illness undergo multiple simultaneous transitions during transfer from CAP to GenP, and that theseinclude developmental, situational/organizational, and health/illness transitions. It was important for the young adult to achieve intrinsic motivation in order to take responsibility for healthcare matters, to continue care, and to strive for recovery. Intrinsic motivation to continue care was created by trustful, caring relationships with professionals who encountered the young adults as a person, with respect to maturity. Furthermore, the result shows the importance of inclusive attitudes towards relatives, with possibilities for them to participate in young adults’ care as well as opportunities to receive professional support for themselves, which facilitated relatives’ abilities to manage their own lives and, moreover, to continue to providesupport to young adults with mental illness.Conclusions:This thesis highlights knowledge about the multiple simultaneous transitions that young adults experience when they reach the age of 18 and have closure of their care at CAP and continue care at GenP. To facilitate these transitions and empower young adults to continue care when it is needed and to strive for recovery, professionals need to take into account the factorsthat facilitate or inhibit healthy outcomes. Transition planning in cooperation with CAP, GenP, the young adult, and his or her relatives is recommended in order to reduce uncertainty about the new situation. It is also important to take into account that young adults need continuity andsupport in order to create trustful relationships. To reduce the risk of “falling into the caring gap,” individual assessments about young adults’ needs,intrinsic motivation to receive care, and access to support from relatives should be implemented in the transition planning. If the young adultsand their relatives fail to receive the support they need, the risk for their dropping out of care is increased.