Jump to content

Child and Adolescent Mental Health Services

Edit links
From Wikipedia, the free encyclopedia
(Redirected from CAMHS)

Child and Adolescent Mental Health Services (CAMHS) is the name for care provided by the NHS and other organisations in the United Kingdom for children, generally until school-leaving age, who have difficulties with their emotional well-being or are deemed to have persistent behavioural problems.[1] The service is also known as Children and Young People’s Mental Health Services (CYPMHS).[2] CAMHS offer children, young people and their families access to support for mental health issues from third sector (charity) organisations, school-based counselling, primary care as well as specialist mental health services. The exact services provided may vary, reflecting commissioning and providing arrangements agreed at local level.[3]

Background

[edit]

Worldwide in 2021, one in seven 10-19 year-olds have mental health problems, with approximately 14% of adolescents, experiencing depression, anxiety, and behavioural disorders.[4] In 2020, it was reported that one in six 5-16 year olds in England had a probable mental health difficulty.[5] One in five children and young people aged 8-25 in England had a probable mental disorder in 2023.[6] The restrictions as a response to the COVID-19 pandemic negatively impacted on the mental health of children and young people.[7][8]

Tiers framework

[edit]

Since 1995, UK CAMHS have largely been organised around the four-tier framework:[9][10]

Tier 1
mental health promotion, ill-health prevention work, and general advice and treatment for less severe problems by non-mental health specialists working in universal children’s 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 and providing services for children and young people with ‘common’ mental health problems such as mild-moderate anxiety and depression.
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 mental health nurses, psychiatrists, social workers, 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 2 to 4

[edit]

Tiers 2 to 4 are often known as specialist CAMHS. Generally, the higher the tier, the more difficult it is for children and young people, or their carers, to self-refer. Referrals to higher tiers can usually be made by a wide range of agencies and professionals, including GPs and school nurses.[1][11]

The Health Advisory Service originally deemed that a specialist CAMHS team should include, at the minimum, a child psychiatrist, a child psychologist and a nurse with knowledge and skills in child and adolescent mental health. More developed teams, however, include members from other disciplines such as occupational therapy, psychotherapy, social work and nursery nursing. Most current services are psychiatrist-led, 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.[citation needed]

The Tier 4 service includes hospital care or intensive home-based crisis care, with about 1,450 hospital beds provided in England for adolescents aged 13 to 18.[12] Typical conditions that sometime require hospital care include severe emotional disorders (depression and anxiety disorders), psychoses, eating disorders and self-harm that is life threatening.[13][14] Although hospitals fulfill an important role in overall systems of care, children and young people who are admitted can be at risk of losing touch with family, friends and education.[15]

The service may, depending on locality, include:

Alternatives to the tiers system

[edit]

In response to the criticisms of the four-tier framework, there have been attempts to transform services using initiatives such as the Choice and Partnership Approach (CAPA),[17] CYP-IAPT (an analogue of the adult Improving Access to Psychological Therapies initiative for children and young people)[18] and ‘THRIVE’.[19]

CAPA, developed in the early 2000s, was an initiative designed to improve service effectiveness and the management of service demand and capacity.[20][21]

CYP-IAPT was a government-supported initiative of the 2010s.[22] Like its adult IAPT counterpart, CYP-IAPT aimed to improve the availability of, and access to, evidence-based psychological therapies. Unlike its adult counterpart, CYP-IAPT did not involve the recruitment and development of new types of workers; instead, it championed the training of existing staff in evidence-based therapies such as cognitive-behavioural therapy, parenting and interpersonal therapy.[23]

THRIVE is a framework for creating coherent and resource-efficient ‘communities’ of mental health that focuses on clarity around need rather than structures or interventions to meet such needs. THRIVE has been mooted as an alternative to the tiers model with the four tiers being replaced by five (increasingly complex) levels of need: thriving, getting advice, getting help, getting risk support, and getting more help.[24]

Performance

[edit]

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] In November 2023, there were 239,715 children and young people who had been referred and were waiting for a CAMHS assessment In England.[29]

According to a collaboratively produced service design model, high-quality CAMHS require:[30]

