Mental health services are often described as the Cinderella service of the NHS. Despite being promised resources and transformation, her child called CAMHS, remains very poor and much neglected. Whenever she is presented with new clothes, her shoes are taken away and then she’s asked to clean larger areas of the estate.
Young people (GEN-Z) are growing up in very different environments to previous generations. The challenges faced are difficult. One in 10 will have a diagnosable mental illness. Some of these are referred to NHS Child and Adolescent Mental Health Services (CAMHS). These children, and no doubt countless others, have challenges in three levels: the environment, the parental and the genetic. Social media enters into parts of children’s lives which were previously private. ‘Impression management’ is part of ‘normal modern life’. Poverty, academic stress, bullying, gangs, drugs, body image, gender and sexual preference all contribute to their challenging environment. Parenting ability also contributes to problematic mental health. The way we parent is often informed by the way we were parented. Sometimes the methods used are punitive, guilt driven or lack structure - in some cases even non-existent. Genetics is a separate discussion but a strong contributory factor.
But every day as I come to work in CAMHS (and I am never first in or last out) my colleagues never cease to amaze me. The complexity of the cases we see, the compassion that is shown, the ability to put people first and push the boundaries to promote what is possible is remarkable. The innovative thinking and adaptation delivered are truly awesome. They remain the total professionals I trust them to be, even though the work and life events that we see and hear on a daily basis move us to emotion. We cry together, we smile together and support each other. Even more powerful is the understanding, willingness, help and participation coming from our young people, families and wider partners (schools, GPs and social services).
A scenario comes to mind - a referral is received. A 15-year-old is referred to us with low mood, malnourished, anxiety, self-harm, child protection issues, parental discord, domestic violence in the home and younger sibling with special needs. The child is also vulnerable to extremism. It can be very simplistic to offer treatments. Sometimes the implications and effects are much wider. Whatever the case may be, CAMHS now has to sort these issues, decide what’s best, coordinate other agencies involved and begin treatment within 18 weeks. Cinderella’s child, doing more with less time. Will her transformative carriage ever turn up to take her to the ball?
The work by members of staff to ensure safety, transparency and a therapeutic relationship across all partners and family continues to make me reflect on how wide and far distress in a young person is both felt and caused. The ability for CAMHS to hold the distress and prevent it getting reflected in the system around the family is often a piece of work that goes unnoticed.
CAMHS services do need to transform. Working to engage young people much earlier is imperative on a number of levels to ensure better use of the resources on offer. It must be okay to talk about mental health. A stronger CAMHS and school link is needed. GPs need also to be able to liaise directly with schools. Parenting programmes that are not called parenting programmes are needed! And a wide expansive offering of these, perhaps even towards the end of school life or during pregnancy. School is where we go and learn. But the skills to cope with life are not being taught. Social skills and a life skill set need addressing. Using digital technology such as Communication, artificial intelligence, machine-learning, online self-help and online therapies is essential. This would improve access. I believe the next three to five years will see more change in all these areas (and it is needed) than the previous 30.
Prevention, early intervention and a needs based approach are ways forward. It will help take the pressure off specialist CAMHS services for those who need it. I hope my reflections stimulate thought on how we meet this need and that of children not reached by current delivery models.
Blog written by Sam Illaiee - Operational Lead, Specialist Children's Services in Waltham Forest