England Expects

Major changes to children’s mental health care are set to
follow the publication of the children’s National Service
Framework. But implementing the wishlist will present a massive
challenge for practitioners and service providers.

Much of the content of standard number nine – on “the mental
health and psychological well-being of children and young people” –
is long overdue. For example, under the framework, child and
adolescent mental health services (CAMHS) will include young people
up until their 18th birthday. Only half of CAMHS currently do this
as historically they have only been resourced for under-16s. As
adult services have a lower age threshold of 18, many 16 and 17
year olds have fallen through gaps.

The location and accessibility of mental health services is also
highlighted. “We want a choice where we get help, for instance in
school and outside school in a place that isn’t medical”, a
CAMHS user is quoted as saying in the NSF document. The government
has responded by proposing that services are offered as near to a
young person’s home as possible and in different settings.
These locations should include “less stigmatising” schools, family
centres, and young people’s homes, as well as the more
traditional clinic settings.

Children and young people who need urgent help and assessment,
such as those who are psychotic or suicidal, should also benefit.
Currently there are no on-call or 24-hour specialist services in
many areas, but under the NSF, 24-hour cover must be made available
to everyone.

Throughout standard nine there is an emphasis on the role that
other agencies, including early years, should play to help
children’s mental health. Supporting

children and young people with mental health problems “is not
just the responsibility of specialist CAMHS”, and often the
intervention that makes a difference comes from another service,
such as a child whose behavioural problems improve once their
literacy problems have been addressed.

Schools have a vital role to play. But as Dinah Morley, acting
director of mental health charity Young Minds, points out, staff
often lack awareness.

“If there’s a scare around meningitis then they know what
to do and what to look out for. Definitely more children have a
mental health problem than have meningitis yet staff do not get any
awareness training,” she says.

The NSF says that while staff who work with children and young
people should be able to offer some support themselves, they should
also be able to access advice from mental health specialists. Joint
working between CAMHS and schools could be improved by, for
example, basing the two services in the same location, or seconding
staff between the two.

The standard says quality services depend on having “sufficient
numbers of appropriately trained staff”, and emphasises the
importance of CAMHS workers in primary care. But Morley warns that
unqualified staff could do more harm than good if they are used in
the wrong way.

“I am concerned there might be a dumbing down of skills and that
could be a disaster. We need to recruit primary mental health
workers but we have to recognise that they can’t do what a
child psychiatrist and psychotherapist does.”

The NSF calls for children, young people and their carers to be
involved in developing services, but Alix Cordell, senior policy
officer for the National Children’s Bureau, says details are
needed on how this should be done.

User involvement forums could be one solution. “At present
children and young people come up for their one-hour appointment
and don’t want to come up at another time of the week to
shape services. If CAMHS are delivered in local areas through
extended schools and children’s centres then hopefully it
will be easier to develop user forums,” she says.

The NSF is an ambitious 10-year programme, made all the more
challenging by the absence of any specific funding. But if it
achieves its objective of “timely, integrated, high quality,
multidisciplinary” mental health services within that time frame,
it will not be a moment too soon for the children who need
them.

Children’s National Service Framework

Standard 1: Promoting health and well-being, identifying needs
and intervening early

• child health promotion programme to promote health and
  well-being.
• improved access to targeted services where take up is low.

Standard 2: Supporting
parents or
carers

• universal, targeted and specialist services to ensure parents
  receive appropriate support
• early identification of parents with specific needs such as
  mental health problems.

Standard 3: Child, young person and family-centred
services

• services to provide appropriate information and listen to young
  people and their parents
• a common core of skills and competencies for staff who work
  with children and young people.

Standard 4: Growing up into adulthood

• age-appropriate services for young people.
• consent and confidentiality policies for young people.
• planned transition to adult services.

Standard 5: Safeguarding and promoting the welfare of
children and young people

• agencies to prevent children suffering harm
• each local authority to have children and young people’s
  plan setting out how key agencies work together.
• effective supervision for staff.

Standard 6: Children and young people who are
ill

• timely access to appropriate services which address health,
  social, educational and emotional needs.
• integrated children’s community teams.

Standard 7: Children in hospital

• evidence-based hospital care in appropriate settings.
• discharge from hospital planned in good time and length of
  hospital stay kept to a minimum.

Standard 8: Disabled children and young people and those
with complex health needs

• services to promote social inclusion for disabled children and
  young people.
• better early identification and support to parents.

Standard 9: The mental health and psychological
well-being of children and young people

• children and young people with mental health problems to have
  access to quality multidisciplinary services from birth to 18.
• professional support for children’s mental health
  available in early years.
• all staff working with children and young people to contribute
  to mental health promotion and early intervention.

Standard 10: Medicines management for
children

• access to safe and effective medicines
• greater support for children and young people who take
  medication at home, in care and in education settings.

Standard 11: Maternity services

• women able to choose most appropriate place to give birth.
• professionals able to identify mental health problems during or
  after pregnancy.