National
Assembly for Wales
Children, Young People and Education Committee
CAM
50
Inquiry
into Child and Adolescent Mental
Health Services
(CAMHS)
Evidence
from : Association of Educational Psychologists
Background to Submission
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The AEP is delighted to provide this response to the
Children,
Young People and Education Committee’s
inquiry into Child and Adolescent
Mental Health Services (CAMHS). The AEP currently has
3250 members across England, Scotland, Wales and Northern Ireland,
representing 210 Welsh educational psychologists. It is the only
trade union and professional association in Wales organised
exclusively for and by educational psychologists (EPs). The
AEP represents the collective interests of its Welsh members,
promotes cooperation between EPs, seeks to establish good
relationships between EPs and their employers and seeks to promote
the overall wellbeing of children and young people across the
country.
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EPs work with children and young people aged from 0-19 but the
majority of their time is spent with school-age children. EPs
play a key part in helping shape how educational settings approach
a vast range of educational issues including Special Educational
Needs (SEN), emotional wellbeing and classroom practice. EPs
carry out a wide range of statutory and non-statutory work that
helps to improve learning, developmental and welfare outcomes for
all children and young people, but especially those within the most
vulnerable situations.
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The role of EPs includes providing advice on identifying and
addressing issues of concern related to children and young
people’s development and functioning, as well as training
around a range of specific issues including management of
behaviour, supporting children and young people with autism and
promoting mental health.
The availability of early intervention services for children and
adolescents with mental health problems
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The AEP feels that the availability of early intervention services
for children and adolescents is currently variable in the different
parts of the country. At the earliest level (i.e. tier 1) the
front line staff are typically teachers, nurses and health
visitors. Early intervention would be the result of good
practice in schools and nurseries utilising the skills and advice
given by professionals such as specialist teachers or EPs.
This would depend on the appropriate staff being in post and
having the time available to do this work. Our experience has
been that it can be difficult to get schools and parents to look at
different ways of working as they seem to prefer having EPs
undertake individual assessments. However, agencies such as
Barnardos have been successful in undertaking some early
intervention schemes many of which have been devised by
psychologists.
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It has been reported that Joint Assessment Family
Frameworks (JAFF)
refer to Primary Mental Health
Teams when mental health is raised as an issue causing
concern. However, we would stress that Primary Mental Health Teams are very
poorly resourced and currently can only carry out very short pieces
of work with minimum input.
Access to community specialist CAMHS at tier 2 and above for
children and adolescents with mental health problems, including
access to psychological therapies
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In a similar vein to the first answer, the access
to community specialist CAMHS is variable across the
country.
In some areas there are staff shortages in CAMHS and the models of
working are not very efficient, with staff being mainly clinic
based. This means that in some cases parents have huge
logistical problems getting their children to appointments.
As CAMHS work under health they have a very strict policy
regarding failed appointments and will cross clients off the list
if one appointment is missed. It can also be quite an
obstacle course for professionals filling in numerous forms in
order to enable a child to obtain an appointment at a CAMHS
clinic.
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We would like to raise concerns that some of our members have
observed that referrals made are often refused for not meeting the
criteria, which has not been discussed or explained. Often requests
are made for more tier 1 interventions and these are limited.
Referrals agreed are then put on very long waiting list. This
has led to a situation in tier 1 where some pupils are waiting 10
months to see clinical psychologist and social communication clinic
referrals are waiting over a year.
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We have been pleased that the Welsh Government has supported school
based counselling services and this has been helpful to date and an
important resource in helping pupils parents and teachers.
However we would query the sustainability of these services given
the funding cuts. Some areas of the country currently seem to have
Primary Mental Health Teams that have
practitioners
who go out into the community and undertake systems work and group
work with vulnerable client groups. In other areas this model
does not seem to exist.
The extent to which CAMHS are embedded within broader health and
social care services
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This would vary from area to area as some CAMHS services seem to
operate very much as a free standing service whereas others are
more embedded into health and social care. Generally CAMHS are not
embedded within broader health and social care services. Individual
CAMHS have built relationships locally between health, education
and social services and there is good practice in this area, but
this has not been driven by policy in the way it has in England.
