Based on a poll of 416 child and adolescent psychotherapists working within the NHS, the report records that specialist services are disappearing and it is becoming increasingly hard to provide effective care and treatment for children and young people, especially those with the most severe and long-standing needs.
The survey of frontline NHS CAMHS staff shows a deterioration of specialist services:
• 61% said that the main NHS service they work in was facing downsizing
• 72% said that the threshold for access to services has increased in the past 5 years
• 33% described services as mostly inadequate or completely inadequate
• 73% had witnessed a down-banding of specialist clinical posts
• 64% reported negative changes in the number of practitioner posts, 62% in sessions per client and 65% in the frequency of sessions
• 73% felt there had been a negative change in staff morale
Just this year, the Care Quality Commission (CQC) rated 39% (26 services) of specialist CAMHS as requiring improvement. In the ACP’s report, 33% of respondents described services as mostly inadequate or completely inadequate in meeting the needs of most children and young people. Whilst the ACP supports the government’s proposals to extend mental health services into schools, they highlight that this will only be effective if it is part of a comprehensive, properly funded and well-designed system. When asked if they could see evidence of the government’s claim of making 'one of the biggest expansion of services in Europe', 93% of respondents saw no evidence of this.
The ACP has identified a number of initial factors of common danger signs of CAMHS in trouble. The top 10 danger signs are:
1. Specialist services disappear and are replaced by interventions that would previously have been offered in primary care, leading to rising levels of suicide, self-referral to A&E departments, and pressure on in-patient units.
2. Profession-specific roles and disciplines are dismantled and there is a loss of senior clinical leadership.
3. Pressure on lower banded staff to perform specialist demands whilst skilled professionals not working to maximum competency.
4. Assessment and treatment focuses on symptoms, not the whole child or young person in context; in-depth case assessment and formulation are missing.
5. Thresholds are increased to manage demand, leaving children and young people to get worse before being seen, and to an increasing mismatch between need and treatment offered.
6. Unrealistic and under-funded service models due to competitive tendering.
7. Loss of multi-disciplinary team working leaving services fragmented and staff isolated.
8. Failing the next generation of practitioners through lack of effective supervision and opportunities for career progression which in turn threatens the future supply of high quality candidates for mental health professions as the field becomes less attractive.
9. High staff turnover, poor morale and poor working conditions.
10. Specialist treatments for the most vulnerable children offered by child psychotherapists and others survive despite, not because, of service design.
The purpose of identifying these danger signs is to inform a debate about what needs to be done to address the danger signs and thus enable delivery of high quality, safe and effective services in all areas. The reports outlines what a high-quality service looks like and also suggests that there may be scope to do better even with existing levels of resourcing as service re-designs can be ineffective in cost terms as well as in outcomes for children and young people.
Dr Jon Goldin, Vice Chair of Child & Adolescent Psychiatry Faculty at Royal College of Psychiatrists, said:
"We welcome this report and the new information it provides about current problems in the provision of mental health services for children and young people in some parts of the country. It highlights that many children and young people, especially those with severe and enduring needs, are not receiving the specialist care and treatment they require. A well-led multi-disciplinary team of experienced clinicians is crucial to the delivery of high quality services and the report shows that this is lacking in many areas. We support the call by the Association of Child Psychotherapists for a review of how specialist services are provided to ensure they meet the needs of all children and young people."
Dr Marc Bush, Head of Policy, from mental health charity YoungMinds, said:
“Every day we get calls to our Helpline from parents whose children have been waiting months for an appointment with CAMHS, or who have been turned down because the thresholds for treatment are so high. The system is overstretched and disjointed, with a devastating impact on thousands of families across the country. This report rightly draws attention to the need for increased, long-term funding for children’s mental health services across the board, as well as greater recognition of the crucial role that specialists play. For early intervention to be effective, front-line staff who work with children need to be able to access advice and guidance from highly-skilled professionals who understand the social, emotional, and psychological needs of children as they develop.”
Dr Nick Waggett, Chief Executive of the Association of Child Psychotherapists, said:
"The ACP's report shows that in many areas specialist CAMHS services are being downgraded, with a loss of much needed clinical expertise and leadership. We know that a lack of resources is one factor but our report raises concerns about recent service transformations and re-designs. These can lead to inefficiencies that mean that resources, especially the skilled workforce, are not used effectively and children and young people are not offered the effective and timely assessment and treatment they require."
A child psychotherapist (who wishes not to be named), said:
“I am considering leaving the NHS as I am worried it is no longer safe to practise. It is tragic to witness the demise of a once flourishing and truly multidisciplinary specialist CAMHS. My skills are going to waste. Once the service was taken over by a new trust, the service was redesigned and now does not meet the needs of a large section of the population who have significant mental health needs. There is no time for proper assessments and treatment.”
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