  • rapid access and short waiting times
  • teaching practical skills and strategies for self-care
  • Individualised support with choice and flexibility
  • clear and accessible information
  • compassionate and competent staff
  • aftercare planning for navigating out of or into other services
  • respecting confidentiality and autonomy
  • engagement and involvement of children and young people in activities, therapies and decision-making
  • collaborative relationships: with children and young people, families and other disciplines and agencies
  • a learning culture allowing the team to learn from each other and from those using the services

Services for mental health crisis

[edit]

Between 2016 and 2020 in Wales, almost 52,000 individual mental health crisis events involving ambulance attendance, A&E visits or emergency admission were recorded amongst 11-24 year olds.[31]

The number of children and young people experiencing mental health crises is increasing but as a result of stretched services and increasing demand there are often lengthy waiting periods before being seen which in turn leads to rising numbers seeking help.[32][33] Crisis care for children and young people has become a policy priority both in the UK and internationally.[34]

Understanding the different kinds of crisis services and how young people and their families experience help in those situations is crucial for making care better. Many young people and their families have no knowledge about available mental health services or how to access them during times of crisis. As a result emergency departments are commonly used during moments of crisis.[35] For mental health crisis care to be effective people need to know where to access services. Triage or assessment-only services, such as in emergency departments, schools, via phone, text or online, are also effective.[35]

History

[edit]

In Europe and the United States child-centred mental health did not become a medical specialty until after World War I.[36] 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,[37][38][39] 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.[40] 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.[41]

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.[42]

Despite the introduction of the four-tier framework in 1995, reports and reviews have consistently described UK children’s mental health services as fragmented, uncoordinated, variable, inaccessible and lacking an evidence-base. These include:

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.[47][48] In 2015 the government published a review,[49] 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.[50][51] 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.[52]

In Scotland, between 2007 and 2016 the number of CAMHS psychologists had doubled, reflecting increased demand for the service.[53] 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.[54]

Current policy in England is based on the Green Paper (2017) and the NHS Mental Health Implementation Plan (2019). It focuses on mental health promotion, mental ill-health prevention and early intervention, workforce expansion, community-based mental support teams (including school-based mental health workers), and 24/7 crisis services. Services are expected to cover the 0-25s (rather than 0-17s).[55] The 2019 implementation plan has been disrupted by the COVID-19 pandemic which has led to increased demand for CAMHS[56] and an impact on the availability of appropriately trained staff.[57]

See also

[edit]

