CAMHS – Not fit for …what… purpose ?

Jim Clifford reflects on the Child and Adolescent Mental Health Services (CAMHS).

A headline caught my eye on Monday last week:

Children with mental health problems are not receiving treatment until they are in crisis and sometimes suicidal, doctors have told the BBC.

With some personal experience of both great and pitiful responses from CAMHS I found the headline unsurprising, or perhaps only surprising that it was hitting the news. I shared it on social media. I heard much that confirmed it, with the most striking challenge being some involved in the sector suggesting “suicidal” wasn’t enough – actual attempts at suicide were the more likely qualification benchmark. This is on the back of the Young Minds report earlier in the month that 75% of young people with mental health conditions worsen whilst waiting to be seen.

Why are we, one of the most advantaged nations, so failing our most vulnerable young people?

Over the last hundred years we have recognised publicly the mental health problems encountered by people in war. Yet still we are struggling to speak about the mental health problems of children and young people who have lived through horrors, or are now experiencing them in domestic settings. We are, thankfully, seeing more open discussion of bullying – at work and at school – of domestic violence, and its effects on all of the family, adult and teenage suicide, and so many more challenges faced by all sorts of people.

The need for support is known: the consequences of not supporting are known.

Yet this week the BBC Panorama documentary Kids in Crisis posed the question: is care for these most vulnerable being rationed? With one in ten children needing help, we all know a young person in this situation.

In the face of such evident need, appalling consequences of not meeting it, and huge cost of meeting it inadequately, I have three questions:

1) Are funds focused on finding reasons not to support, or on helping vulnerable people?

With clear energy going into assessing need, and arguing why very needy children and families don’t need help, leading to challenge, appeals, and possibly legal action by some, can’t we find a way to move that spending into services?

2) Why are services formulated around cycles of appointment that are ineffective?

The needs of these young people are complex, and the support they need will often be far longer term, and coordinated across clinical, therapeutic, and social prescribing solutions. Too often one of the teams or agencies that needs to be involved offers only a standard course of six one hour appointments, followed by a multi-month gap. Sometimes one or more agencies refuses to engage at all, which is even more damaging to the need for coordinated support.

3) Are the services seeing families as support mechanisms, which could help (and avoid mental health consequences themselves), or as irrelevant, or even the cause of the problem?

All too frequently I hear it is the latter, with the professionals discounting or undermining family support, which for many, including young people in adoptive or foster care, is an insane waste of resource, and creates damage to the young person’s support network.

At the other end of the week, on Sunday, another headline caught my eye: Mentally ill held without charge for lack of NHS beds . This includes those as young as 15 being held in police custody because of lack of proper provision.

How bad does this have to get before we wake up, invest sensibly and save in the long term both money, and more importantly, people’s lives?

This information is necessarily of a general nature and doesn’t constitute legal advice. This is not a substitute for formal legal advice, given in the context of full information under an engagement with Bates Wells.

All content on this page is correct as of October 1, 2018.