Child X reveals crisis in CAMHS
Professor Sue Bailey
Tuesday, August 29, 2017
The Child X case highlights failures across the mental health system, not just inpatient care, says expert.
President of the family division Sir James Munby last month raised the case of a 17-year-old girl, Child X, who was on the verge of being released from youth custody back into the community because there were no inpatient beds available across the country and despite her being at significant risk of attempting suicide (see box).
Child X had been let down by a system that failed to step in early with support before she reached crisis point. Like a fractal pattern, if we zoom out a similar story emerges; the system too has been let down - namely by policy makers and those in government who failed to act early before it too reached crisis point.
Children cannot effectively be supported before they reach crisis point by a system that is itself in crisis. Interventions required to help Child X are more complex now than they would have been if problems were picked up earlier - and the same is true for the mental health system.
CAMHS crisis
Historically, specialist child and adolescent mental health services (CAMHS) have been underfunded. It has been known for years that there is a crisis in CAMHS. The question has and continues to be if those who hold the purse strings are willing to make the sustained investment required.
Political rhetoric has grasped the truth of the value of prevention. It is moving towards more community-based over inpatient provision. This fits with what we want to see happen and what children, young people and their families want. But it needs to be implemented.
The Future in Mind strategy and Five Year Forward View were both game changing in terms of policy recommendations - after which came extra money for CAMHS from government to help local areas implement their local transformation plans.
The problem is that this money hasn't always being used for its intended purpose - because it had not been ringfenced, the money was used to plug other holes in local budgets.
Over the years, there have been short-term policy initiatives and funding that seem to have some impact, but it is never fully implemented - sometimes because there is a change of government, or there isn't the traction or funding needed at local level to drive through the implementation.
In highlighting Child X's case to the media, Munby issued a stark wake up call to the health system, describing it as "a disgrace to any country with pretensions to civilisation, compassion and, basic human decency".
One thing the government has been able to offer is to recruit an additional 2,000 CAMHS staff. While this boost in resource will be a start, staff numbers alone is not enough. We must also ask how we can better support and value the staff who work in these difficult settings, particularly if we hope to attract people to join the profession.
These are staff who, when a child reaches "the end of the line", must be able to remain present for and faithful to the child however challenging and anxiety-provoking their behaviour may be.
Yalom in 1989 described the role of the therapist as being present and faithful, and Rose (2017) tells us present and faithful is a good way to describe the qualities required for working with young people in a secure environment.
Time and resources
Ensuring that new staff have the time and resources to get the basics right will deliver the support young people need to recover. Staff need to be able to give back the right to these young people to experience a stable, predictable and caring living environment, infusing their daily routines with meaning and significance relevant to the needs of the young people with whom they are working.
The seemingly mundane patterns of life are often lost by spreading resources so thinly.
For now, those working within the system can only hope that each young person will have their individual needs met. It is time to move beyond hope and into action.
Supporting the mental health of young people is a complex challenge that goes beyond the mental health sector. It needs to be tackled by a much broader workforce including those working in education and justice.
If we're ever to have a mentally thriving nation, it will be because we fully realise this and put the necessary social scaffolding in place.
Professor Sue Bailey is chair of the Children and Young People's Mental Health Coalition
AT A GLANCE - THE CHILD X CASE
- Child X was being held in a secure unit in youth custody, where she had made a number of suicide attempts
- Efforts to find her an inpatient bed in a child mental health hospital had failed and Cumbria County Council had proposed a care package in the community
- Eleven days before she was due to be released, Sir James Munby raised concerns about the plan, saying sending her into the community was a "suicide mission to a catastrophic level"
- Munby said the situation highlighted the "disgraceful and utterly shaming lack of proper provision of clinical, residential and other support services"
- His judgment sparked widespread media coverage and five days later, Munby approved a care plan for the girl to be transferred to an inpatient facility after a place was found