Tag Archives: CAMHS

Keeping our finger on the pulse: recent additions to our collection across health

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The health and care landscape has been changed in unprecedented ways over the past year. The coronavirus pandemic has not only highlighted strains within the system and required a response to a public health emergency unlike anything else that has been seen for decades, it has also provided an opportunity to push innovation in areas like digital infrastructure and partnership working, and encouraged decision makers to look at public health as an essential part of policy making in all areas.

The Knowledge Exchange database is full of reports, articles and documents which offer insight into these themes, published by organisations from across the heath and social care landscape. In this blog post, we’re highlighting some recent additions to our collection and some of the big themes being discussed within the sector.

Covid-19, “building back better” and a “health in all policies” approach

In March 2021 think tank IPPR published their report State of health and care: the NHS Long Term Plan after Covid-19. The recommendations form a £12 billion blueprint to ‘build back better’ in health and care and the report calls for an adaptation of the NHS Long Term Plan published in 2019 focusing on cancer, mental health, cardiovascular disease and multimorbidity. The authors believe the Long Term Plan needs to change to ‘build back better’ health and care post-pandemic, in relation to: ensuring a sustainable workforce; resourcing the NHS to deliver transformation; empowering integration; upgrading the digital NHS; funding and reforming social care; and levelling up the nation’s health.

Another report, from the Local Government Association (LGA), published in September 2020, provides specific guidance to local authority councillors on ways to improve the approach to population health and use of public health resources in dealing with the pandemic, highlighting the Health in All Policies (HiAP) approach to addressing health inequalities and improving wellbeing. There are a number of other resources which look at public health approaches to tackling other areas of policy such as youth violence and urban regeneration.

Build back fairer: the Covid-19 Marmot Review: the pandemic, socioeconomic and health inequalities in England, published by the Health Foundation and the Institute of Health Equity examines inequalities in coronavirus mortality, looks at the effects that the pandemic, and the societal response, have had on social and economic inequalities, the effects on mental and physical health, and the likely effects on health inequalities in the future. The report assesses the inequalities in the risk of COVID-19 and mortality and explores the impact of containment on inequalities in the social determinants of health, in terms of: early life; education; children and young people; employment and working conditions; a healthy standard of living; healthy and sustainable places and communities; and healthy behaviours.

Mental health

Mental health services have been under significant pressure in the UK for a number of years now, with children’s services (CAMHS) particularly stretched as the number of specialist practitioners is limited. The coronavirus pandemic has, according to many specialists, exacerbated existing pressures and placed even more demand on services. In April 2021 the All-Party Parliamentary Group on a Fit and Healthy Childhood published a report: The COVID generation: a mental health pandemic in the making – the impact on the mental health of children and young people during and after the COVID-19 pandemic  which explores a range of themes in relation to the impact of the pandemic on the mental health of children and young people. The report presents evidence from a range of sources on the potential implications of the pandemic on young people’s mental health and discusses the impact of school closures on children’s future health and well-being.

The Children’s Commissioner for England recently published a report  which looks at the progress made in improving children’s mental health services in England, and  the impact of the pandemic on the mental health of children. The report also examines the provision and accessibility of children’s mental health services in 2019/20, finding that access is still not adequate and not improving as quickly as expected.          

The other pandemic: the impact of Covid-19 on Britain’s mental health  explores how the mental health of people in the UK has been affected by the pandemic, drawing on a survey of over 4000 people. It describes the different experiences of groups across society and the highlights the disproportionate mental health impact on people who are exposed to higher levels of social deprivation, as well as on women, younger people and those who live alone.

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Structural reform

In August 2020 the Health Devolution Commission launched its final report, Building back health and prosperity. Among other themes, such as taking a “health in all policies approach”, the report found that devolving accountability and power to a more local level creates the potential to understand communities and places better, and to meet their needs.

One of the main focuses of the health and social care white paper published in February 2021 is around developing an integrated health and social care system and taking a ‘population health’ preventative approach to healthcare, while a report from the NHS confederation recommends a reformation of the framework for elective care and increased healthcare funding.

Digital transformation

Even before the pandemic, The King’s Fund was publishing widely on digital transformation. But their recent report Understanding factors that enabled digital service change in general practice during the Covid-19 pandemic  looks specifically at the impact of the pandemic on accelerating the transformation of the delivery of some services by GPs to focus more on digital delivery and whether this change can (or should) be sustained once the pandemic is over. It explores the challenges around trust, staff and patient digital literacy and the evaluation of digital tools in practice. Parliamentary Office of Science and Technology (POST) published their own review of AI and healthcare , providing an overview of AI in the healthcare system and its potential impacts on the cost and quality of healthcare, and on the workforce.