References

[edit]
  1. ^ a b "A guide to mental health services in England". NHS England. Archived from the original on 2 February 2017. Retrieved 2 February 2017.
  2. ^ "Guide to CAMHS". YoungMinds. Retrieved 23 March 2024.
  3. ^ "CAMHS mental health services". Contact. Retrieved 23 March 2024.
  4. ^ "Mental health of adolescents". World Health Organization. Retrieved 25 March 2024.
  5. ^ "Mental Health of Children and Young People in England, 2020: Wave 1 follow up to the 2017 survey". NHS England Digital. Retrieved 25 March 2024.
  6. ^ "Mental Health of Children and Young People in England, 2023 - wave 4 follow up to the 2017 survey". NHS England Digital. Retrieved 25 March 2024.
  7. ^ Samji, Hasina; Wu, Judy; Ladak, Amilya; Vossen, Caralyn; Stewart, Evelyn; Dove, Naomi; Long, David; Snell, Gaelen (28 August 2021). "Review: Mental health impacts of the COVID-19 pandemic on children and youth – a systematic review". Child and Adolescent Mental Health. 27 (2): 173–189. doi:10.1111/camh.12501. ISSN 1475-357X. PMC 8653204. PMID 34455683.
  8. ^ "Covid Impact On Young People With Mental Health Needs". YoungMinds. Retrieved 25 March 2024.
  9. ^ "CAMHS: Four-tier strategic framework". Department for Children, Schools and Families. 7 January 2010. Archived from the original on 2 February 2010.
  10. ^ "Model Specification for Child and Adolescent Mental Health Services: Targeted and Specialist levels (Tiers 2/3)" (PDF). NHS England. 23 December 2014. Retrieved 23 March 2024.
  11. ^ "Child and Adolescent Mental Health Service (CAMHS)". Somerset Partnership Foundation Trust. Archived from the original on 2 April 2015. Retrieved 31 March 2015.
  12. ^ McDougall, Tim; Worrall-Davies, Anne; Hewson, Lesley; Richardson, Greg; Cotgrove, Andrew (13 October 2008). "Tier 4 Child and Adolescent Mental Health Services (CAMHS) - Inpatient Care, Day Services and Alternatives: An Overview of Tier 4 CAMHS Provision in the UK". Child and Adolescent Mental Health. 13 (4): 173–180. doi:10.1111/j.1475-3588.2007.00481.x. ISSN 1475-357X. PMID 32847182.
  13. ^ Clark, Jacob; MacLennan, Euan (24 May 2023). "Measuring Experience of Inpatient Child and Adolescent Mental Health Services (CAMHS)". International Journal of Environmental Research and Public Health. 20 (11): 5940. doi:10.3390/ijerph20115940. ISSN 1660-4601. PMC 10252505. PMID 37297544.
  14. ^ "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.
  15. ^ Hannigan, Ben; Edwards, Deborah; Evans, Nicola; Gillen, Elizabeth; Longo, Mirella; Pryjmachuk, Steven; Trainor, Gemma (May 2015). "An evidence synthesis of risk identification, assessment and management for young people using tier 4 inpatient child and adolescent mental health services". Health Services and Delivery Research. 3 (22): 1–228. doi:10.3310/hsdr03220. ISSN 2050-4349. PMID 25996025.
  16. ^ 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)
  17. ^ Campbell, Leslie Anne; Clark, Sharon E.; Chorney, Jill; Emberly, Debbie; MacDonald, Julie; MacKenzie, Adrian; Warner, Grace; Wozney, Lori (1 October 2022). "Choice and Partnership Approach to community mental health and addiction services: a realist-informed scoping review". BMJ Open. 12 (10): e064436. doi:10.1136/bmjopen-2022-064436. ISSN 2044-6055. PMC 9582326. PMID 36261240.
  18. ^ Burn, Anne-Marie; Vainre, Maris; Humphrey, Ayla; Howarth, Emma (14 October 2020). "Evaluating the CYP-IAPT transformation of child and adolescent mental health services in Cambridgeshire, UK: a qualitative implementation study". Implementation Science Communications. 1 (1): 89. doi:10.1186/s43058-020-00078-6. ISSN 2662-2211. PMC 7556968. PMID 33073242.
  19. ^ "Helping young people THRIVE: Implementing a person-centred model of care for young people's mental health". The Health Foundation. Retrieved 24 March 2024.
  20. ^ Campbell, Leslie Anne; Clark, Sharon E; Chorney, Jill; Emberly, Debbie; MacDonald, Julie; MacKenzie, Adrian; Warner, Grace; Wozney, Lori (19 October 2022). "Choice and Partnership Approach to community mental health and addiction services: a realist-informed scoping review". BMJ Open. 12 (10): e064436. doi:10.1136/bmjopen-2022-064436. ISSN 2044-6055. PMC 9582326. PMID 36261240.
  21. ^ "Introducing CAPA". CAPA. Retrieved 24 March 2024.
  22. ^ "What was CYP IAPT?". Anna Freud. Retrieved 24 March 2024.
  23. ^ Burn, Anne-Marie; Vainre, Maris; Humphrey, Ayla; Howarth, Emma (14 October 2020). "Evaluating the CYP-IAPT transformation of child and adolescent mental health services in Cambridgeshire, UK: a qualitative implementation study". Implementation Science Communications. 1 (1): 89. doi:10.1186/s43058-020-00078-6. ISSN 2662-2211. PMC 7556968. PMID 33073242.
  24. ^ THRIVE Elaborated: Second Edition. CAMHS Press. November 2016. ISBN 978-0-9933436-4-3.
