Child and Adolescent Mental Health Services

Child and Adolescent Mental Health Services (CAMHS) is the name for NHS-provided services in the United Kingdom for children, generally until school-leaving age, who are having difficulties with their emotional well-being or are deemed to have persistent behavioural problems.[1] CAMHS are organised locally, and the exact services provided may vary, often by local government area.[2]

History

In Europe and the United States child-centred mental health did not become a medical specialty until after World War I.[3] In the United Kingdom children's and young people's mental health treatment was for decades the remit of the Child Guidance Movement increasingly working after World War II with local educational authorities and often influenced by psychoanalytic ideas. Provision in NHS hospitals was piecemeal across the country and disconnected from the youth justice system. However opposition to Psychoanalysis with its pioneering research work into childhood and adolescence,[4][5][6] which was poorly understood by proponents of the Medical model, caused the service to be abandoned in favour of evidence-based medicine and evidence-based education.[7] This led to the eclipse of the multidisciplinary child guidance approach in the 1990s and a public policy-motivated formal take-over by the NHS.[8]

The development of CAMHS within a four-tiered framework started in 1995. In 1998, 24 CAMHS Innovation Projects started, and the Crime and Disorder Act 1998 established related youth offending teams. In 2000 the NHS Plan Implementation Programme required health and local authorities to jointly produce a local CAMHS strategy.[9]

In November 2008 the independent CAMHS Review was published.[9][10]

From about 2013 onward major concerns have been expressed about reductions in CAMHS, and apparently increasing demand, and in 2014 the parliamentary Health Select Committee investigated and reported on provision.[11][12] In 2015 the government published a review,[13] and promised a funding increase of about £250 million per year. However the funds were not ring-fenced and as of 2016 only about half of England's Clinical commissioning groups had increased local CAMHS funding.[14][15] CAMHS funding remains a popular topic for political announcements of funding and the current aim is to increase funding to the level that 35% of young people with a disorder are able to receive a specialist service. Different models of service organisation are also advocated as part of this transformation.[16]

In Scotland, between 2007 and 2016 the number of CAMHS psychologists had doubled, reflecting increased demand for the service.[17] However in September 2020, 53.5% of CAMHS patients in Scotland had waited for an appointment longer than the 18 weeks target, and in Glasgow the average waiting time was 26 weeks.[18]

131 new CAMHS beds were commissioned by NHS England in 2018, increasing the existing 1,440 bed base by more than 10%. 56 will be in London, 12 at Bodmin Hospital and 22 at St Mary’s Hospital in Leeds.[19]

Service framework

In the UK CAMHS are organised around a four tier system:[20]

Tier 1
general advice and treatment for less severe problems by non-mental health specialists working in general services, such as GPs, school nurses, social workers, and voluntary agencies.
Tier 2
usually CAMHS specialists working in community and primary care, such as mental health workers and counsellors working in clinics, schools and youth services.
Tier 3
usually a multi-disciplinary team or service working in a community mental health clinic providing a specialised service for more severe disorders, with team members including psychiatrists, social workers, board certified behaviour analysts, clinical psychologists, psychotherapists and other therapists.
Tier 4
highly specialist services for children and young people with serious problems, such as day units, specialised outpatient teams and in-patient units.

Specialist CAMHS – Tiers 3 and 4

Generally patients cannot self-refer to Tier 3 or 4 services, which are sometimes called specialist CAMHS. Referrals can be made by a wide range of agencies and professionals, including GPs and school nurses.[1][21]

The aim is to have a team led by a consultant psychiatrist, although other models exist and there is limited evidence of what system works best. It is suggested that there should be a consultant psychiatrist for a total population of 75,000, although in most of the UK this standard is not met.

The Tier 4 service includes hospital care, with about 1,450 hospital beds provided in England for adolescents aged 13 to 18.[22] Typical conditions that sometime require hospital care include depression, psychoses, eating disorders and severe anxiety disorders.[23]

The service may, depending on locality, include:

Performance

As of December 2016, some young English people with eating disorders were being sent hundreds of miles away to Scotland because the services they required were not available locally. Not withstanding good care in Scotland it was said that being away from friends and family compromised their recovery. In response the government had adopted a policy of ending such arrangements by 2021, and had allocated a cumulative £150M to improve local availability of care. [25] There are concerns that not enough is being done to support people at risk of taking their own lives.[26] 1,039 children and adolescents in England were admitted to beds away from home in 2017–18, many had to travel over 100 miles (160 kilometres) from home. Many had complex mental health issues frequently involving a risk of self-harm or suicide, like severe depression, eating disorders, psychosis and personality disorders.[27]

In 2017-18 at least 539 children assessed as needing Tier 3 child and adolescent mental health services care waited more than a year to start treatment, according to a Health Service Journal survey which elicited reports from 33 out of the 50 mental health trusts.[28]

