The NHS Long Term Plan puts great emphasis on the need to improve access to mental healthcare for rising numbers of children and young people. Demand is rising but CAMHS staff and funds are in short supply.
Dr Ahmad Khouja, Medical Director at Tees, Esk and Wear Valleys NHS Foundation Trust says referrals into his Trust's children's services are going up year on year by 15 to 20% "and we have no way of increasing our workforce to manage that".
"The CCGs are not releasing enough money to dedicate to it, so there is a significant resource issue. There is a gap between resources, capacity and demand, so we have had to set a cap on what we can do, but as a civilised nation we should be reaching anyone who can benefit from our help."
EXPLORING OTHER WORKING MODELS
The Plan calls for more use of digital healthcare platforms to provide talking therapies. Dr Gill Bell, Assistant Medical Director at Northumberland, Tyne and Wear NHS Foundation Trust, cites the example of patients with co-morbid autism spectrum disorder (ASD). "For those patients, being able to do a computerised programme is more acceptable than with a person in the room.
"I have a patient who is transitioning into adulthood, who is going through an online CBT programme to see how it works for them. It's about having a spectrum of interventions that are accessible to the individual, which goes along with the drive for more individualised care and treatment."
She feels mental health services need to take a lead from
physical healthcare in the way it deals with transitioning from
child to adult services. "There are good examples of diabetes,
cancer care and chronic illness models where actually
paediatricians are able to hold onto some people longer, and
likewise some people are allowed to graduate earlier, if
appropriate."
SCHEMES WITHIN SCHOOLS
Dr Bell's Trust is part of a pilot scheme training education mental health practitioners who will be working in schools. By 2023, the NHS aims to have 1,000 specialist mental health workers in and around schools and colleges. While governance and indemnity for the new practitioners will lie with the local Clinical Commissioning Group (CCG) via her Trust, as they are employing the trainees, she feels it's right for the workers to be 'owned' by schools.
"If I were to put a health worker in, they would stick out like a sore thumb, which would also draw attention to the child. Somebody that is part and parcel of the school will be more effective in terms of providing low-level intervention, signposting people and being a huge resource for teachers.
"Workers can also disseminate information and you can skill-up the teaching workforce. It's so much easier to receive that information from someone who is one of your own – who can also challenge you more – than someone from outside."
Forming novel alliances, further integration and service changes were part and parcel of the pilot. The bids submitted to the CCG lead had to have clear evidence of education, health and local authority sign-up, with strong user and carer involvement and guarantees of access for excluded groups specific to the local population.
TECH SUPPORT
Dr Lynne Green is a Consultant Clinical Psychologist and Clinical Director at XenZone, which uses technology to help children, young people and adults with mental health problems by connecting them with clinicians in safe online communities. XenZone's online emotional wellbeing, counselling and support service for children and young people, Kooth, is being used by 40% of CCGs in England.
She too welcomes the new focus on technology. "We know that digital, although not the answer for everybody, provides easily accessible treatment. Having a service that can be accessed – not perhaps 24/7 but out of hours – is going to be one of several solutions to access problems."
The focus on providing Improving Access to Psychological Therapies (IAPT) services via digital means is welcome, but Green warns that clinical models do not make a straight crossover into the digital world and need detailed adaptations.
She says the digital environment provides young people with a level of control and autonomy to allow them to "dip their toe in the mental health system, without feeling committed to having professionals around them trying to help and persuade them to do things that they might be unsure about".
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