‘All we’ve done is tick a box’: the problems getting children in care mental health support

A CAMHS child psychotherapist who resigned in the past year lifts the lid on the problems facing children in care who need of mental health support

teenager
Photo: tugolukof/Fotolia (posed by model)

by David Jones

A recent report by the Association of Child Psychotherapists (ACP) has highlighted chronic inadequacies within the NHS in addressing the mental health issues of children and young people, labelling the situation a “silent catastrophe”.

The report also includes a survey of frontline staff working in child and adolescent mental health services (CAMHS) and the picture that emerges is a bleak one, ranging from serious underfunding and increased thresholds for treatment, to waiting times to see a practitioner and a workforce unable to meet the demand of young people seeking support.

Looked-after children don’t fare any better of course, and it’s a story I’ve heard many times. Both my colleagues in the home and visiting social workers have been disparaging when the subject of CAMHS has been discussed. And the main criticisms have always centred on the same concerns; the lamentable length of time it takes for a kid to secure an appointment, and when, or if they do, “they must be threatening to jump off a very tall building”.

Troubling experience

Indeed, I recall the disheartening and extremely troubling experience of accompanying two young people to see CAMHS counsellors. In the first instance, I was astonished by the counsellor’s indifferent and even critical attitude, a manner which clearly intimidated a very vulnerable boy whose refuge in silence brought the session to an abrupt end.

On the second occasion, the young person had a very confident disposition and soon made it quite clear that she didn’t understand some of the words the counsellor was using. I remember her telling him, “you sound like a text book” and then asking me, “what’s he going on about?” This wasn’t well received and after 10 unproductive minutes I was asked to return the girl to the home. So much for respecting the child’s voice, I thought.

When we entered the reception area, I asked the girl to wait a minute and returned to the counsellor’s office. I asked him if he thought he had acted professionally and he replied that the young person hadn’t given him “enough information on which to make a clinical judgement”. I then felt compelled to tell him that I’d brought her to this appointment for a reason, and he asked me to leave.

When I reported the details of these two visits to CAMHS to my home manager, he wasn’t surprised, saying that in his experience the outcomes had always been disappointing, adding: “I hate to say this, but all we’ve done is tick a box.”

Disillusioned

George is a friend of mine who worked as a child psychotherapist at CAMHS for nearly 10 years until resigning from the service seven months ago. He admits that he became disillusioned working in such a demoralising environment.

“The critical comments of residential child care workers and social workers were a familiar refrain during my time at CAMHS. Thresholds remain way too high and the young person is basically left to flounder and their acute mental state worsens before they are seen. In my experience these thresholds have actually risen over the past five or six years.”

“And of course the waiting times are simply unacceptable at six months and sometimes even longer. To be left in limbo like this is hardly conducive to a kid’s emotional and psychological wellbeing.”

Another major consideration and one that has been voiced by professionals in the field for what seems like an age, remains the serious underfunding of child mental health services.

“I’m far from alone in decrying the fact that an increase in funds for CAMHS as trumpeted by the government in 2015, hasn’t materialised,” George explains. “An extra £1.4 billion over five years was promised to transform the service, yet this dire situation continues.”

‘Morale has suffered’

The knock-on effect of this financial hole is also seen in the down-banding, or reduction in the level of expertise required of specialist mental health posts, resulting not only in disenchanted and fewer staff, but in less qualified practitioners being expected to fill the gaps.

“It’s hardly surprising that in these circumstances staff morale has suffered,” says George. “And if you aren’t going to utilise a professional’s skills, but in effect, waste these skills, can you really not expect to lose staff?”

“I worked with some of the most dedicated and compassionate people I had ever met and I considered it to be a privilege. When I started in the service it really felt like you were in a position to make a difference to troubled young lives, our roles were clearly defined and you knew you were part of something vital.”

George says a growing sense of his own frustration was born of the increasing number of phone calls he received from anxious parents and social workers chasing up appointments with a counsellor after a referral had been made. Equally hard was having to explain why a child had been turned down.

‘I didn’t know what to say’

“It got to the point where I actually didn’t know what to say to them and it felt like all I was doing was apologising. People were at their wits’ end and calling mental health charity helplines seeking advice. It was awful. The shortcomings have become ever more acute, but even seven or eight years ago I began to realise that we weren’t meeting a need that was growing all the time.”

Eventually George resigned but with a heavy heart. “To be honest I felt impotent, and what had originally been a vocation turned into a job I hadn’t signed up for. It hurts to say it but I really don’t think that CAMHS, in its present state, is fit for purpose. And that means as a society we are letting down too many of our kids and leaving them dangerously adrift. It’s not overstating the case to describe it as a tragedy.”

When I ask George under what conditions he might consider returning to CAMHS, he apologises for being blunt. “More funding, a return to clearly delineated roles and a radical change in ethos.”

