Debate on Community Care’s campaign

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