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CAMHS staffing changes and high workloads 'causing care to suffer'

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Young people’s mental health care in England is suffering because of regular staffing changes and practitioners often appearing too busy, children have said in a national review of mental health services for young people.

The government-commissioned review, which is being carried out by regulator the Care Quality Commission, found overall that the system was “complex and fragmented” leading to a variation in quality of care.

“One young person told us that they ‘don’t have time to build a relationship’ with their looked-after children nurse”

CQC report on children’s mental health services

It also warned that some children and young people “fall through the gaps” because they are unable to access services in its report published today, which marks the first stage of its review.

The CQC’s report, called the Review of children and young people’s mental health services, is based on new evidence from speaking with children, as well as organisations providing care and other experts.

It is also based on an analysis of 101 CQC inspection reports of child and adolescent mental health services (CAMHS) provided by both the NHS and independent providers, as well as existing evidence.

Children told the CQC that relationships with professionals and staff were the most important part of their experience of care.

But the regulator was also told by them that staffing changes and a feeling that professionals were too busy were causing their care to suffer.

Staff moving on to new jobs or other responsibilities meant young people were unable to continue the relationship they had built up with them.

“In some services, staff were not being offered appropriate support or regular supervision. This is crucially important for both clinical and administrative staff”

CQC report on children’s mental health services

This was frustrating for children and made it difficult to build trust with healthcare professionals, they told the CQC.

“They did not want to have to tell their story to someone new or have to build a relationship from scratch. As one young person told us, ‘When someone leaves this has a major effect on my wellbeing’,” said the CQC report.

Meanwhile there was a “common perception” among the children that staff did not have enough time to provide the quality of care they would like.

“One young person told us that they ‘don’t have time to build a relationship’ with their looked-after children nurse. Another told us, ‘Sometimes staff are good… but they are overwhelmed and over worked’,” said the report.

The CQC highlighted that 14 of the 101 CAMHS services it had analysed had breached regulations requiring them to have enough suitably qualified, competent and experienced staff.

It also noted some services, such as those in primary care, were experiencing a high turnover of staff which meant there was an increasing use of temporary workers to fill gaps left by vacancies.

Children also told the regulator that A&E staff were not always trained to meet their needs when experiencing a mental health crisis.

“We will take [children’s] voices into the next phase of this work, so that we can make effective recommendations for an improved system”

CQC report on children’s mental health services

“In some services, staff were not being offered appropriate support or regular supervision. This is crucially important for both clinical and administrative staff, to make sure that people are supported to deliver their role effectively,” added the report.

Overall, among the 66 community mental health services for children in England, 59% are rated as good, while 9% are outstanding, according to CQC inspections. A total of 29% require improvement and 3% are inadequate.

Among the 60 services with inpatient mental health wards for children, 73% are good and 7% are outstanding. But 18% require improvement and 2% are inadequate.

However, the CQC said the safety of services remained a significant concern due to the fact around a third of all services required improvements in this area of assessment.

“We have listened to children and young people who have used services so that we can better understand the strengths, weaknesses, barriers and bridges to care they have experienced,” said CQC deputy chief inspector Dr Paul Lelliott, who leads on mental health.

“We will now take their voices into the next phase of this work, so that we can make effective recommendations for an improved system,” he said.

“This report reveals a mental health system that is splintering and struggling to cope with fragmented care and staff shortages”

Fiona Smith

“There are many people out there working to make sure that children and young people who experience mental health issues are offered caring support. Their dedication is to be celebrated. However, we must also address those times when a child or young person feels let down or not listened to and make sure the same level of support is available to each and every one of them,” he added.

Commenting, the Royal College of Nursing’s professional lead for children and young people, Fiona Smith, said: “This report reveals a mental health system that is splintering and struggling to cope with fragmented care and staff shortages.”

“It is encouraging that high quality care is available but the organisations that provide, fund and commission support for children and young people are failing to work together and communicate effectively,” she said.

“Better collaboration between services could reduce the variation in care provided across the country and make it easier for patients to access the care they need,” she added.

“Trusts face enormous funding pressures, and workforce challenges are growing – once again, particularly in CAMHS”

Saffron Cordery

She called for the government to reverse the “dwindling” number of school nurses, who have the skills and experience to provider early intervention mental health support.

NHS Providers, which represents employers, said the report showed children often encountered “unacceptable” delays in accessing care.

“Our recent report…pointed to the growth in the numbers of children attending A&E departments for psychiatric reasons and the rise in referrals for child and adolescent mental health services (CAMHS),” said Saffron Cordery director of policy and strategy at NHS Providers.

“At the same time trusts face enormous funding pressures, and workforce challenges are growing – once again, particularly in CAMHS,” she added.

“We look forward to the speedy publication of the government’s green paper, to support improvements in care that we all want to see,” she said.

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Readers' comments (1)

  • It isn't just children who are suffering adults are too. Many of the older sufferers are victims of often insensitive, unhelpful "care" they have experienced within the mental health services.

    It has been too easy to overlook this group of people in an area of the NHS that has been grossly underfunded.

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