Supplementary memorandum submitted by
YoungMinds
1. YoungMinds wishes to submit additional
evidence to the Education Select Committee Behaviour and Discipline
Inquiry concerning how we would model effective child and adolescent
mental health services (CAMHS) and how referrals to specialist
CAMHS can be improved.
2. At YoungMinds we believe that the comprehensive
CAMHS model is the most effective way to deliver the full range
of mental health services to young people. By comprehensive we
are referring to the full range of services that are required
to meet child and adolescent mental health needs eg promoting
good mental health, early intervention when problems first arise,
and when specialist mental health help is needed. This comprehensive
range of services is important because mental health is a continuum
with mental health and wellbeing at one end, and severe mental
illness at the other. Young people move along this continuum at
different stages in their lives so mental health services should
not only be viewed as specialist NHS services that are focused
on people with severe mental health problems. The concept of comprehensive
CAMHS emphasises that mental health and wellbeing is the responsibility
of every service that works with children, young people and their
families and not just specialist mental health teams.
3. This conceptual model for CAMHS is not
new. The tiered model for CAMHS was first outlined in Together
We Stand in 1995, and Standard 9 of the National Service Framework
for Children, Young People and Maternity Services stated that
a comprehensive CAMHS would be available in all areas by 2006.
Some areas have made significant progress, but this is certainly
not the case in all areas.
4. We believe that the Comprehensive CAMHS
model is still a good one, but the problem is connected to its
implementation. The comprehensive CAMHS should be seen as a system
and if parts of the system are not working, then the model will
not be able to work effectively. There are a number of reasons
why there are problems with the implementation. This has been
discussed in detail elsewhere (CAMHS Review, National Advisory
Council), but from our perspective the main reasons are connected
to:
— Mental health continuing to be marginalised
so it not seen as important, and just seen as the responsibility
of specialist CAMHS within the NHS
— The different relevant agencies not working
together
— Lack of good leadership from the relevant
agencies
— Mental health services still being the
Cinderella of Cinderella services and there being a lack of funds
for CAMHS; and
— Lack of training in child development
and mental health for staff who work in universal or tier 1 services
eg GPs, teachers etc.
— Services not implementing what children,
young people and their families tell them.
5. There is a greater awareness of mental
health, but it still seems to be seen as the responsibility of
specialist CAMHS, rather than tier 1 or universal level services.
So if the number of young people being identified as potentially
having mental health problems increases, but capacity within specialist
CAMHS doesn't grow, then it is not surprising that there are difficulties
in being referred to specialist CAMHS, and that there are long
waiting lists.
6. Relevant services in a given area need
to work in genuine partnership to plan, commission and deliver
the comprehensive CAMHS model. The different agencies need to
have a mandate and incentives to encourage them to work in partnership.
There also needs to be good leadership within these agencies to
drive forward partnership working. Partnership working relies
on trust, and this needs to be nurtured and developed through
good working relationships between staff in different agencies.
7. The full range of mental health services
should be developed in line with the needs of children or young
people and their families, rather than the needs of the services.
So services within a local area should ensure that the joint strategic
needs assessment (JSNA) and that the views of children, young
people and families are central to how services are developed
and delivered.
8. There needs to be a shared understanding
of mental health and wellbeing, and of the range of services that
are required, and what the responsibilities are for each agency.
IMPROVING REFERRALS
9. We appreciate that there are difficulties
in referring children and young people to specialist CAMHS services.
To improve referrals there needs to be:
— Adequate capacity at all levels, to ensure
that the entire system works, and that undue pressure is not put
on one part of the system. For instance, specialist CAMHS need
to have the capacity to meet the mental health needs of young
people in their area. This is important to ensure that lower level
services such as school counselling services are not left to care
for young people who have serious mental health problems.
— A better understanding of relevant local
services. This is important as there may be good voluntary sector
services that might be more appropriate for some young people.
These services may be able to provide support whilst they are
waiting to access specialist CAMHS.
— An understanding of referral protocols,
so tier 1 or universal level staff know how to refer on, and what
the criteria are. So time isn't wasted on inappropriate referrals.
— Flexible ways to access services such
as self referral. Referrals need to be less bureaucratic and enable
young people to be able to self refer.
— Support from specialist CAMHS to support
universal and tier1 staff. Support from a practitioner such as
a primary mental health worker (PMHW) could provide support for
teachers who are concerned about a particular child.
— Targeted support in schools such as counselling,
to provide support to children and young people who have mental
heath needs.
— Emphasis on promoting mental health and
wellbeing. This could be carried out in a number of settings,
and in partnership between various agencies. For instance, universal
mental health promotion could take place in schools as part of
PSHE lessons, but other agencies such as the NHS and the voluntary
sector could contribute to these lessons.
— Tier 1 and universal level staff should
receive appropriate training in children and young people's development,
and mental health. This would enable them to correctly identify
mental health problem and be able to make more appropriate referrals.
— Good quality information via online platforms,
print and telephone helplines needs to be provided in accessible
ways for those young people who are waiting to access services,
or who have concerns about their mental health. This could give
them some support whilst they are waiting, rather than being left
with no help at all when they may be very distressed.
REFERENCES
Department of Health (2004) Standard 9: The
mental health and psychological well-being of children and young
people. London: Department of Health. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4089114
Independent CAMHS Review (2008) Children and
young people in mind: the final report of the National CAMHS Review.
London: Department for Children, Schools and Families, and Department
of Health. http://www.dcsf.gov.uk/CAMHSreview/downloads/CAMHSReview-Bookmark.pdf
National Advisory Council for Children's Mental
Health and Psychological Wellbeing (2009) One year on: the first
report from the National Advisory Council for Children's Mental
Health and Psychological Wellbeing. London: Department for Children,
Schools and Families and Department of Health. http://www.dcsf.gov.uk/CAMHSreview/pdfs/NAC%20OYO.pdf
Williams, R. & Richardson, G. (1995) Together
we stand: the commissioning, role and management of child and
adolescent mental health services: An NHS Health Advisory Service
(HAS) thematic review. London: HMSO.
For further information please contact Paula
Lavis, Policy and Knowledge Manager, at 48-50 St John's Street,
London EC1M 4DG. Telephone 0207 336 8445 or visit www.youngminds.org.uk
November 2010
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