Role of CAMHS in Delivering Mental Health in the UK - Term Paper Example

Role of CAMHS in delivering mental health services to children in the UK Role of CAMHS in delivering mental health servicesto children in the UK Introduction The foundation for good mental health is laid in the early years of a child, as it benefits from a society that invests in children. Fortunately, many people in the European Union enjoy good mental health (NHS Health Advisory Service, 1995). But statistics suggest that one in every five children (Stroul & Friedman, 1996), as well as adolescents suffers from emotional, behavioural, and developmental problems, and an eighth of these cases have been diagnosed clinically with mental disorders (Moran, Kelesidi, & Guglani, 2011). In 2014 however, most data about the number of children and young people with mental health problems was not reliable. This is because the NHS England review is based on outdated data, which was surveyed ten years ago (NHS Health Advisory Service, 1995). The best estimate, according to the office of national statistics, is one in ten children between the ages of five and sixteen has mental problems. Half of them have conduct disorder; others have emotional disorders, including depression and anxiety, while the rest have severe attention deficit hyperactivity disorder (ADHD) (NHS Education for Scotland, 2011). A small percentage of these young people have neuro-developmental disorders. Rates are rising rapidly among middle to late adolescent children. Unfortunately poor regions in the European Union are facing large problems in child and adolescent mental health services (CAMHS) as there is an increasingly high rate of poor mental health in young people (World Health Organisation, 1992). This calls for a clear need to come up with CAMHS policies in the UK, and good practices that encourage engagement and proactive involvement in all regions of the country. In autumn 2013, there were reports in the media and parliament about young people with mental problems having to travel across counties in order to get treatment. In most cases, many miles from their families, local communities and homes (Meltzer, 2014). A committee held in 2013 reported that there are serious problems that affect the provision and commissioning of children’s and adolescents’ mental health services (Ford, et al., 2012). These problems run through the early intervention and prevention stages, as well as in patients’ services for the most vulnerable children (Fleming, 2001). The lack of up to date data on the number of children suffering from mental disorders affects health care planning. It is difficult to plan, improve or even provide funds for services in the area of mental health for children (Crown, 1998). There are however two documents that are current in the national policy to help manage the mental health of children in the united kingdom; The children’s Act of 2004 that specifies that every child matters, and the national service framework for young people, children and maternal services (Department of Health, 2009). Additionally there are various policies in the government that address poverty and social exclusion. Programmes specifically related to CAMHS have also been implemented. They include; provision of parenting support by the national academy of parenting practitioners, sure start nursery program for toddlers and infants, national suicide prevention strategy of England that covers young people and children, and connexions (Mental Health Foundation, 2008). CAMH Services There are about eight CAMHS offices in England to help and support children and young individuals with mental health difficulties both in the communities and as inpatients (Udwin, Goddard, Stallard, & Hibbert, 2007). They are not stand alone services in the sector; they interface with other child and family health services, adult mental health services and social care services, to work efficiently (Schmidt, Hugo, & Treasure, 2005). There are a number of external organizations that work with CAMHS such as youth justice, education, and voluntary sectors who work diligently to give advice and support for children with mental health disorders, as well as their families (Salmon, 2004). The services offered by these institutions are recognized in the 5 step care model of CAMHS. The CAMHS tier model is a needs based model (Worrall‐Davies, Hewson, McDougall, Richardson, & Cotrove, 2008). It creates the potential for deriving the greatest benefit from therapeutic resources. To achieve this, needs are assessed and addressed, according to the intervention necessary, using the lowest step appropriate. This model also ensures that barriers in professional and service boundaries are removed by strengthening connections between steps (Bailey & Dolan, 2004). These steps have the advantage of coherence between needs of clients and the services offered. The model is a framework for organizing and integrating social services and child health services (Kraam & Cottrell, 2005). It emphasizes the importance of prevention, early intervention and a proactive recovery. CAMHS service model Tier 1 – this is the universal prevention stage that involves adoption of various services that are designed to give the best emotional and developmental start for children. These children are supported through to their adulthood (Lamb, 2009). Services offered in this step provide for infant and family mental health and emotional well being. Early childhood intervention is important as it acts as a building block for achievements in their later life. Supporting the health and wellbeing of children by investing in their early years of