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Mental health workforce feels 'excluded and devalued'

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The mental health workforce often feels “excluded and devalued”, according to a new report calling for fundamental changes in the way child and adolescent mental health services are delivered.

The report, published by a new commission set up by organisations including Royal College of Psychiatrists and charity YoungMinds, highlights the vital importance of including mental health professionals in efforts to improve services.

It calls for a new “values-based” approach to care based on what really matters to young people and says training for everyone who works with young people – including clinicians - should reflect that.

”A striking finding was the overall sense of disjunction between different services and the wider system, particularly in the relationships between schools and other parts of the system”

Values-based Child and Adolescent Mental Health System Commission report

The report - called What really matters in children and young people’s mental healthalso highlights the need for more opportunities for staff to share ideas and good practice, and for much greater collaboration between health services and schools.

However, commenting on the report, the Royal College of Nursing noted children’s services were struggling to cope with rising demand.

It also highlighted that without the right numbers of school nurses and other health professionals the potential for schools to help was limited.

The Values-based Child and Adolescent Mental Health System Commission, which produced the report, is made up of the RCP and charities YoungMinds and the Children and Young People’s Mental Health Coalition.

It gathered evidence from child and adolescent mental health services, social services, education providers, commissioners, charities, young people and parents to inform its report, which makes 10 core recommendations.

These include the need for more alternatives to hospital care for young people with severe mental health problems, such as crisis intervention teams and home treatment teams. These should be jointly commissioned or managed with inpatient care, says the report.

One example highlighted in the report is a nurse-led crisis and liaison team developed by Durham and Darlington, and Teesside CAMHS.

The seven-day service is open to children and young people aged up to 18 who are experiencing a mental health crisis and aims to start assessment within one hour of a referral.

”As the report highlights, better collaboration between services could make a real difference but we need the right staff and processes in place”

Fiona Smith

“The service has significantly improved access to mental health support for young people in crisis and significantly reduced the use of overnight paediatric beds, as well as emergency department attendance, because assessments are offered in the community,” says the report.

Overall the commission found services were disjointed particularly when it came to involving schools in improving mental health.

“We found many individual examples of best practice in joined-up, whole-system approaches,” says the report.

“Yet a striking finding was the overall sense of disjunction between different services and the wider system, particularly in the relationships between schools and between education and other parts of the system.”

The government needs to recognise schools’ role in supporting children’s emotional and mental wellbeing and provide appropriate funding, it added.

”Schools have the opportunity to help many more children…but without the right numbers of school nurses and other this potential will never be fulfilled”

Fiona Smith

However, this call comes at a time when school-based health services such as school nursing are being cut and many mental health services have been hit by staffing shortages.

The Royal College of Nursing said services were struggling to cope with rising demand with at least 10 % of children and young people experiencing mental health difficulties.

“Current services simply don’t have the resources to meet this growing challenge and, as demand rises, those resources become more and more inadequate,” said Fiona Smith, RCN professional lead for children and young people’s nursing.

“As the report highlights, better collaboration between services could make a real difference but we need the right staff and processes in place.

“For instance, schools have the opportunity to help many more children get the help they need but without the right numbers of school nurses and other health professionals this potential will never be fulfilled.”

The commission said more research was needed into “staff values” – what matters to mental health professionals - in order to understand factors that could be getting in the way of long-term change.

It called for the creation of a network to enable professionals to “explore their values and their practice implications” and exchange best practice.

Commission members hope to continue work to explore the role of staff recruitment and training in developing quality CAMHS provision.

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