David Jones is a pseudonym. He is a residential children’s home worker. 

7 Responses to ‘All we’ve done is tick a box’: the problems getting children in care mental health support

  1. Ken Talbot August 28, 2018 at 10:20 am #

    As a foster carer we have experienced the same totally unacceptable service as David describes from CAMHS. If it were any other area of health care there would be a national scandal

    • Abhashashi August 29, 2018 at 10:46 am #

      Very true indeed,the confinements shall be overcome through humane dealings and adequate empathetic and facilitative through open communication and unconditional acceptance of the client.

  2. sw111 August 29, 2018 at 10:53 pm #

    The bureaucracy, the process led service where ticking box intervention is rife, it’s sad vulnerable children are being let down.

  3. Steve Hudson August 30, 2018 at 7:25 am #

    Totally true my experience is just the same only waiting times in Wales are 18 months, it is just not a service the children are the people who suffer I have no faith in local government at all

  4. Jayne Gale August 30, 2018 at 8:38 am #

    As an art Psychotherapist I appear to be supporting children in school via pupil premium, who can’t access CAHMS. Those I see often require intense 1:1 therapy over a year or more. I worked for CAHMS over 4 years ago, it started to deteriorate then when they wanted therapists to be keyworkers. This blurring of roles to save money is driving good therapists away. None of my colleagues would work for CAHMS in its present state. Too much inappropriate short term, cheap, CBT. The system is broken

  5. Planet Autism August 31, 2018 at 10:02 pm #

    “Indeed, I recall the disheartening and extremely troubling experience of accompanying two young people to see CAMHS counsellors. In the first instance, I was astonished by the counsellor’s indifferent and even critical attitude, a manner which clearly intimidated a very vulnerable boy whose refuge in silence brought the session to an abrupt end.”

    And this is typical of CAMHS. They are utterly clueless in how to engage children. 1 in 10 children under CAMHS is autistic (the rate may be higher as they are also clueless at diagnosing high-functioning autistic disorders) and yet they have no idea how to help autistic children. They do not adjust the therapy to the autistic neurology.

    And as this article focuses on children in care with mental ill-health, it’s worth understanding this also from the autistic perspective:

    “Are Thousands of Children with Autism in Care for Erroneous Reasons? Quite Probably”

    https://www.rightpro.org.uk/s/article/Are-Thousands-of-Children-with-Autism-in-Care-for-Erroneous-Reasons-Quite-Probably

    It’s traumatising for a child to be taken from their parents as it is, then to be put into the care system which does not meet their needs, then to consider they may be undiagnosed autistic falsely labelled with attachment disorder. If CAMHS (and social services) don’t buck their ideas up pronto we will have a whole swathe of a generation of totally screwed up children who will not be able to become functioning members of society.

    But the most sadly ironic part of this is, that social services trust any and all information that comes out of CAMHS no matter how wrong. For instance, where a parent is falsely accused of FII, if they have been seeking an autism diagnoses through CAMHS and incompetent CAMHS fail to diagnose the child, that is fodder for social services. CAMHS operate in a parent-blame culture, sending parents on parenting courses without finding out if their child is autistic or not.

    It’s high time professionals realised that the word of other professionals can be (and often is) misinformation, lies (often used to cover up medical or clinical negligence), incompetence, speculation etc. and treated parents as the experts in their own children.

    When a child has ASD-PDA, they are resistant to a huge amount of things, CAMHS counsellors, therapists, psychologists should be able to get through that and work out the best way to engage the child in their own support. But they seem unable. They simply sign the children off and leave their poor parents to try to support them. Many CAMHS don’t even recognise the PDA subtype of autism and that means the child won’t get any diagnosis at all, or at least not the correct one. Attachment problems or parenting issues are the favourite go-to. Gets them entirely off the hook.

    The bottom line is, however under-funded CAMHS are, there is absolutely no excuse for incompetence, laziness, dismissiveness or a failure to work well with families.

  6. Anonymous September 6, 2018 at 8:17 am #

    I agree with most of the comments made above. As CP SW at the time I accompanied children and YP to CAMHS and felt that instead of helping the YP and their parents became more frustrated. Apart from the fact that a long waiting list had exasperated the family’s life when it was finally assessment time CAMHS’ response almost always was parenting, poor attachment and other unrelated issues which meant the situation was made worse. On one ocassion only after the YP was placed in residential accommodation where key workers who also had counselling experience, was able to make any changes, thus enabling that YP to receive the right support and mother felt less guilty and was able to identify what ger son’s needs were from the age of 5 but was always turned away from CAMHS.
    As we know, MH issues don’t disappear overnight, the same as they didn’t occur overnight and as such a long term therapy is necessary to enable change and improvement, a service which CAMHS is equipped to provide.

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