Final thoughts

The landscape of health and care is changing. The Covid-19 pandemic has placed unprecedented demands on a system which was already facing significant challenges. While in some instances this has led to innovation and accelerated the pace of change, it has also exposed some of the significant weaknesses of the system.

This blog highlights some of the big topics the sector is currently grappling with, but there is more available for TKE members on our database. Members can also sign up to receive our health Topic Update, which will provide fortnightly email updates of items recently added to the collection in health, easily allowing you to stay up to date.

If your organisation is not a member of the Knowledge Exchange and you would like more information, please contact us.

If you liked this article you may also be interested in reading:

A nudge in the right direction? Using behavioural insights in health

Virtual reality: a game changer for mental health treatment?

Devolving health and social care in England: an opportunity to transform how we approach health and care?

Cross-border handshakes: what’s next for digital contact tracing?

“For many children we are the first point of contact”: supporting children’s mental health in schools

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A 2018 evidence review from Public Health England reported that one in 10 young people have some form of diagnosable mental health condition. This, the report suggests, equates to as many as 850,000 children and young people with a diagnosable mental health disorder in the UK. It also reported that half of all mental health problems emerge before the age of 14, and children with persistent mental health problems face unequal chances in life.

Research has also highlighted the impact of “key factors” like poverty and adverse childhood experiences (ACEs), including emotional trauma, abuse or neglect (which people living in higher areas of deprivation are more likely to experience) on an individual’s chance of developing a mental illness. However, an additional factor often cited in surveys around child mental health and wellbeing is the impact of school, including exam stress, and bullying. Mental ill health has also been found to have an impact on attainment, behaviour and a child’s ability to learn. As a result, teachers are often part of the front line of supporting adults for children who are suffering from mental ill health, with increasing pressure being placed on teachers and schools to identify and signpost children to other services.

Schools, as well as teachers,  are increasingly becoming a focus for the delivery of Child and Adolescent Mental Health Services (CAMHS) in their community. Often schools are at the centre of their local community, so it is logistically convenient to coordinate services there; it can for some be a less intimidating or stigmatising environment than attending a clinic at a GP surgery, for example. School is the primary developmental space that children encounter after their family, and children’s learning and development and their mental health are often interrelated, so it makes sense for teachers to take an interest in terms of attainment and progress in learning. In December 2017, the Department of Health and Department for Education (DfE) published the Green Paper Transforming children and young people’s mental health provision which highlighted the role of schools as key in promoting a positive message about mental health and wellbeing among school age children and young people.

Good work is already being done, but how can we do more?

Research has shown that there is already a lot of good and effective practice being done in schools around children’s mental health. Many schools already work in partnership with local health teams to provide in house CAMHS support in the form of mental health nurses and social workers who are posted on site for children to access. One of the major recommendations in a 2018 Audit Scotland report on child mental health in Scotland was to encourage more of this type of partnership working. The report stressed the importance of joint working between public services if child mental health is to be improved, and where possible to include as wide a spectrum of public services in the delivery of CAMHS support, including criminal justice and housing practitioners, as well as health and social care and education staff.

In some schools senior pupils and designated members of staff are being offered mental health first aid training, and wear lanyards to help students identify them should they ever need to talk to someone. While it is important – particularly for students who participate in mental health first aid programmes – to be made aware of the challenges the role may entail, it can be a rewarding experience for young people to participate in and can also be a vital in-road to support for some students who would otherwise feel uncomfortable talking to a member of staff.

Other programmes like those developed by the Anna Freud National Centre for Children and Families, Centre for Mental Health and the ICE PACK and Kitbag tools (which have been used widely in UK schools) look at resilience building  and promoting coping mechanisms among young people, as well as encouraging the creation of trusting relationships which focus on nurturing and normalising mental illness to encourage children and young people to feel comfortable discussing their feelings and thoughts. These programmes also integrate early intervention and prevention approaches, hoping to identify children and young people who are suffering from mental illness as early as possible and signpost them to appropriate support.

The specific role of teachers

Teachers need to remember that they are not health or social care professionals and that – as much as they would like to completely solve all of the problems of their students – they can only do what they can, and that is enough.

It is also very important for teachers to practise what they preach in as much as teacher self-care is as important as signposting children and young people who are struggling with mental health issues. A 2016 survey by the National Union of Teachers (NUT) found almost half of teachers had sought help from their doctor for stress-related condition. Teacher stress and burnout and those leaving the profession due to conditions like stress do not help to create an environment that is supportive of good mental health in the classroom. Teacher wellbeing is so important and building their own resilience is one way that teachers can start to embed good mental health in their practice. If you are doing it yourself it will be easier to help and show children how to do it if they come to you for advice!

