By Bill Bows and Ben Fraser, National Children’s Bureau
Children with social work involvement are more likely to be refused access to CAMHS, despite it being well established that they are more likely to suffer mental illness than their peers.
That was the striking finding from an analysis* of more than 71,000 children’s health records from a London mental health service, published last month by researchers at Cambridge University and the National Children’s Bureau (NCB).
The findings, which were welcomed by the Children’s Charities Coalition (comprising Action for Children, Barnardo’s, The Children’s Society, NCB and NSPCC), shed light on the links between children’s mental health, social care and deprivation.
Children with social workers ‘considered too unstable’ for treatment
Consultations with practitioners, clinician interviews, and analyses of health records indicate that the finding on refusal of access may be because the circumstances of children with a social worker are considered too “unstable” for mental health support.
These young people’s lives can be highly unpredictable, whether that’s because of poor parental mental health or being at risk of harm or abuse, or due to more practical issues like lacking the funds to take public transport to appointments.
But the net result is that these children may never get the support they need
However, existing evidence suggests that some treatments can be helpful, even when a child experiences “instability”.
The experiences of children accessing CAMHS
This week, the findings of a subsequent study** of data from over 20,000 initial risk assessments from the same mental health service, provides unprecedented detail on the adverse experiences of young people as recorded by CAMHS professionals.
Until now there has been little understanding of the volume and nature of these experiences, or risk factors, including how they relate to one another. These risk factors may be linked to a child’s mental health need or independent of it.
Around 15-20% of the young people assessed by CAMHS in the study, which was published by Cambridge University, NCB and partners as part of the Living Assessments collaboration, were at some point identified as having received protective interventions from children’s services.
This indicates that social care experienced young people represent a significant portion of the population assessed by CAMHS.
What a dedicated CAMHS pathway should look like
Together, the findings suggest that a dedicated pathway for children with social work involvement to access CAMHS would be a real step forward for a group of children who desperately need more help. This should focus on three key areas.
- Mental health assessment: Any child in contact with social workers should be offered a specific assessment to understand their mental health needs. This should be co-designed with young people and families.
- Expertise in both social work and mental health needs: Co-locating more social workers within CAMHS teams and vice versa would help ensure understanding of the unique needs of young people with all forms of social work involvement at CAMHS intake and assessment.
- Joining up services: Services should use a single, consistent identifier for all young people. This would promote joined-up working across health, education and social care, support information sharing and make it easier to identify what works for young people.
Mental health services ‘should be beacon not barrier’
As Taliah Drayak, an adult with experience of being supported by social workers and mental health services as a child, who worked on the first of these two studies, says: As a child you can’t access what you need without support. When the adults in your life become barriers to accessing what you need, the message that you write upon your heart is, ‘I am not good enough, I do not deserve, and I am the problem’.
“Instead of first being a barrier, and then teaching children to be our own barriers, children need mental health services to be an inclusive beacon of hope and support.”
* A call for change: tackling inequalities in access to mental health support for children with social work involvement and those living in poverty was funded by the National Institute for Health and Care Research (NIHR) and the NIHR School for Primary Care Research, as part of the NIHR Three Research Schools Mental Health Programme, in conjunction with the British Academy, Foundations, and the Wellcome Trust.
** This study is part of the Living Assessments research project, which is funded by the Wellcome Trust.
Bill Bows is communications officer and Ben Fraser policy and public affairs officer at the NCB
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My daughter has a chromosome duplication. When she started school we were not aware, I thought she had autism as I have an MA in counselling. I asked the GP to refer to CYPS as she broke down when she started school. Rather than consult with us school thought it better to contact social services because her behavior was so erratic. We never had social service involvement prior to this. They insisted on doing a child and family assessment. During this the social worker stopped the referral to CYPS. I kept fighting for my daughter and eventually a Paediatrician diagnosed her with a rare chromosome disorder, Xq25 duplication syndrome, obviously with autism as a symptom! I demanded that she was referred back to CYPS, after
all I could have then sued them for disability discrimination. She was accepted into CYPS a year after the social worker had stopped the referral. In the meantime she was put on regular exclusions from school and I had to leave my job of nearly ten years to accommodate her. Social Workers should not be allowed to interfere with medical issues. We have no social worker involvement now as we have not done anything wrong.
Never heard of a SW being able to stop a GP referral. Are you sure it happened like this or are you looking to blame SWs for failures in other services
Actually as a social worker I’ve had many conversation with GPs and the like who’ve changed their intended actions as a consequence. That’s our job isn’t it? We take decisions and convince others to follow our advice don’t we? Why do you think social workers are
pathetic and powerless and are doormats ignored by other professionals? Strange kind of confident practice that. You’ve been told a family experience
but rather than listen to that you respond with cynicism and rancour. Some would say that sums
up current social work practice perfectly. That’s not
my kind of social work.
It’s a shame you feel that was as a disabilities children’s social worker could support your child and your family to access the right school and provide respite you, if that’s something you feel you need. There is also a fund for children with complex care needs as your child. The money can be used for specialised equipment or to support you all to have a family holiday. Also you could access support in to adulthood. Social workers are there to support the family to remain together.
I 100% agree I’ve had a similar experience as a mother of two autistic daughters both the primary school and social workers thought I was delusional, the s/w put in a court report that I had Munchausen by proxy and that I was overprotective. I had my kids taken off me and had to fight to get them back. Years later both were finally diagnosed with Autism. A lot of S/w ‘s have too much power and no knowledge or experience to back it up.
I agree 1000%. They do not even have the general qualification in visible and invisible disabilities and should not be given the general medical status GPs have to refer anyone anywhere. They can support referrals but if they are given a path then what happens to those who are on the list without social services? They get pushed back which in itself can lead to family breakdown so what is the solution?
Are the NHS going to provide separate consultants just for this purpose? Then everyone starts introducing aspects of illness that are not manifesting to get social care. Put the funding into bringing down the current waiting lists
It’s a cinderella service. With the same response. Waste of time
Children with social workers should have access to mental health services and other support services to ensure whatever the reason social workers were involved with them to begin with is resolved and the areas of these children’s lives were lacking or unmet needs should ensure their needs are met with the support required to enable them to heal and grow.
I totally agree its the same for vulnerable adults. Specialist agencies that have no understanding of mental health issues interfere in peoples lives and cause more problems
In my council, we’ve got an amazing camhs pathway for our children in care. We can request consultations with a specialist camhs practitioner who will signpost and guide us if needed to access the full camhs service.