News Insight: Health - The future of mental health services
Tuesday, November 25, 2008
The drive to improve child and adolescent mental health services took a step forward last week with the publication of an independent review ordered by ministers in last year's Children's Plan. Joe Lepper asks whether it will make a difference.
Mental health services for children and young people are in a dire state, according to an independent review set up by the government.
The final report of the child and adolescent mental health services (CAMHS) review team found specialist mental health workers are overworked, problems are not being spotted at an early stage and services are taking too long to respond.
Change is needed and review team recommendations include mental health training for the entire children's workforce, as well as individualised budgets where the money follows the patient.
The government has pledged to act and has agreed to the review team's call for a National Advisory Council on Children's Mental Health and Psychological Wellbeing. This will hold the government to account on improving services, champion the mental health needs of young people and encourage partnership working locally.
Training
But a question mark still hangs over many of the review team's other proposals.
It is still not clear whether the proposal for mental health training across the children's sector will be acted on, as it is being considered as part of the forthcoming children's workforce strategy.
Roger Catchpole, principal consultant at charity YoungMinds and member of the CAMHS review team, is optimistic universal training will eventually get the green light, saying that, "ministers recognise that training for the wider workforce is crucial for early intervention".
The training is set to include concepts of attachment and relationship building, as well as when and who to refer problems on to.
Other areas where detail is lacking include funding. For example, it is not clear whether individual budgets for children with complex needs will be implemented.
Mental Health Foundation policy head Simon Lawton-Smith is also concerned that the new national advisory council will not have any real power.
"Even the name 'advisory' suggests it will not have any teeth, no powers to force trusts or authorities to improve or explain themselves if they are not improving," he says.
Criticisms of the review
Jo Williams, the former chief executive of Mencap who has been appointed as the council's chair, says its role is not to name and shame poorly performing areas. Instead, "we are about offering guidance and support where improvements are needed," she says.
However, the council's annual report to ministers will flag concerns, as will regular surveys of users which will be conducted by the new body.
Despite these changes, the review itself has been criticised. While Lawton-Smith welcomes the recommendation for training for everyone who works with children, he would have liked to have seen recognition that more specialist staff, such as community psychiatric nurses, are also needed.
Mencap's national children's officer Lesley Campbell thinks the review team should have given more emphasis to those with learning disabilities, around a third of whom have mental health conditions.
"It mentions vulnerable children but doesn't break this down or offer any concrete proposals about how those with learning difficulties will be helped," she says.
She also agrees that a call for more specialist mental health staff was a glaring omission.
"It is no good training people to know when to refer when there isn't anyone available to refer to," she adds.
THE GOVERNMENT'S RESPONSE
- The CAMHS review team wants the entire children's workforce to receive mental health training within two years. The government says it is considering including the change in its children's workforce strategy. It is hoped this will spell out the type of training and guidance on offer
- The government has agreed with the recommendation to set up a National Advisory Council on Children's Mental Health and Psychological Wellbeing. This will champion mental health needs, ensure services are coordinated, promote good practice and hold the government to account
- Good practice needs to be replicated across the country. The review found patchy provision of CAMHS. The government has pledged to create a national programme to offer mental health teams support and advice
- At a local level, multi-agency teams called children's mental health and psychological wellbeing boards should be set up. Their remit should include overseeing local service delivery and improved outcomes. They should also handle joint commissioning, which was seen as the most effective way to deliver care. The government has yet to respond to this
- Support and information for parents and carers needs to improve. The government has pledged £500,000 in additional funding to improve telephone support services
- A lead person should be appointed from within mental health services for each parent or carer to be their main point of contact and ensuring that support is properly coordinated. This role is seen as crucial to young people making the transition from children's to adult services. The government has yet to respond