This Have your say debate was based on the aims of the new Community Care campaign - 'Changing Minds: Better Mental Health Care for Children'
We asked for your views on how mental health services for children and adolescents can be improved.
These are the responses we received:
"One of the biggest challenges for CAMHS (child and mental health services) is one of definitions and language used for 'mental health problems'. Many young people with severely challenging behaviours (which could also include serious self harming behaviours) are often deemed not to have mental health problems. These young people cause much anxiety within social services departments with social workers often struggling to manage the case, and feeling let down by specialist CAMHS. Often these young people end up in out of area placements or secure accommodation.
1. There needs to be some guidance from the government on these young people otherwise they will continue to be excluded from mental health service provision.
2. Services for this group need to be jointly commissioned. It is the only way that these young people's needs will be adequately met by all services. At the moment disagreements between agencies over who has responsibility for individual young people is one of the main reasons for poor relationships between social services and specialist CAMHS.
3. Appropriate training for tier 3 social workers in recognition of the fact that they work in children's mental health and therefore do not fit neatly into the 'normal' children and families/adult mental health divide.
4. Multi-agency mental health training programme - this should be properly resourced and structured and not left to individual CAMHS to provide when they are already working under pressure.
5. Input into residential services/foster care to give carers of looked after children the tools they require to manage increasingly challenging behaviours. Practical support and practical behaviour management techniques.
6. Extra resources for specialist CAMHS to develop services in primary care where they can provide consultation and support to workers to increase confidence and expertise.
7. Assessing mental health problems before they become entrenched - offering many different levels of support - widening the definition of what constitutes 'therapeutic' services.
8. Appropriate residential/community resources for young people who have a mental illness - currently resources of this kind are more geared to adults - need for specialist adolescent services."
Tina Jackson
CAMHS Development Officer
Tees
"I welcome your campaign to improve services for children and young people with a range of emotional and behavioural problems. However, I feel very strongly that it is a mistake to follow the prevailing fashion and describe all these as mental health problems.
* The close link in people' s minds between mental health problems and mental illness leads to confusion and frankly disbelief of the 'statistics';
* the identification of mental health problems with the field of psychiatry leads to an excessive focus on the role of psychiatrists, and child and adolescent mental health teams generally;
* this diverts attention away from the much broader arenas of child and family services, and youth and community services (including schools), where as you imply much later on in your article, it is likely that the majority of children's problems are encountered, and hopefully responded to.
Clearly there are specific types of problems, including extreme self-harm and frank mental illness, that require a service from an appropriately resourced CAMHS. But in general I agree with the comments from Jane Held (ADSS) and Bruce Irvine (Young Minds) that the best use of CAMHS expertise would be in providing consultancy to, and helping to devise programmes with, community services that already have the skills and location to reach a variety of young people in a variety of ways.
In this model, not only do we need resources for CAMHS to provide those services that are appropriately directly provided by them, and consultancy; but just as important, there needs to be funding for mainstream statutory and voluntary sector services on a sufficiently long-term basis to make a difference.
I don't underestimate the shift in culture that would be required in many cases, both for CAMHS teams and for the GPs who refer to them: CAMHS teams seem to be inescapably bound to the clinical model of service delivery in most cases at present. But it has always seemed to me that when all services seem so harassed by overwork, a much more genuine pooling of resources must be the most profitable way forward.
Equally, many creative projects, particularly but certainly not only in the voluntary sector, are hamstrung by short-term funding regimes. Yet, as your case histories illustrate, it is the combination of practical services and understanding, that so often make the difference to parents and children under stress.
I hope very much that your campaign will help to raise the profile of these critical issues and result in better services for children and young people."
Anonymous
