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 or behavioural well-being.[1] CAMHS services are organised locally, and the exact services provided may vary, often by local government area.[2]

Service organisation

In the UK CAMHS are organised around a four tier system:[3]

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][4]

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.[5] Typical conditions that sometime require hospital care include depression, psychoses, eating disorders and severe anxiety disorders.[6]

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. [8] There are concerns that not enough is being done to support people at risk of taking their own lives.[9] 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.[10]

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.[11]

History

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.[12]

In November 2008 the independent CAMHS Review was published.[12][13]

From about 2013 onward major concerns have been expressed about reductions in CAMHS services, and apparently increasing demand, and in 2014 the parliamentary Health Select Committee investigated and reported on provision.[14][15] In 2015 the government published a review,[16] 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.[17][18] 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.[19]

In Scotland, between 2007 and 2016 the number of CAMHS psychologists had doubled, reflecting increased demand for the service.[20]

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.[21]

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See also

References
  1. "A guide to mental health services in England". NHS England. Retrieved 2 February 2017.
  2. Sarah Wright (16 November 2016). "The 30-second briefing: What are CAMHS?". TES Connect. Retrieved 2 February 2017.
  3. "CAMHS: Four-tier strategic framework". Department for Children, Schools and Families. 7 January 2010. Archived from the original on 2 February 2010.
  4. "Child and Adolescent Mental Health Service (CAMHS)". Somerset Partnership Foundation Trust. Retrieved 31 March 2015.
  5. Mason, Rowena (4 August 2017). "UK judges rule DWP wrong to deny appeals over refused benefits". The Guardian. Retrieved 4 August 2017.
  6. "Children in UK mental health hospitals 'not improving', parents say". The Guardian. 27 February 2017. Retrieved 27 February 2017.
  7. 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.CS1 maint: multiple names: authors list (link)
  8. Marsh, Sarah; Campbell, Denis (11 December 2016). "NHS England sending anorexic patients to Scotland for treatment". The Guardian.
  9. "Scale of suicide unacceptable, say MPs". BBC News. 19 December 2016 – via www.bbc.co.uk.
  10. Children forced to travel hundreds of miles for NHS mental health treatment The Guardian
  11. "Hundreds of children wait more than a year for specialist help". Health Service Journal. 30 August 2018. Retrieved 2 October 2018.
  12. "A brief timeline of CAMHS policy in England". YoungMinds. 2014. Retrieved 2 April 2017.
  13. CAMHS Review (PDF) (Report). Department for Children, Schools and Families. 2008. Archived from the original on 30 December 2008. Retrieved 2 April 2017.CS1 maint: BOT: original-url status unknown (link)
  14. "Problems with children's and adolescents. mental health services, says Committee". Health Select Committee. UK Parliament. 5 November 2014. Retrieved 21 March 2015.
  15. "Major concerns about CAMHS reductions in England". British Psychological Society. 25 February 2015. Retrieved 21 March 2015.
  16. "Improving mental health services for young people". Department of Health. 17 March 2015. Retrieved 2 April 2017.
  17. "CAMHS cash at risk of being diverted from frontline, commission finds". National Health Executive. 15 November 2016. Retrieved 2 February 2017.
  18. "Former care minister slams May's 'puny response' to CAMHS funding". National Health Executive. 10 January 2017. Retrieved 2 February 2017.
  19. https://www.elht.nhs.uk/services/east-lancashire-child-and-adolescent-services/understanding-camhs-what-it%5B%5D
  20. "More children getting help from mental health services". BBC News. 6 September 2016. Retrieved 3 October 2016.
  21. "Ten per cent increase in CAMHS beds confirmed". Health Service Journal. 29 January 2018. Retrieved 10 March 2018.
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