development means the realization of benefits beyond educational attainment, reducing criminal justice numbers, and improving employment. There is increasing evidence that shows that early prevention and intervention is important to prevent long term emotional, conduct and behavioural disorders, which can lead to increased alcohol consumption, criminal behaviours, drug abuse, and poor lifestyle patterns (Aggett, Boyd, & Fletcher, 2006). In addition, intervening to prevent mental disorders in the early years of childhood development helps to maximize child potential. CAMHS has incorporated services and systems that give support in identifying and intervening so that children with mental health requirements can maximize their chance of positive outcomes. Step Two (Tier 2) - this is targeted intervention involving early detection and preventative support provision for children and their families. Support is given to children and young people who are already experiencing early behavioural difficulties, as well as mental and emotional health difficulties (Appleton, 2000). This is characterized by children engaging in risky behaviour which impacts on their psychological, educational, and social functioning progressively (Frey, Hirschstein, & Guzzo, 2000). This step has structured self help methodologies and behavioural support, provided to reduce the effects of emotional disorders and mental health problems, and also to prevent these effects from escalating to greater difficulties. Step three (Tier 3) – this is an intervention offered by specialists. It involves diagnostic assessment and the provision of systemic, pharmacological and psychological therapy (Kelvin, 2005). At this step intervention is given to young people and children experiencing moderate emotional and mental health difficulties that have a significant impact on their daily social, psychological and educational functioning. Intervention is provided by specific multidisciplinary teams and specialists, e.g. those for mental health and drug addiction. Step four (Tier 3+) – this intermediate care step aims to provide crisis resolution and intensive residential or day care services created for the children under immediate risk or those in need of intensive therapeutic care (Salmon, Darwish, Ahuja, & Steed, 2006). The purpose of this step is to prevent admissions in the acute hospital care division. Services available for provision of this step includes CAMHS crisis teams and intensive care units. Step 5 (Tier 4) – highly specialist care that involves admissions as an inpatient (Rowlands & Gowers, 2005). Care is provided for children with complex mental health disorders that severely affect their daily psychological and social functioning. The young people require the attention of various specialist agencies or secure care or acute inpatient services. The aim of these services is to provide family-centred inpatient and outreach mental health care for children whose conditions can not be treated by community-based services (Young Minds, 2011). This aim is achieved through provision of a holistic comprehensive assessment of the needs of the child and the family. It provides appropriate intensive mental health care with due regard to the age of the child and their developmental stage (Cotgrove & Gowers, 2003). Disorders that are treated in the tier 4 step include affective disorders, psychosis, obsessive compulsive disorders, self harm, attachment disorders, other mental illness, and developmental disorders like autism In most cases children presenting with severe disorders are aggressive and violent. These children often have several risk factors which may include: parental offending behaviour, parental mental illness or substance use (Williams, Wright, & Richardson, 2008). Some of the children are under the care of local authorities or are refugees or live as asylum seekers. CAMHS services in general are aimed at improving the mental health of the young people who access these services, up to the age of eighteen (Stallard, 2010). The child and adolescent mental health service assesses and manages the mental health of children at all stages, but the service has to collaborate with adult services to achieve its objectives. CAMHS works directly with adolescents and children through community assessment, liaison services and treatment. By so doing they deliver: Pre-assessment screening and provide advice and information on the same. Crisis assessment. Advice and consultation services as well as treatment. Liaison services and consultation on tier 1 and 2 services including other services like adult mental health services, paediatric services, juvenile, justice, alcohol and drug services and child protection. The services offered at the community level directly also include: clinics for special client populations; outreach services for youth; day programs for intensive rehabilitation of young people, and inpatient services in cases of acute disorders (Audit Commission, 1999). CAMHS and Vulnerable Groups There are certain groups of young people and children that are vulnerable to poor mental health which may result from continuing problems in their adulthood such as homelessness, personal relationships that are unsatisfactory and committing of crimes (Fillmore, 2010). CAMHS aims to identify and treat these individuals in their settings. Suicide Prevention This is a strategy that acknowledges a category of children and young people who are risk of committing suicide (Leenars & Wenckstern, 1999). This includes the people living in poverty, those who have had experiences of child abuse, and juvenile cases. Harming oneself is common among the young when