Opinion

What Really Matters?

An up-to-date policy documenting mental health services in children and young people has been published by NICE.
Counsellor at school

Child and Adolescent Mental Health Services (CAMHS) have been through 'interesting times' over the past few years. Once a Cinderella service, attention has been very much focused on the mental health of children and young people recently, both in the media and in government policy.

Additional funding needed for school counsillors. Picture: iStock

The 2004 National Service Framework for children and young people (in England) brought with it policy attention and some additional funding (although much of this was lost in the recent local authority cuts), and other administrations in the UK followed suit in different ways.

Relevant guidance

The development of a better body of evidence for treatments and approaches to working with children and young people led to more relevant and applicable guidance from NICE.

In England, the children and young peoples Improving Access to Psychological Therapies programme has been

...

Child and Adolescent Mental Health Services (CAMHS) have been through 'interesting times' over the past few years. Once a Cinderella service, attention has been very much focused on the mental health of children and young people recently, both in the media and in government policy.

Counsellor at school
Additional funding needed for school counsillors. 
Picture: iStock

The 2004 National Service Framework for children and young people (in England) brought with it policy attention and some additional funding (although much of this was lost in the recent local authority cuts), and other administrations in the UK followed suit in different ways.

Relevant guidance

The development of a better body of evidence for treatments and approaches to working with children and young people led to more relevant and applicable guidance from NICE.

In England, the children and young people’s Improving Access to Psychological Therapies programme has been rolled out across the majority of CAMHS, bringing some additional training and a focus on evidence-based practice and routine outcome measures.

Last year, in the dying days of the coalition government, 'Future in Mind' was published, with a comprehensive set of arguments and evidence for the development of future services and the need for increased preventative work in schools and elsewhere.

This brought with it some additional funding to offset the losses, though much of that is targetted at preventative schemes, rather than NHS provision.

Downside to demands

But while there is some benefit to being in the spotlight rather than hidden in the shadows, there are also downsides. Providers are struggling to meet increased demand, and self harm in young people has become a major problem, with greater numbers of children and young people presenting at emergency departments either having self harmed, or with suicidal thoughts requiring immediate care.

They get varied responses according to where they are and what provision has been made locally for such urgent care. At the same time, more is demanded from a struggling NHS, emergency departments are swamped, and attitudes towards young people presenting in this way can sometimes be less than optimal.

With increased guidance, and in the face of increased demand, and in a context of more proscriptive ways of delivering services, where are the clinicians left? Currently the focus on shorter term interventions has created something of a cognitive dissonance for some in CAMHS, which will resonate with clinicians in other parts of the mental health sector.

Limited resources

Nurses train in methods that stress the importance of therapeutic relationships, but there seems only a limited space for this concept in the rush to apply models and make the best use of limited resources.

Service user participation in developing services is also being stressed as important, but a lot of service users point out that what they most want is someone who can sit and listen to their needs, and has time to simply 'be' with them.

A recent tweet from a service user said: 'Last therapy session tomorrow and then I'm discharged from services. Not because I'm better. Because I've had an arbitrary number of sessions.'

Over the past few months the Children and Young People’s Mental Health Coalition had set up a commission to look at some of these problems in the UK system, and their report is due out 7 November.

In looking at some of these issues, the commission settled upon a values-based approach, based on the work of Professor Bill Fulford and others, to ask 'What Really Matters?' within the CAMHS system.

Values-Based Approaches 

Values are often overlooked or taken for granted within practice, but they are at the heart of all professional trainings, and increasingly have become overtly stated by service providers, in statements of ‘trust values'. But they can be squeezed by pressures to perform, and need to be more overtly stated as at the centre of what we do as service providers, clinicians, and, especially, as nurses.

One of the values stated as essential in the report is particularly relevant to nursing: the need for 'long-term relationships', which picks up on the therapeutic relationship building that is at the heart of psychiatric nursing.

While this can be difficult to focus on, it is essential that nurses use their skills to make and keep a connection with young people and their families that is genuine and empathic.

Young people, especially adolescents, see this as vital, and are very much tuned into what is 'fake' and what is grounded in a genuine concern.

'What Really Matters in children and young people's mental health? Towards a values-based child and adolescent mental health system' will be available for download from the RCPych website   


Further information


Laurence Baldwin is a senior lecturer in mental health nursing at Coventry University and was formerly nurse consultant (CAMHS) at Derbyshire Healthcare NHS Foundation Trust.

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