Teachers simply being there and offering a safe space and first point of contact for many children is important. Listening and signposting can be so valuable for those pupils taking the first step and teachers should not be put off by any personal perception of a lack of expertise in mental health – a small amount of knowledge or understanding of what to do next is more than enough. In some respects, teachers should feel almost privileged that a student has chosen to come to them, someone they feel they can trust and talk to.

A poll conducted as part of a webinar held for educational practitioners found that rather than requiring more information about mental illness, what teachers actually wanted was more practical examples of how to apply support in the classroom and how to embed mental health into their teaching and the learning of their students.

A unique opportunity

Schools and teachers are on the front line of public services and have a unique opportunity through regular contact with children to help to build and promote resilience among pupils, and embedding this within the whole school can be an effective way of ensuring pupils feel the benefit without being singled out. Taking nurturing approaches to learning and teaching, and promoting the creation of trusting relationships is key to some of the already effective practice going on in schools. Sharing the learning and best practice that is already happening will be vital to ensuring that support for children suffering from mental ill health improves and adapts to changing needs in the future.

If you liked this article, you may also be interested in reading:

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Exploring Barnahus: a Nordic approach to supporting child abuse victims

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Barnahus (which literally means Children´s house) is a child-friendly, interdisciplinary and multiagency centre where different professionals work under one roof in investigating suspected child sexual abuse cases and provide appropriate support for child victims.

Learning from the Nordic countries

Barnahus has assumed a key role in the child protection and child justice systems of many Nordic countries, including Sweden and Iceland. While there are some small differences in definition of the model across these nations, the general principle remains the same: to create a one-stop-shop for services that children can access under one roof. Services range from country to country, but usually include a combination of police, criminal justice services, child and adolescent mental health practitioners, paediatric doctors and social services.

The Barnahus model involves a high level of interdisciplinary working between different teams and allows for a complete package of care and support for a child to be created to reflect their needs. Within the Barnahus centres there are normally facilities including medical rooms, interview rooms, courtrooms, and residential facilities for those young people deemed at risk and who need to be taken immediately into temporary residential care.

Evaluations of areas that use this model of intervention have found significantly better outcomes for child victims and their families because of the multidisciplinary and multi-agency approach. Some discussions have also suggested that creating an adapted model for adult victims could also be a possibility in the future.

Reducing the trauma for victims of child sexual abuse

In England, it is estimated that only 1 in 8 victims of child sexual abuse are identified by the authorities. Children who disclose that they have been sexually abused face multiple interviews in multiple settings to a number of different people, often asking them the same questions. This can be confusing and frightening, as well as traumatic for many children who have to repeatedly recount the story of their abuse. Once the interview process is over, they can also then face long waiting times to access specialist therapeutic support.

The Barnahus model seeks to reduce some of the trauma experienced by victims of child sexual abuse by making the approach child-focused, emphasising the importance of a positive, safe and supportive environment in which to be seen by specialists, give evidence and receive support. For example, within the models used in Iceland children and young people are interviewed and examined within a week of the abuse allegation being made. These interviews are all conducted and recorded in a single location with specially trained officers and medical professionals, and they are then used in court as evidence, avoiding the victim having to revisit court in order to give evidence or testify.

Inside the centre, a specially trained interviewer asks questions, while other parties watch via a video link. Any questions they have are fed through an earpiece to the interviewer. Lawyers for the accused have to put all their questions at this point.

Another benefit to the model is that children who are interviewed are then able to access immediate assistance and counselling; in the current system in England, children may face cross-examination in court months after the alleged abuse, and would have to wait for victim support therapy.

Allocation of funding from government

In 2017, in response to the success reported in the Nordic models, the UK government earmarked Police Innovation Funding of £7.15m to help establish and roll out a similar scheme in London, which would see criminal justice specialists working alongside social services, child psychologists and other services and, it is hoped, pave the way to create a UK-wide Barnahus model in the future.

Building on the existing model in London, CYP Haven, which provides largely clinical, short term care, will provide a multi-agency, long-term support and advocacy service that is expected to support over 200 children and young people each year. Criminal justice aspects of aftercare will be embedded in the service, with evidence-gathering interviews led by child psychologists on behalf of the police and social workers, and court evidence provided through video links to aid swifter justice.

Follow us on Twitter to see what developments in public and social policy are interesting our research team.

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Child abuse by children: why don’t we talk about it?

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Who’s caring for our young carers?

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In less than two months time the UK will come together to recognise the 700,000 young people in the UK who provide care and support to families and friends, on Young Carers Awareness Day on 25 January.

