Written evidence submitted by Islington CAMHS (CMH0077)

I am responding on behalf of Islington Child and Adolescent Mental Health Service (CAMHS) and are very pleased that the Commons Health Committee is concerned and interested in the mental health needs of children and young people and their families. We would like to draw to your attention a number of issues for your consideration of the services for this extremely important area of public provision.

Child mental health has struggled to gain the public recognition that other areas of health need have obtained. The reasons for this are likely to be complicated but not least because it may be hard for the public to accept that children can experience mental health problems of anxiety, depression, trauma and anger in much the same way that adults can. Their vulnerability and powerlessness may make this less easily expressed than for adults but there is no doubt that their distress is being communicated in important ways. For example, increasing rates of self harm such as cutting provide a poignant indication that the mental health needs of children deserve as much of the public purse as the mental health needs of other age groups. So we would begin by asking you to consider the issue that services for children and young people should be funded to the same degree as for adults. We note for example the dramatic contrast in funding between the adult IAPT programme (Increasing Access to Psychological Therapies) and that of the IAPT programme for children and young people.

Secondly, services for children and young people need a more stable commissioning base. Located between local authority, education and health commissioners, CAMHS  runs a tightrope of fragile commissioning arrangements so that initiatives are too often short term, with an uncertain funding base and reliant on collaborations between commissioning agencies who themselves have cost pressures which they are often unable to control. The time and energy spent by CAMHS service leaders in negotiating and securing funding for services from a wide range of stakeholders is extraordinarily wasteful of expertise that should be used on more direct project work within the services they manage and supervise. The on-going structural fragmentation of children’s services at a local and national level means that child mental health becomes a separate service provision rather than an integrated components of all provision for children including amongst others schools, children’s centres, social care teams, health visiting, youth offending and disability services. The goal of integrated provision remains as strong a need as ever so that the mental health needs of children and young people cannot be addressed by services separated from mainstream services for children in general, the most extensive of these is education but also social care. Mental health provision should be integrated as part of these services and not separated off as if the problem itself is not linked to social, economic or educational contexts.

Thirdly, psychiatric hospital admission remains an important part of the care needed for a small minority of young people with severe mental health needs. Such treatment should only be offered as part of a comprehensive package that includes pre-admission and post-admission provision. Hospital care in isolation runs the risk of disconnecting a young person from a local service, family and community to provide appropriate care. Recent commissioning changes which have located in-patient  psychiatric care as part of specialist national commissioning has had a disastrous impact on enabling local services to provide in-patient treatment as part of a package of longer term out-patient treatment. This has resulted in longer admissions and young people being admitted to units very distant from their local service. This decision to disconnect in-patient care from local commissioning should be reversed and this service should revert to being part of local joint commissioning arrangements and CCGs.

Fourthly, as described by the Good Childhood Report led by Richard Layard and Judy Dunn (2009) concluded that children need three things:  love, respect and help that is based on evidence.  Strong opinions abound about the needs of children and what is helpful to them but certain interventions should no longer be tolerated on the basis of both ethics and evidence. For example, youth violence should be considered a major mental health concern so that the incarceration of young people in prison type facilities should be recognised as a completely unacceptable and ineffective response to the needs of these highly troubled young people. Similarly, permanent school exclusion should be considered a useless and destructive response to a young person’s. There is no evidence that school exclusion benefits the young people that endure it.

Fifthly, we need to strengthen community resilience through preventative programmes that build on peer to peer models of care. The mental health needs of children cannot be met by solely by professionalised state funded services. As part of receiving help we need to develop the capacity to help as part of a comprehensive programme of public mental health improvement. This has been demonstrated in parent programmes that engage parents as part of the implementation team. Similarly we need to engage young people is their capacity to help their peers engaged in behaviour such as cutting, self harm or substance misuse.

Thank you for providing the opportunity for us to contribute to your work. We hope that the issues raised will be given consideration and that the work of the committee results in improved services for this crucial area of public need.

2 April 2014