  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.
  29. ^ "Mental Health of Children and Young People in England, 2023". NHS England. Retrieved 24 March 2024.
  30. ^ Pryjmachuk, Steven; Kirk, Susan; Fraser, Claire; Evans, Nicola; Lane, Rhiannon; Crooks, Jodie; McGowan, Rose; Naughton, Georgia; Neill, Liz; Camacho, Elizabeth; Bower, Peter; Bee, Penny; McDougall, Tim (24 January 2024). "A collaboratively produced model of service design for children and young people with common mental health problems". BMC Health Services Research. 24 (1): 133. doi:10.1186/s12913-024-10562-7. ISSN 1472-6963. PMC 10809440. PMID 38268003.  This article incorporates text available under the CC BY 4.0 license.
  31. ^ Bentley, Laura; Carter, Bethan; Davies, Alisha R; et al. (July 2022). "Children and young people's mental health: Exploring presentation in mental health crisis through linked routine health care data in Wales, NDL Wales Team". Public Health Wales. Retrieved 25 March 2024.
  32. ^ a b Mind over matter: A report on the step change needed in emotional and mental health support for children and young people in Wales (PDF). National Assembly for Wales, Children Young People and Education Committee. April 2018.
  33. ^ a b Future in mind: promoting, protecting and improving our children and young people's mental health and wellbeing (PDF). NHS England. 2015.
  34. ^ Edwards, Deborah; Carrier, Judith; Csontos, Judit; Evans, Nicola; Elliott, Mair; Gillen, Elizabeth; Hannigan, Ben; Lane, Rhiannon; Williams, Liz (14 February 2023). "Review: Crisis responses for children and young people – a systematic review of effectiveness, experiences and service organisation ( CAMH-Crisis )". Child and Adolescent Mental Health. 29 (1): 70–83. doi:10.1111/camh.12639. ISSN 1475-357X. PMID 36785997.
  35. ^ a b Evans, Nicola; Edwards, Deborah; Carrier, Judith; Elliott, Mair; Gillen, Elizabeth; Hannigan, Ben; Lane, Rhiannon; Williams, Liz (May 2023). "Mental health crisis care for children and young people aged 5 to 25 years: the CAMH-Crisis evidence synthesis". Health and Social Care Delivery Research. 11 (3): 1–165. doi:10.3310/BPPT3407. ISSN 2755-0060.
  36. ^ 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 978-1-904671-35-0. Archived (PDF) from the original on 2 May 2021. Retrieved 2 May 2021.
  37. ^ 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.
  38. ^ Bowlby, John (1995) [1950]. Maternal Care and Mental Health. 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]. {{cite book}}: |journal= ignored (help)
  39. ^ Fordham, Michael (1969). Children as Individuals. London: Hodder & Stoughton.
  40. ^ 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.
  41. ^ 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.
  42. ^ "A brief timeline of CAMHS policy in England". YoungMinds. 2014. Archived from the original on 13 September 2016. Retrieved 9 August 2022.
  43. ^ Children in mind: child and adolescent mental health services (PDF). London: Audit Commission. 1999. ISBN 9781862401600. OCLC 42887442.
  44. ^ 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)
  45. ^ Murphy, Margaret; Fonagy, Peter (2013). "Mental health problems in children and young people" (PDF). Annual Report of the Chief Medical Officer 2012. Our Children Deserve Better: Prevention Pays. London: Department of Health.
  46. ^ "Lightning Review: Access to Child and Adolescent Mental Health Services". Children's Commissioner for England. 28 May 2016. Retrieved 3 April 2024.
  47. ^ "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.
  48. ^ "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.
  49. ^ "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.
  50. ^ "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.
  51. ^ "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.
  52. ^ https://www.elht.nhs.uk/services/east-lancashire-child-and-adolescent-services/understanding-camhs-what-it[permanent dead link‍]
  53. ^ "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.
  54. ^ 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.
  55. ^ Garratt, Katherine; Kirk-Wade, Esme; Long, Robert (26 January 2024). Children and young people's mental health: policy and services (England) (PDF). House of Commons Library.
  56. ^ Huang, Hannah Chu-Han; Ougrin, Dennis (5 August 2021). "Impact of the COVID-19 pandemic on child and adolescent mental health services". BJPsych Open. 7 (5): e145. doi:10.1192/bjo.2021.976. ISSN 2056-4724. PMC 8353214. PMID 34348823.
  57. ^ "Provider collaboration review: Mental health care of children and young people during the COVID-19 pandemic". Care Quality Commission. 12 May 2022. Retrieved 3 April 2024.
[edit]
Retrieved from "https://wiki.riteme.site/w/index.php?title=Child_and_Adolescent_Mental_Health_Services&oldid=1253706837"