Every day, children and young people provide physical and emotional care and support to their family members. Helping with household tasks, they care for young siblings, administer medication and deal with the emotional and physical stress of caring for a loved one with an illness. Estimates of the number of young carers living in the UK vary greatly. But Carers Trust suggests the number of young carers to be around 700,000 – that’s 1 in 12 secondary school-aged pupils. And those are only the ones we know about. Too many are falling through the net, going unnoticed and unidentified by services who can support them.

Attainment and employment

Earlier this year we joined in publicising the 2017 Young Carers Awareness Day, whose theme was “When I grow up”. The idea was to help people to understand how difficult it can be for young carers to realise their hopes and dreams for the future without the right support in place. A survey conducted by the Young Carers Trust found that over half (53%) of those surveyed were having problems in coping with schoolwork, with nearly 60% struggling to meet deadlines. Over 70% have had to take time out of school or learning specifically to care for a family member. A third admitted that they have to skip school most weeks.

With over 50% of young carers surveyed by The Children’s Society admitting that their caring responsibilities have caused them to miss days at school, and the burden of caring impacting on the ability of children to engage fully with school activities, it is unsurprising that young carers are twice as likely to be NEET as their peers. In addition, young carers in work find caring responsibilities have a disruptive effect on their workplace attendance, with understanding and flexible employers often being the difference between young adult carers remaining in work or becoming unemployed.

Mental health and wellbeing

Caring for a relative takes a massive toll on a young person. Recent reports published by Carers Trust and the Children & Young People’s Commissioner Scotland (CYPS) both show the significant mental health burden that caring places on a young person. Stress, isolation and anxiety that can come as a result of being a carer can have a significant impact on a child as they lose much of their contact with the outside world, become removed from social groups and miss out on opportunities to experience a “normal” childhood. Projects like Off the Record’s Young Carers Project in Croydon provide support and opportunities for respite for young carers. But it is clear that as child and adolescent mental health services  (CAMHS) are becoming increasingly stretched themselves, it is more important than ever to ensure that specialist services are also made available to young carers.

Partnerships working to provide support

Young carers often come into contact with multiple services. Education, social care, health and others all have an impact on young carers and their experiences and as a result can have a positive impact on their experiences too. Increasingly, services are being encouraged to cooperate in order to create a holistic support network for young carers, which encompasses every area of need they may have, and creates a seamless transition for young carers through all of their interactions with various services. Key coordinators and facilitators are vital in this role.

In the previously referenced report from CYPS, it was highlighted that many young carers felt positive about – and took pride in – their caring role, but that around two-thirds also said they felt “left out of things” at least some of the time. While they care for their loved ones, we need to make sure someone is caring for them.

Young Carers Awareness Day 2018 will take place on 25 January 2018.

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The way forward for mental health services for children and young people

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Black and white photo of young girl.

Image courtesy of Flickr user darcyadelaide using a Creative Commons license

By Steven McGinty

“Not fit for purpose” and “stuck in the dark ages”

These are two of the phrases used by the Care Minister, Norman Lamb, to describe mental health services for children and young people in England. The minister admitted that young people are being let down by the current system and has announced that a new taskforce will look into how the system should be improved.  To coincide with this review, I decided to look at the current situation for children and young people with mental illness, as well as highlight some of the main themes from the latest evidence.

The Office for National Statistics (ONS) reports that one in ten children and young people (aged 5-16) have a clinically diagnosed mental health disorder. This covers a broad range of disorders, including emotional disorders, such as anxiety and depression, as well as less common disorders such as autism spectrum disorders (ASD) and eating disorders. Approximately 2% of these young people will have more than one mental disorder. The most common combinations of disorders are conduct and emotional disorders and conduct and hyperkinetic disorders.

The likelihood of a young person developing a mental disorder is increased depending on a number of individual and family/ social factors. There are a whole range of risk factors, but some of these include:

  • having a parent in prison
  • experiencing abuse or neglect
  • having a parent with a mental health condition
  • having an autistic spectrum disorder (ASD)

It’s important to note that mental illness is complex, and that not everyone in these risk groups will struggle with it. This is particularly true when a young person is in receipt of consistent long-term support from at least one adult.

The impact of mental illness can be particularly difficult for young people. For instance, the National Child and Adolescent Mental Health Service (CAMHS) Support Service reported that young people who suffer from anxiety in childhood are 3.5 times more likely to suffer from depression or anxiety in adulthood. There is also an increased chance of young people coming into contact with the criminal justice system, with Young et al highlighting that 43% of young people in prison have attention deficit hyperactivity disorder (ADHD). The Centre for Mental Health also suggests that young people with mental health problems struggle to achieve academically, as well as in the employment market.

When a government minister condemns his own department, it’s evident that there are severe problems.  However, this does not have to be the case.

Below I’ve outlined some of the key lessons to come from evidence on what makes a good mental health service for children and young people.

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