Looked-after children and mental health: Is Camhs fit for purpose?

“I only missed one appointment with them because I got the day wrong, but when I turned up they refused to see me. They said I knew the rules and should be more responsible. I didn’t mean to muck them about. I just got the day wrong.”

This is just one experience of a looked-after child currently dealing with child and adolescent mental health services (Camhs).

Poor mental health services for children in care is not a new phenomenon. In fact it was roundly condemned in a 2008 report, ‘Children and young people in mind’ the final report of the National Camhs Review. The report detailed numerous areas where the service had been found to be conspicuously lacking in its provision of therapeutic care for looked-after children.

These included failures to be as accessible, responsive or child-centred as they should be, while some “entrenched professional views” were also leaving needs unaddressed, the authors concluded.

But in four years very little appears to have changed according to young people in care and professionals.

“The man I saw was really unfriendly and hardly looked at me. He used big words that I couldn’t understand and I found it really hard to talk to him,” says one young person who wished to remain anonymous.

A third confesses that after his first visit he never went back. “I felt really uncomfortable with the bloke and he didn’t seem to get what I was saying. He looked at me like I wasn’t telling the truth.”

Self-governing

Social worker experiences are not any better with one telling Community Care: “I couldn’t challenge their decision not to provide a service because they are so self-governing. Where are the ethics in refusing to provide a service to a child who has mental health issues? Also, Camhs weren’t always available for multi-agency working with the young person, which wasn’t helpful to the process or to a very confused child.”

Alan Burnell, manager of Family Futures Consortium, the specialist therapeutic service for children in adoptive and foster families goes so far as to claim that Camhs “simply isn’t fit for purpose”.

“It’s a generic service wedded to single practitioner responses, when what is needed is a multi-agency approach.

“The service offered has always been dire. For example, if a young person has no recognised psychiatric disorder, Camhs won’t get involved. The thresholds are too high, meaning they won’t see a child unless they are in fear of life and limb. And six month waiting lists aren’t acceptable.”

A report earlier this year by Sheffield City Council and NHS Sheffield, found there had been an increase in both the numbers of people waiting and in waiting times for generic community Camhs in that area. In February over 260 youngsters had been waiting more than 18 weeks, with some facing waits of up to 44 weeks.

Local authorities need a mandate from government to force improvements, Burnell says, although he admits budget cuts means this is unlikely to happen.

Professional Officer (England) of the British Association of Social Workers (BASW), Nushra Mansuri, echoes these concerns.

“A lack of resources means referring to Camhs can be a lengthy procedure. And the process of gaining a service can involve parents and carers having to fill in a long questionnaire which can be onerous, stressful and overly bureaucratic.”

Mansuri agrees Camhs is not child centred. “Children are expected to go to them rather than flexible, outreach services being available and many have been known to close cases if a child misses more than one appointment.

“This is very frustrating and the wrong way round, as it should be about engaging young people effectively. They shouldn’t have to fit the service.”

Good practice examples

Lead for the northern looked-after children forum based in Leeds and a Camhs psychotherapist, Stuart Hannah concedes there are problems both with waiting lists and rising thresholds across the country.

“But there are examples of good practice. Leeds has a very well established and respected post-adoption service that has succeeded in reducing adoption breakdown since its inception.

“However, in some areas, good multi-agency collaboration is very hard to achieve. In Bradford where I practise, it feels like we all operate on islands separated by seas of difference. Children and families really do need us to connect up as a matter of urgency.”