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”.
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.”
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.