CAMHS restructuring makes it difficult to treat young people, says report

CAMHS restructuring makes it difficult to treat young people, says report: it is becoming increasingly hard to provide effective care and treatment for children and young people with mental health problems, the Association of Child Psychotherapists has warned.

Child and Adolescent Mental Health Services are not only “chronically underfunded”, but the way in which services are sometimes being restructured makes it difficult to ensure children and young people, particularly those with severe and long-standing needs, are being effectively treated and supported.

Dr Nick Waggett, Chief Executive of the Association of Child Psychotherapists, said: “The ACP's report shows that in many areas specialist CAMHS services are being downgraded, with a loss of much needed clinical expertise and leadership.  We know that a lack of resources is one factor but our report raises concerns about recent service transformations and re-designs. These can lead to inefficiencies that mean that resources, especially the skilled workforce, are not used effectively and children and young people are not offered the effective and timely assessment and treatment they require.”

Based on a poll of 416 child and adolescent psychotherapists working within the NHS, the report records that specialist services are disappearing and found:

• 61% said that the main NHS service they work in was facing downsizing
• 72% said that the threshold for access to services has increased in the past five years
• 33% described services as mostly inadequate or completely inadequate
• 73% had witnessed a down-banding of specialist clinical posts
• 64% reported negative changes in the number of practitioner posts, 62% in sessions per client and 65% in the frequency of sessions
• 73% felt there had been a negative change in staff morale

The ACP supports the government’s proposals to extend mental health services into schools but highlights that this will only be effective if it is part of a comprehensive, properly funded and well-designed system. When asked if they could see evidence of the government’s claim of making 'one of the biggest expansion of services in Europe', 93% of respondents saw no evidence of this.

One child psychotherapist, who wished not to be named, said: “I am considering leaving the NHS as I am worried it is no longer safe to practise. It is tragic to witness the demise of a once flourishing and truly multidisciplinary specialist CAMHS. My skills are going to waste. Once the service was taken over by a new trust, the service was redesigned and now does not meet the needs of a large section of the population who have significant mental health needs. There is no time for proper assessments and treatment.”

The ACP has identified a number of initial factors of common danger signs of CAMHS in trouble including:

1. Specialist services are disappearing and being replaced by interventions that would previously have been offered in primary care, leading to rising levels of suicide, self-referral to A&E departments, and pressure on in-patient units.
2. Profession-specific roles and disciplines are dismantled and there is a loss of senior clinical leadership.
3. There is pressure on lower banded staff to perform specialist demands whilst skilled professionals not working to maximum competency.
4. Assessment and treatment focuses on symptoms, not the whole child or young person in context meaning in-depth case assessment and formulation are missing.
5. Thresholds are increased to manage demand, leaving children and young people to get worse before being seen, and to an increasing mismatch between need and treatment offered.
6. There are unrealistic and under-funded service models due to competitive tendering.
7. There is a loss of multi-disciplinary team working leaving services fragmented and staff isolated.
8. The next generation of practitioners are being failed through a lack of effective supervision and opportunities for career progression which in turn threatens the future supply of high quality candidates for mental health professions as the field becomes less attractive.
9. There is high staff turnover, poor morale and poor working conditions.
10. Specialist treatments for the most vulnerable children offered by child psychotherapists and others survive despite, not because, of service design.

The ACP has identified these danger signs in a bid to inform a debate about what needs to be done to address the danger signs and thus enable delivery of high quality, safe and effective services in all areas.

The report is a call for action to renew mental health care and treatment for children and young people through a whole system response including public health and treatment components.

“The view of the Association of Child Psychotherapists is that the time has come for a major renewal of mental health care and treatment for children and young people. This must include both early intervention in the community and access to highly trained clinicians, working in multi-disciplinary teams, who have the skills and experience to properly assess need and to understand and formulate how to respond to the complexity of emotional, behavioural and developmental difficulties that many children, young people and families are experiencing in 2018,” the report concluded.

The report is available here SIlent Catastrophe: Responding to the danger signs