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Current services in relation to need

Background papers: children :: Emotional health and wellbeing of children and young people :: Current services in relation to need

CAMHS currently aim to meet the MH and emotional wellbeing needs of children and young people up to 18 years of age. CAMHS services are multidisciplinary and, in line with the strategy to improve MH services for children, young people and families laid out in Together We Stand (1995),[1] are formed of four tiers that recognise differing levels of need and aim to better deliver the necessary care pathways. The tiered approach has guided the current structure of CAMHS services in most areas, including Medway. CAMHS services consist of medical, psychological, educational nursing and social work professionals working in a variety of teams and settings across the four tiers.

Tier 1

Tier 1 is a term loosely used to describe a level of need that is higher than the normal day-to-day expectations of a population, but where the client does not yet require the intervention of a specialist practitioner. These services can be provided as a dedicated offer, e.g. from the Health for Learning team at Medway Council, or as part of wider provision, e.g. via a GP surgery or the Educational Psychology Service. CAMHS also offers a tier one service as part of its remit and there is also a MH Promotion Specialist within Medway Council's Public Health Team.

Tier 1 encompasses a number of services in Medway including; Family Nurse Partnership, Educational Psychology Service, Emotional and MH First Aid, Onside therapy services, Youth workers, Medway Youth Diversion Service Triage, Integrated Youth Support Service (IYSS), Positive Parenting Programme and Medway Children's Action Network (CAN).

Tier 2

Sussex Partnership NHS Foundation Trust (SPNFT) provides Tier 2 CAMHS, delivery of which is led by the Child and Adolescent Support Team (CAST). The CAST is a multi-disciplinary, early intervention team that offers services to young people up to the age of 18 years and their families. CAST offer short-term help with emerging emotional difficulties, including mild to moderate anxiety, phobias, low mood, sleeping difficulties, eating difficulties, encopresis and enuresis, low-risk self-harming behaviour, underlying issues expressed as anger and early risk of educational or social exclusion. The CAST meet regularly with Tier 3 services to review care plans in complex cases.

The single point of access (SPA) for Medway CAMHS was designed to simplify access to CAMHS, provide advice, support and appropriate signposting to referrers and ensure that decisions made about referrals are taken in a timely and integrated way. This function is embedded in the Tier 2 service in Medway. The service received 1,486 referrals in 2014/15, the main referrers being general practitioners (36.7%), educationalists (10.4%) and paediatricians (6.2%).

Tier 3

SPNFT provide specialist community MH Services for children and young people aged under 18 years with complex MH needs. Referrals for depression, ASD, ADHD, OCD, PTSD, eating disorders, self-harm and suicidal ideation are usually accepted, provided that the condition has been assessed as moderate or severe in nature.

Services include assessment/formulation/diagnosis of MH disorders; therapeutic interventions including psychotherapy, psychiatric/psychological assessment, art therapy, family therapy, cognitive behavioural therapy (CBT); Children in Care team. The Kent and Medway out-of-hours service also provides a crisis response service to the Medway NHS Foundation Trust Accident and Emergency department, local police custody suites and related service locations.

Tier 4

Based at Woodland House Adolescent Unit in Kent, South London & Maudsley NHS Foundation Trust (SLaM) provides inpatient and specialist outreach for people aged 12 to 18 years across Kent and Medway. Referrals are primarily received through tier 3 CAMHS. The service includes inpatient provision for young people in crisis, a dedicated in-patient and day eating disorder service, and management pathways for. e.g., neuropsychiatry, forensic services and secure provision. Young people requiring highly specialist inpatient care, e.g., secure, psychiatric intensive care, specialist eating disorder care or care for complex learning disabilities are accommodated in NHS or private/third sector units commissioned by NHS England. If Woodland House is full, other adolescent units within the SLaM estate are used, namely the Snowsfield and Bethlem Units in London.

Estimated need for services at each tier

The MH Foundation report “Treating Children Well"11 estimates the number of children and young people aged up to 17 years who may experience MH problems appropriate to a CAMHS response. Using these prevalence estimates to Medway's population, table 4 shows the estimated number of children and young people in Medway who are likely to require CAMHS input at different tiers.

  Children and Young People who may experience MH problems appropriate to a response from CAMHS
Tier 1 9,385
Tier 2 4,380
Tier 3 1,160
Tier 4 50
Total 14,975
Table 4: Estimated number of Medway children/young people aged 17 years and under who are likely to require CAMHS input. Source: ChiMat. Calculated using population estimates from Office for National Statistics mid-year population estimates for 2014 and CCG population estimates aggregated from GP registered populations (Oct 2014) and prevalence estimates from Kurtz, 1996.[2]

Thirty young people aged 17 years and under were admitted for Tier 4 services in 2013/14: this is almost half the estimated number who may require tier 4 services as described in table 4. It has not been possible to ascertain the actual numbers of children and young people in Medway currently receiving Tier 1, 2 or 3 services.

In addition to CAMHS, there are also a number of services in Medway aimed at identifying and monitoring child MH needs, such as the Educational Psychology Services in schools; perinatal MH services; Autism Spectrum Disorder diagnostic pathway; and the ADHD care pathway. In Medway, a specialist Early Intervention in Psychosis service spans the years of adolescence and early adulthood.


References

[1]   Together we stand: commissioning, role and management of cchild and adolescent mental health services (NHS Health Advisory Service thematic reviews) 1995;
[2]   Kurtz Z. Treating children well: a guide to using the evidence base in commissioning and managing services for the mental health of children and young people. 1996; Mental Health Foundation..