Appendix 13: Summary of the visit to a CAMHS clinic
On Monday 24 October we visited children and adolescents’ mental health services (CAMHS) at the Maudsley Hospital in South London. The Chair, Lord Bach and Lord Mawson were in attendance.
We held two discussions, the first with two young people, four parents, and four members of staff; the second with a young person, an adoptive parent, and five members of staff. Recurring themes are set out below. Although we were hosted by CAMHS and focussed on mental health, many comments related to other agencies and policy areas including special educational needs and disabilities and the care system.
Early intervention. We heard that young people often do not receive help until their mental health reaches a crisis point, such as having to go to A&E. Moreover, sometimes special educational needs are sometimes only diagnosed after a mental health crisis. We heard that girls’ needs can be at particular risk of being overlooked, as problems may not be so obvious from their behaviour, although there is perhaps greater stigma attached to mental ill health in young men. It was suggested that more could be done to educate children about social, emotional and mental wellbeing at an early age.
Patient experience. One parent told us that sometimes practitioners “forget the humanity that is required.” Parents and children generally felt that, although many of the clinicians they had worked with were excellent, long waiting lists meant that help didn’t last as long as they would have liked because the clinician had to move onto the next patient. Some felt that decisions are too often based on paperwork without spending time with a child. One young person told us that they would have liked more face-to-face meetings rather than letters and phone calls. More broadly, children’s voices being heard was thought to be key. One young person in the care system told us that social workers had often been dismissive and hard to get hold of—not taking their wishes seriously until they were well into their teens. They had seldom been asked for feedback on the support they were receiving.
Accessibility of information. Communication could be improved. This includes being told where a child is on a long waiting list. More generally, at times parents felt overwhelmed by information which they had difficulty processing. At other times, including immediately after a diagnosis, they felt abandoned with little guidance or signposting to further support. Parents would have liked more pro-active follow-up from practitioners. One young person suggested that helplines could be better publicised.
Support for families. Parents and clinicians highlighted that young people’s mental ill health puts strain on their families as well as themselves. Parents did not always feel they had personally received enough support at a very tough time for them. We heard about how families sometimes mentor each other and that there could be scope for more such work.
Disconnected systems. One of the most common criticisms was about fragmentation and dysfunction in systems. The young people and parents we spoke to suggested that they had received excellent care but this was because of excellent practitioners and in spite of the systems and processes in which they must operate. One told us that they would like individual clinicians to be more empowered to make decisions. Families often felt like they were being passed between different siloes, each of which was required to engage in a series of box-ticking exercises rather than tailoring support for the child as much as they might have. However, schools were singled out for praise: providing continuity and bridging the gap between different agencies. There was praise for the Department for Education’s Alternative Provision Specialist Taskforce Pilot, which brings together specialists in health, education, social care, youth services and youth justice in schools.
Education, Health and Care Plans. We were told of the difficulty of getting an EHCP. One participant suggested that, although they were supposed to increase parental choice, EHCPs only work for middle class parents who have the resources to appeal to tribunals, hiring private psychiatrists and lawyers. Schools are not always supportive. There was also concern about a lack of support for those who have special needs but do not meet the threshold for an EHCP.
Challenges for children in care. It was also noted that early intervention can be essential to address trauma for adopted children from their early years with birth parents. We heard how contact with birth families can exacerbate trauma and a concern that this is not always taken into account when arrangements are made. There was a further concern about continuity of care, both in relation to children being moved too often between families and having several social workers.
We are very grateful to all those who gave up their time to speak to us. We would particularly like to thank the young people and parents we met for sharing their experiences with us.