they want to commit suicide. This strategy identifies local interventions that are effective and efficient to identify and prevent suicide by such individuals (Hickey, 2002). The services include personal, social and health education, and healthy child programs to ensure access to all. It is estimated that 40% of all children with learning difficulties experience mental disorders and these children are vulnerable (Young, Callaghan, Pace, & Vostanis, 2004). Thus CAMHS gives these children a priority. Similarly, mental ill health prevalence in children with physical disabilities is three times higher than those without. Providing health care for these individuals requires special skills and consideration of their access requirements (Allan, Kelly, Roscoe, & Herrick, 2003). Many poor families choose not to access these services when they hide their child’s mental health problems or treat mental illness as a part of their physical disability. It is recommended that a strong strategy to save children with disability and long term conditions which affect their mental health be implemented as a way of reducing the risk of false attributions for their behaviour from the their family. Young offenders are also vulnerable children. Society treats them as outcasts, thus they mostly end up with behavioural disorders even though they try to correct their mistakes (Payne & Butler, 2000). Criminal activity is also a sign of mental ill health and CAMH services are provided to these children to avoid repeated offenses and to help them deal with their self esteem after stigmatization. Services for children with challenging behaviour Young people and children with challenging behaviour have complex needs and they are challenges to the agencies involved. Both voluntary and statutory agencies find a way of enacting the planned interventions (Harwin, Pugh, Brady, Scott, & Sinclair, 2005). Lack of resources and long waiting times for tier two and three in CAMHS have led to management of these children in their communities. Schools contribute to the positive promotion of mental health, largely through developing the children’s self esteem, promoting resilience and encouraging sociality (Smith & Howie, 2009). Schools also have negative effects; some schools place too much emphasis on academic excellence and make pastoral care a secondary issue, so vulnerable children suffer as a result (Kubiszyn, 1999). The CAMH team requires a close liaison between educational psychologists and teachers, including consultations and school observations. Joint working is available but limited by capacity issues. In addition to this, CAMH requires schools to offer counselling services to vulnerable children in the schools. These are offered through counsellors employed by schools on independent terms. These services benefit the well being and mental health of children (Baginsky, 2003). Local CAMHS teams are available for consultation and partnership. However, schools in poor areas of the country may not manage to hire an independent counsellor, thus leaving the poor children to deal with their mental health issues by themselves (Burnison, 2003). Increased crime rates by people on a low income can be attributed to lack of such services in their youth, allowing it to increase and cause harm (Avevor, 2007). Not attending school, on the other hand, is also a precursor to behaviour difficulties, of which, many have mental health consequences. Thus it is evident that educational welfare plays a major role in reducing mental ill health in children. Voluntary and statutory organisations provide direct support in the provision of mental health care through helpline services and day care services. CAMH works with several voluntary organizations at all tier levels to give support to children and their parents (Weare, 2000). They provide additional and innovative methods of tackling mental health issues and promotion of recovery after ill health. However, these organizations are not able to do long term planning because of the uncertainty in their funding (Salmon, 2004). Hence services are offered for a limited period and inconsistently, leading to geographical inequality. There is also a problem of communication between statutory members who provide services and service users have no idea what services are offered by CAMHS partners (Watson, 2006). Deficits in CAMHS According to a review, many carers are frustrated by the waiting times and the limited specialist services available (Audit Commission, 1999). There is also lack of information about young people’s mental health problems for the public, as well as the services provided to these people and their families. Some of the problems in the services include the upper age range, which leads to problems accessing health and educational services (McAuley & Young, 2006). The specialized provision of CAMH varies across provinces in ways that are not similar in other UK areas. For example the age limit varies from 16 to 18. CAMH services are not comprehensive for children at this age bracket because of the demand for adult services (McDougall, 2005). In some areas, over eighteens are still treated under this service, making it difficult for children to access the service as there are less resources left for the children to access the service. There is little development in the Tier one services, and where there are developments, many of the sectors do not conceptualize themselves as members or part of the CAMH services (Kerfoot & Williams, 2005). This becomes difficult for families coming from poorer regions of UK because they are less aware of where to access the services. Collaboration of CAMH with