See also

References
  1. "A guide to mental health services in England". NHS England. Archived from the original on 2 February 2017. Retrieved 2 February 2017.
  2. Sarah Wright (16 November 2016). "The 30-second briefing: What are CAMHS?". TES Connect. Archived from the original on 3 February 2017. Retrieved 2 February 2017.
  3. Bewley, Thomas (2008). "11 - Development of Specialties Child Psychiatry". Madness to Mental Illness: History of the Royal College of Psychiatrists (PDF). RCPsych Publications; Illustrated edition. ISBN 978-1904671350. Archived (PDF) from the original on 2 May 2021. Retrieved 2 May 2021.
  4. Freud, Anna (1935). An Introduction to Psychoanalysis: Lectures for Child Analysts and Teachers 1922-1935 (PDF). International Universities Press Inc. Archived (PDF) from the original on 4 May 2021. Retrieved 2 May 2021.
  5. Bowlby, John (1995) [1950]. Maternal Care and Mental Health. Bulletin of the World Health Organization. The master work series. Vol. 3 (2nd ed.). Northvale, NJ; London: Jason Aronson. pp. 355–533. ISBN 978-1-56821-757-4. OCLC 33105354. PMC 2554008. PMID 14821768. [Geneva, World Health Organization, Monograph series no. 3].
  6. Fordham, Michael (1969). Children as Individuals. London: Hodder & Stoughton.
  7. Rutter, Michael (1986). "Child psychiatry: looking 30 years ahead". Journal of Child Psychology and Psychiatry. 27 (6): 803–840. doi:10.1111/j.1469-7610.1986.tb00202.x. PMID 3793821.
  8. Barrett, Susan (2019). "From Adult Lunatic Asylums to CAMHS Community Care: the Evolution of Specialist Mental Health Care for Children and Adolescents 1948-2018". Revue Française de Civilisation Britannique, XXIV-3. XXIV (3). doi:10.4000/rfcb.4138.
  9. "A brief timeline of CAMHS policy in England". YoungMinds. 2014. Archived from the original on 13 September 2016. Retrieved 9 August 2022.
  10. CAMHS Review (PDF) (Report). Department for Children, Schools and Families. 2008. Archived from the original on 30 December 2008. Retrieved 2 April 2017.{{cite report}}: CS1 maint: bot: original URL status unknown (link)
  11. "Problems with children's and adolescents. mental health services, says Committee". Health Select Committee. UK Parliament. 5 November 2014. Archived from the original on 18 February 2015. Retrieved 21 March 2015.
  12. "Major concerns about CAMHS reductions in England". British Psychological Society. 25 February 2015. Archived from the original on 19 March 2015. Retrieved 21 March 2015.
  13. "Improving mental health services for young people". Department of Health. 17 March 2015. Archived from the original on 3 April 2017. Retrieved 2 April 2017.
  14. "CAMHS cash at risk of being diverted from frontline, commission finds". National Health Executive. 15 November 2016. Archived from the original on 3 February 2017. Retrieved 2 February 2017.
  15. "Former care minister slams May's 'puny response' to CAMHS funding". National Health Executive. 10 January 2017. Archived from the original on 2 February 2017. Retrieved 2 February 2017.
  16. https://www.elht.nhs.uk/services/east-lancashire-child-and-adolescent-services/understanding-camhs-what-it%5B%5D
  17. "More children getting help from mental health services". BBC News. 6 September 2016. Archived from the original on 15 September 2016. Retrieved 3 October 2016.
  18. Hunter, Catherine (2 December 2020). "Waiting times for CAMHS branded "ridiculous"". Glasgow Evening Times. Archived from the original on 18 January 2021. Retrieved 23 February 2021.
  19. "Ten per cent increase in CAMHS beds confirmed". Health Service Journal. 29 January 2018. Archived from the original on 11 March 2018. Retrieved 10 March 2018.
  20. "CAMHS: Four-tier strategic framework". Department for Children, Schools and Families. 7 January 2010. Archived from the original on 2 February 2010.
  21. "Child and Adolescent Mental Health Service (CAMHS)". Somerset Partnership Foundation Trust. Archived from the original on 2 April 2015. Retrieved 31 March 2015.
  22. Mason, Rowena (4 August 2017). "UK judges rule DWP wrong to deny appeals over refused benefits". The Guardian. Archived from the original on 4 August 2017. Retrieved 4 August 2017.
  23. "Children in UK mental health hospitals 'not improving', parents say". The Guardian. 27 February 2017. Archived from the original on 27 February 2017. Retrieved 27 February 2017.
  24. Monica Dent, Lisa Peto, Michael Griffin, Nick Hindley (January 2013). Community Forensic Child and Adolescent Mental Health Services (FCAMHS): a map of current national provision and a proposed service model for the future (Report). Department of Health. Archived from the original on 3 April 2017. Retrieved 30 March 2017.{{cite report}}: CS1 maint: multiple names: authors list (link)
  25. Marsh, Sarah; Campbell, Denis (11 December 2016). "NHS England sending anorexic patients to Scotland for treatment". The Guardian. Archived from the original on 23 August 2018. Retrieved 2 October 2018.
  26. "Scale of suicide unacceptable, say MPs". BBC News. 19 December 2016. Archived from the original on 20 October 2018. Retrieved 2 October 2018.
  27. Children forced to travel hundreds of miles for NHS mental health treatment Archived 12 September 2018 at the Wayback Machine The Guardian
  28. "Hundreds of children wait more than a year for specialist help". Health Service Journal. 30 August 2018. Archived from the original on 2 October 2018. Retrieved 2 October 2018.
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