With increasing cuts to front line services and increased
waiting lists, there is less time for multi-agency liaison and
approaches.
Whether CAMHS is given sufficient priority within broader mental
health and social care services, including the allocation of
resources to CAMHS
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CAMHS seems to be a ‘Cinderella’ service when it comes
to funding. We believe that, because resources are scarce, CAMHS
can be given lower priority for allocating funding – tough
decisions have to be made and sometimes those making the decisions
do not fully appreciate the need for CAMHS services. For
example, we have heard reports from one member that a psychiatrist
left and there were no plans to replace her job. We
understand that there is a similar situation in clinical
psychology. We would also like to make the point that there
is a gap in provision: when children leave school they are no
longer entitled to receive CAMHS but do not yet qualify for adult
services.
Whether there is significant regional variation in access to CAMHS
across Wales
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Yes, there does seem to be regional variation which would depend on
the priority the various Health Boards give to CAMHS and also how
the particular CAMHS operates within the community. The AEP
has found that there is a significant difference in how CAMHS
services operate with EPs and that where robust protocols are in
place then good practice generally occurs.
The effectiveness of the arrangements for children and young people
with mental health problems who need emergency services
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Our members have reported that there is a lack of suitable
provision for young people in crises. This is a very
demanding group of young people and the care and support that they
need is specialised with staff involved needing to be well trained
and supported. Often the staff have not received appropriate
training and are not being sufficiently supported. Children
who are admitted to hospital are receiving support. However,
other children who have presented with mental health issues at
accident and emergency but who are not admitted do not appear to
have robust follow-up and support.
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This kind of care is expensive and currently the funding is not
available. We would like to see the Welsh Government invest
in this area in future to ensure that these children and young
people, who are most in need of support, benefit from early
intervention.
The extent to which the current provision of CAMHS is promoting
safeguarding, children’s rights, and the engagement of
children and young people
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In our experience this varies from area to area but we would like
to see more work to assess how effective CAMHS are in promoting
safeguarding, children’s rights, and the engagement of
children and young people. Safeguarding, in this sense,
should be early intervention and lowering the risk of more serious
issues developing later. In an earlier question we have
already commented on long waiting lists and difficulties accessing
CAMHS, which do not promote either children’s rights or
safeguarding. Current provision isn’t fit for purpose.
Children’s rights are not protected as they are not receiving
treatment and in some cases this leads to them being excluded from
their school and so not receiving education.
Any other key issues identified by stakeholders.
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Over the past few years AEP members have increasingly expressed
concerns that children with behavioural difficulties are being
prescribed drugs without full discussions with other professionals
to see if other strategies or approaches could be used instead of,
or at least alongside, the medication. It is of particular
concern to the AEP that the number of children aged under six, and
as young as three, who have been prescribed ADHD drugs to address
challenging behaviour, including inattentiveness and hyperactivity,
is rising substantially.
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The AEP feels that there is insufficient evidence to have
confidence in what the long-term neurological impact of these drugs
might be on the developing brains of children and would like to see
increased use of psychological treatments. NICE guidance advises
that psychological treatments should occur first, however, the AEP
does not feel this guidance is always being followed due to
pressures of work and the shortage of time to make the multi-modal
assessments advised by NICE.
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Simply relying on medication is no solution; the AEP believes that
the Quality Standard on ADHD developed by NICE should advocate a
more collaborative approach to the treatment of children with
conditions such as ADHD – involving GPs, teachers, EPs and
healthcare professionals alongside the child’s parents
– that is not reliant on medication, but considers a
comprehensive programme of treatment and therapies.
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We would like to see the Welsh Government collect information on
the number of children and young people being prescribed
powerful psycho-stimulant drugs, such as Ritalin, and undertake a
study into how current guidance on ADHD is being
implemented.
We would also like to see more done to ensure that
health professions
are better informed in supporting children with conditions such as
ADHD via training.
For more information about the Association of Educational
Psychologists, please contact Gary Jones at
gary.jones@whitehouseconsulting.co.uk
or 0207 463 0697.