The NHS is making headlines on a near daily basis, with the system under enormous pressure to provide services, to an increasingly large population, with less relative funding, and staff shortages within several professional groups. The implications of this are longer waiting times and a drive for most efficient—which could be interpreted as meaning brief—interventions. Child and Adolescent Mental Health Services are no exception to this; you don’t have to look very far in the media before stumbling across criticism about rising thresholds to access therapeutic interventions, or complaint and disappointment about the advice or help that was offered to young people and their families.
On the ground however, it’s not all doom and gloom! Speaking of my own experience within a CAMHS clinic, staff are very stretched but committed. There continues to be passion and determination to work in increasingly difficult conditions to ensure the mental health needs of children and young people get met. All referrals, which do show signs of a mental health problem, are offered assessment and in discussion with the young people and their families clinicians work out together whether and what further support is needed. Sometimes it is the case that the most therapeutic way forward is not to access clinic CAMHS on an ongoing basis: that what would make the most difference in decreasing the child’s distress is to increase the understanding and support from within the child’s everyday context such as school or home. Where there are moderate-to-severe mental health difficulties, staff work together with the young people, families and networks to find ways to improve healthy functioning. Treatment plans are informed by NICE guidelines and the current research and evidence, to try to help the young person as best as possible. The benefit of the team setting is that clinical knowledge, experience and perspectives can be pooled, in order to provide the best possible care plan.
CAMHS does not fit all though, and I have been finding within my private practice, that I encounter young people and families who are, or would historically (even a decade ago) have been, under CAMHS. Some young people who I see in art therapy, are under the care of a CAMHS’ consultant, but feel that the day to day therapy they were offered was just not the right approach for them. Parents often tell me how they have been recommended art therapy for their child, but that they must seek it themselves, because of it not being available within CAMHS or school. This might be because there is a recognition that their daughter or son is ‘not a talker, but they do enjoy art’, the hope being that by using an art therapy approach, their child might gradually feel more comfortable to open up. Sometimes people struggle to open up within a CAMHS environment because it is a medical model, which can evoke its own complex feelings about being labelled or diagnosed. It is possible to work with a private art therapist whilst also being seen by a CAMHS psychiatrist; in these cases, consent for professionals to liaise is usually important and helpful.
Healing also takes time, and when there is a sense that support may be time limited, and potentially influenced by service—rather than individual—need, this can make it very difficult to trust that it is safe enough to open up and build a therapeutic relationship with someone. A benefit of accessing therapy privately is that there are no time constraints and it can simply focus on what the young person needs.
There seems to be a growing awareness about the mental health of our young people, with royals Kate, William and Harry speaking out about their own personal emotional wellbeing and journeys in a bid to lessen stigma and encourage people to access Talking Therapies and support when needed. Whilst this is obviously great, it doesn’t mean that waiting lists for school-based therapy or thresholds for CAMHS assessments reduce: if anything there may be longer to wait as demand for services grows with more people asking for help… no wonder many parents are concluding that the most sensible thing for them really is to consider ‘going private’. What are your thoughts on this? I would be interested to hear…