The review of Camhs seeks to address specialist care issues while ensuring universal services play their part, says Daniel Lombard
The review of child and adolescent mental health services (Camhs) in England, which issued a call for evidence last week, could signal a shake-up of both specialist care and mainstream services that will affect children’s emotional well-being.
The inquiry was launched in December, three years after the government set a new direction for Camhs through standard nine of the 2004 National Service Framework for Children, Young People and Maternity Services, with clear expectations of what a “comprehensive Camhs” should look like.
This has been accompanied by a extra £400m over the past four years for local authorities and primary care trusts, which jointly commission Camhs.
However, when he launched the review in December, children’s secretary Ed Balls said there were inconsistencies in Camhs, adding: “Children with mental health problems deserve a better service than they are currently being given.”
One mental health trust manager told Community Care that some PCTs were still “a long way off” achieving the aims of the NSF. Other professionals point to gaps in areas that have been subject to specific government targets before the NSF, such as the use of adult psychiatric wards for young people and poor out-of-hours cover.
Kathryn Hill, director of mental health programmes at the Mental Health Foundation, argues Camhs and adult mental health services must create better links with each other to improve services for 16 to 25-year-olds.
Ann Baxter, chair of the Association of Directors of Children’s Services health, care and additional needs committee, highlights accessible services for looked-after children as a priority.
But away from the specialist end, the buzzword is now “early intervention” – treating the mole before it becomes a tumour. As part of its remit, the review is examining the role universal services can play in detecting warning signs and promoting mental health.
When he launched the review, Balls highlighted schools’ role in particular. This is reflected in a £60m Department for Children, Schools and Families programme to provide targeted mental health work in schools from 2008-11.
Paul Jackman, director of child and family services at Lincolnshire Partnership NHS Foundation Trust, backs this approach. “Expanding preventive services to support the early recognition of, and response to, the onset of mental health and emotional difficulties is a crucial focus for further investment.”
Hill underlines the importance of mental-health promotion in universal services: “Developing the skills of the workforce in this area is vital if true progress is to be made.”
Meanwhile, Rosalind Godson, professional officer for school-aged children’s health and public health at the union Unite, says school nurses should be employed on-site at every secondary school to deal with any referrals on mental health grounds from teachers.
Gloucestershire Council’s children services director, Jo Davidson (pictured), who is chairing the review, explains the reasons for the study’s breadth of scope.
“On the one hand the emotional well-being of children is a simple subject when you think in general terms of happiness, but on the other it’s such a complex area because so many people are involved,” she says.
“It’s not just about specialist staff. If you think about where children and young people spend most of their time, it’s in their home and with their families, and in schools, nurseries, colleges and youth clubs. This review is asking everybody to contribute to the debate.”
Roger Catchpole, principal consultant at YoungMinds, the mental health charity for under-25s, hopes the review will spell an end to the haphazard approach towards services that saw just 23% of English councils report Camhs were working effectively with health, education and social care agencies to meet young people’s needs in 2005.
He says a “long-term agenda for services” is badly needed and calls for “clearly focused, achievable recommendations” from the review.
Catchpole also urges the review to take into account “the needs and experiences of children and young people and of their parents and carers”.
Historically, Camhs is an area which commissioners place “very low on their shopping lists”, according to Dr Greg Richardson, chair of the faculty of child and adolescent psychiatry at the Royal College of Psychiatrists. A child psychiatrist of 27 years’ experience, he adds: “Few commissioners really understand Camhs.”
However, the NHS Operating Framework for 2008-9, which sets out annual priorities for the NHS, includes children and young people’s mental and physical health as one of four key priority areas, alongside cancer, stroke and maternity.
David Stout, primary care trust network director at the NHS Confederation, rejects the idea that commissioners fail to understand the importance of child and adolescent mental health. But he admits: “It’s fair to say there is variation between the levels spent on Camhs by PCTs.”
Stout expects commissioners to use the joint strategic needs assessment, a new requirement for councils and PCTs to comprehensively assess the health and wellbeing needs of their communities, to improve matters.
He adds: “An important area is ensuring that children are placed in services designed for them and not for adults.”
Dr Gabrielle Pendlebury, a specialist registrar in child and adolescent mental health at Maudsley Hospital, south London, hopes the review, due to be submitted to Balls and health secretary Alan Johnson in October, will provide practitioners with the bigger picture.
“Resources are so minimal that people try to make the best of things in isolation and just get on with their jobs. Having an evidence-based review that focuses on good practice allows you to broaden your perspective,” she adds.
The review, which is due to report this autumn, will receive no shortage of ideas on how to improve Camhs. But it may struggle to satisfy all of the hopes invested in it.
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