non statutory sectors is important to help identify problems for all children according to their developmental age (Penny & Rolls, 2011). It is more important for those who cannot afford specialist services, however this collaboration is lacking or not known to the people in need of the service. Similarly, tier 2 developments are limited. Some clinical psychologists have developed services using behavioural and counselling models for families, to address the needs of young people up to the final year of primary school (Stallard, 2010). These services are not consistently provided in the United Kingdom. A report by the London school of economics mental health policy group found out that out of, approximately 700,000 children suffering from mental illness such as anxiety, depression and other behaviour problems, only a quarter gets treatment (Crown, 1998). This is due to the expensive nature of the services offered. The report argues that the service providers should think of better ways of offering the CAMH services and to incorporate inexpensive psychological treatments, to reduce the suffering of millions of children and adults in the country (Rivett, 2008). Where services provided by CAMHS do not follow the guidelines of clinical excellence provided by the National Health Institute, the outcome reduces the quality of services provided, and thus reduces the number of children with effective treatment. The government has provided for improvement through the Access to Psychological Therapies (APT) programme, but some local authorities fail to fund the necessary expansion of the scheme or even cut mental health care provision for children (Mathai, Anderson, & Bourne, 2002). This is more disadvantageous for poor families as they can not afford the high cost of private treatment offered; they have to deal with the poor services. To be specific, the tier four, according to minister Michael Upsall,a commissioner from Derbyshire, costs approximately £ 5,000 a week, and £25,000 a month for a bed (Beecham, Green, Jacobs, & Dunn, 2009) (Audit Commission, 1999). Some people are also forced to pay because the kind of therapy they need is not offered by NHS. Several services can instead be provided in the communities with less funding, only if the funds were accessible to the local representatives. Increasing the beds only means that more children will be admitted, even wrongly admitted (Ayyash, et al., 2013). Inspite of the efforts showed by the government to address inequlity in psychological therapy accessibility, it is apparent that certain groups still have poor accessibility rates; especially the minority communities, children and young people, homeless people, and older people (Mind, 2012). Most poor people do not take behavioural disorders seriously; they assume it is a stage of growth. Hence young people and children tend to get services at a stage when it is too late. They therefore require more complicated and time consuming interventions to take care of the challenges they face. Often the services are expensive (Shastri, 2009). Another deficit is the relationship between the tiers of care. They often operate in reverse. As children get better, they require a lower tier service for ongoing care, but when the services are lacking, their discharge from hospital is delayed or repeated admissions are made (Worrall‐Davies, Hewson, McDougall, Richardson, & Cotrove, 2008). Local services are also scared of young people going back into the community, possibly to face a crisis that resulted in their admission to hospital in first place. The local services do not offer appropriate provision for young people due to their stretched funding (Slee, 2000). Young people may be forced to wait for a long period of time, up to two years, to get an appropriate placement after their recovery. This can lead to worsening of their condition. This is called a revolving-door patient; young people and children are admitted into hospital, recover, and are then discharged but, due to lack of support, they deteriorate quickly and are readmitted (Acute Hospital Review Group, 2001). This problem can be reduced through appropriate funding and the deployment of trained CAMHS staff in schools to tackle the problem of mental ill health in children and young people. In return, this will increase awareness of mental health problems and encourage them to seek help before the problems results in crisis. In most cases, lack of awareness caused the escalation of the problem, leading to a high risk situation for themselves and others around them. Without enough funding for the CAMHS, they are put on a waiting list (Pettitt, 2003). Recommendations and Conclusion A comprehensive CAMH service should be facilitated through the establishment of a structured implementation process across all social services, youth justice, and education and health sectors (Salmon & Kirby, 2008). It should put in mind the poor who are not able to get the services in due time or at all. Costs for these services should be reduced as well as an emphasis being laid in the Tier one step where prevention and early intervention takes place to prevent the children from causing harm to themselves or to others (Cooklin, 2004). Child and Adolescent Mental Health Services are significant as part of a planned health care program for children. For example, in schools, involving pupils in initiatives to promote healthy behaviour assists in healthy development mentally and socially. References Acute Hospital Review Group. (2001). Acute hospitals review group report. Belfast: DHSSPS. Aggett, P., Boyd, E., & Fletcher, J. (2006). 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