“An orphan service is an unprotected one, for CAMHS to ever be effective, this has to change” Dr Andrew McCulloch
Although community mental health services are under great strain and financial pressure in general, if there is one specific care area within mental health that requires a significant level of re/investment and strengthening, it is Children’s and Adolescent Mental Health Services(CAMHS).
Currently sitting at the media forefront for all the wrong reasons, criticisms range from them being both “severely underfunded” and having “serious, deeply ingrained problems.” Neither of which to my mind are unfounded, but could be misinterpreted. Although it’s not so much that the services available are bad, more that they just aren’t to scale and don’t always have the right format for families and young people.
There are 11 million children in England, representing 22% of the population, yet the spend on children’s and young people’s mental health services, stands at just 6%. An amount that is effectively four fold less than we invest for each adult – surely too small to give every young person who needs it a quality experience – or even a chance at that.
There is currently no evidence to suggest that children have orders of magnitude less mental health problems than adults, and a lot of evidence showing both how amenable children are to psychological treatment, and how they can in some cases recover completely, building resilience for life. So, no sensible reason for such a limited funding commitment then?
The Deputy Prime Minister and Liberal Democrat leader Nick Clegg’s recent announcement that he will be establishing and chairing a newMental Health Taskforce underlines a renewed and welcome move towards a government commitment to mental health service improvements – both in adult services and CAMHS.
The central problem with CAMHS provision is that unlike adult mental health care services, it has no fundamental structure – and to all intents and purposes never has done. When the service was originally set up it was with the intention of being delivered via a multi-disciplinary team; NHS, social services, educational psychologists etc. Without a clearly defined home, or a single organisation taking ownership for both “managing” the strategy for, and overseeing the facilitation of, CAMHS care the service has become more of a concept than the actual, physical service it was intended as. At first glance it appears to be a multiple-agency service, but in reality it does not really exist as such.
Although set up with the best intentions, each of the supporting CAMHS service provider connections are for various reasons, such as policy changes and funding cuts, gradually collapsing. Without any solid form of protection, a consistent care model has never been established or carried through.
Not only has CAMHS “orphan status” affected care delivery, but it has also meant that there is no consistent place to actually use the service. Depending on the user’s postcode, care is sometimes delivered in mental health facilities, and others, children’s hospitals. This has created a number of access and navigational problems, ranging from people experiencing referral difficulties, to services jumping from very family friendly, and centred-around school hours, encouraging ease of use, to being the exact opposite. A natural yet fatal reaction to such chaos has been a high service user drop-out rate.
For CAMHS service to ever fulfil their possibly waning potential and be effective, two things must happen; service user feedback must be utilised and the current level of financial investment re-evaluated.
Customer feedback is as we all know, an essential aid to quality improvements in any service – mental health is no different. Both the children themselves, and their families are mental health service customers. It is therefore fundamentally important to continuously measure children and young people’s experiences, if we are to ever not only radically improve the mental health services available, but in doing so potentially reduce childhood suffering, achieve a better education process and generally increase the level of functioning families in today’s society.
Comprehensive and accessible services for children and young people allow for early intervention, potentially preventing mental health deterioration later life, repeated hospital admissions, or families breaking down because of this.
At present the bulk of mental health funding is spent in reverse order of potential impact. A limited approach to protecting and nurturing the mental health of children leads to grave consequences in adulthood, some with a large human cost – by which stage it is too late to administer any form of prevention. So instead we have to spend very large sums at the backend of the system.
The current approach shows no signs of being productive or profitable. But if we take a step back, listen to the views of the very people who use and rely on CAMHS, and redistribute mental health service funding, we might just be able to make them effective again. Let’s use the considerable skills of the staff in the system to best effect.