The “grey space” between CAMHS and adult mental health services is often described as an administrative gap. In reality, it is a structurally produced zone of abandonment – one that does not simply fail young people, but actively contributes to their deterioration.
I know this space intimately. At eighteen, I transitioned out of CAMHS into adult services while my eating disorder was escalating. I was no longer considered a child, but I was not yet “unwell enough” in the right way to receive immediate, specialist adult care. What I experienced was not a pause in treatment, but a fragmentation of responsibility: different services, thresholds, and decisions that collectively created a vacuum where my condition worsened.
This is not an individual anomaly. It reflects how mental health systems are designed – through age cut-offs, diagnostic thresholds, and risk categories that prioritise bureaucratic eligibility over continuity of care. In practice, this means that support is often withheld until distress becomes visible, measurable, and severe enough to meet institutional criteria.
In my case, this escalation had consequences. I moved from CAMHS, where I had some continuity, into adult services where I was placed in a general psychiatric ward. The environment was not designed for eating disorders, nor for young people navigating transition. Patients were significantly older, with a wide range of diagnoses and acute crises. I often felt unsafe and misunderstood, and my eating disorder behaviours were not consistently recognised or addressed. Over time, my physical health deteriorated further while I waited for access to specialist care.
This is not about individual clinicians failing to act with care or intention. It is about the structure they are working within. When services are divided into rigid categories – child/adult, physical/mental health, “severe”/“moderate” – people who exist between those categories are rendered temporarily invisible. The system does not know how to hold complexity, so it delays intervention until crisis becomes undeniable.
From a mental health justice perspective, this is not neutral. Thresholds such as weight criteria, risk scoring, and service eligibility are not simply clinical tools; they are mechanisms of gatekeeping. They determine who is seen, who is believed, and who is left to wait. In eating disorder care especially, this often translates into a dangerous logic: the sicker you become, the more likely you are to receive help.
This raises a fundamental question: what kind of system requires deterioration as proof of need?
The grey space also reflects geographic inequality. In Wales, where I am from, access to specialist eating disorder services is limited, meaning many people are placed in non-specialist settings or must wait for beds elsewhere in the UK. This lack of local provision compounds the sense of displacement and delay. Care is not only fragmented across age thresholds, but across geography and availability.
A mad liberation framework helps name what is often obscured in policy language: that distress is not simply an individual pathology to be managed, but is shaped by systems of power, access, and exclusion. It challenges the assumption that psychiatric systems are neutral arbiters of need, and instead asks how those systems produce harm through their structures.
It also insists that lived experience is not secondary to clinical expertise. From this perspective, my understanding of what was happening to me was not a symptom to be corrected – it was knowledge about how care was (not) being delivered. Many people I have met through my own experience have similar stories: long delays, inappropriate placements, and repeated crises that could have been prevented with earlier, more consistent support.
So what would it look like to dismantle the grey space?
It would mean moving away from crisis-driven thresholds towards continuity of care that does not collapse at the point of transition. It would mean services designed around need as it is experienced, not as it is measured. It would also mean investing in non-crisis interventions, peer-led support, and models of care that do not rely on escalation as a prerequisite for attention.
Most importantly, it would require accepting that “waiting until it is bad enough” is not a safeguarding strategy – it is a systemic failure.
My experience is not an exception, but part of a wider pattern that many people encounter when moving between services or categories that do not fit lived reality. Naming the grey space is not only about describing a gap; it is about recognising how that gap is produced, maintained, and normalised.
If mental health systems are serious about prevention, then the grey space cannot remain. It must be understood as an active site of harm – not an unfortunate delay, but a structural condition that demands change.