Top child psychiatrist calls for better mental health commissioning

Dr Sue Bailey, whose three-year tenure as president of the Royal College of Psychiatrists ended last month, told CYP Now that commissioning of child and adolescent mental health services (CAMHS) is too driven by what providers offer rather than designing a service that best meets the needs of young people.

An example of this is the shortage of inpatient unit beds - known as Tier 4 CAMHS - in some parts of the country, which is resulting in young people sometimes being placed in facilities hundreds of miles away from home as there is no provision available locally.

Bailey said. “It is clear to everyone that there is a shortage of beds. We need more capacity.”

In a report published last week, NHS England, which oversees the commissioning of inpatient units, admitted children being placed out-of-area was due to a shortage of provision in some parts of the country and pledged to increase the number of beds available by 50.

The report also highlighted concerns that some children and young people are being inappropriately admitted to inpatient units because of a lack of intensive CAMHS support in the community and weaknesses in commissioning and case management.

Bailey agreed that young people were finding it hard to access intensive support in the community – known as Tier 3 CAMHS - to prevent the need for hospital treatment or to help them “step down” from inpatient care.

Bailey said: “At the moment there is such a push and pull on Tier 3 that they are bound to be pulling up the drawbridge."

She added that commissioners need to look at the system as a whole to ensure there is enough of the right type of support to meet needs. “We are too much driven by what providers will provide rather than what is needed locally. We should say to providers ‘this is what the kids need, you need to go and deliver it’.”

Bailey has also just become chair of the Children and Young People’s Mental Health Coalition, a partnership between 14 children’s and mental health charities set up in 2009. Bailey says she wants to strengthen the Coalition’s voice with MPs and policymakers, and focus on perinatal care, mental health in schools and transition services.