As a result of a lack of CAMHS services, an increasing number of young people are reaching crisis point and are often being placed in inappropriate settings such as adult wards or police stations.
The independent sector would like to be in a position to develop new services to help meet growing levels of demand for CAMHS services. NHS England’s current moratorium is preventing the development of new services, resulting in increased lengths of stay, high waiting times and delayed discharges for children and adults.
Investment in early intervention and prevention services such as training for children’s social workers, school nurses or GPs could assist in detecting health concerns earlier before a young person reaches crisis point. This could help relieve pressure on CAMHS and achieve better outcomes for the young person.
IMHSA members have reported that a high level of demand in CAMHS Tier 4 services has been apparent for up to ten years and that a lack of availability is a national problem. When this demand was highlighted, and new services were opened, wards regularly operated at maximum occupancy with waiting lists, often accommodating patients from out-of-area. In Tier 4, IMHSA members have frequently seen a higher level of acuity in patients, often due to patients’ having to wait longer to be appropriately placed, which can lead to an increased length of stay. NHS England’s moratorium on developing new services has prevented providers from increasing capacity.
At Tier 4, a lack of capacity has increased waiting times to concerning levels. Too many children and young people are only gaining access to an inpatient setting at a point where their need is critical. This is seen in acute eating disorders where often young people need additional followup support to address the deep psychological and social issues that underlie their disorder. This support for eating disorders can often not be provided in a community setting, especially if family life is problematic. This ongoing condition, severe and enduring eating disorder, is not currently a recognised diagnosis and therefore young people are not getting the funding for residential therapeutic provision and instead go in and out of acute services for many years.
Capacity issues exist all along the care pathway, resulting in service users being treated, often for a considerable length of time, in inappropriate settings. Low secure and medium secure beds are scarce, despite patients often being quickly assessed as requiring these higher levels of care. This results in further delay. Equally, moving down the care pathway to Tier 1-3 CAMHS has been known to take up to two years due to a lack of local community services. Many providers are unable to meet the waiting times requirements or discharge timescales set by NHS England in cases where step-down services are simply unavailable.
If assessments were undertaken earlier in the process, complex patients could be cared for successfully in the community and through Tier 3 services. This would contain costs for the NHS, reduce waiting times and prevent service users reaching a crisis point that leads to a longer length of stay to effectively treat. IMHSA members – who include CAMHS specialist providers - also note that a number of psychiatric intensive care beds are vacant and fully staffed yet remain un-commissioned by NHS England as a result of the moratorium.
Better early intervention and prevention services provided in a joined up way by children's social services, health visitors, school nursing and voluntary sector services are required to specifically address the emotional and psychological needs of the 60,000 looked-after children as well as children with comorbidities. This group is most likely to require mental health care in future. With this in mind, the current age of 18, which is the age that adolescents move into ADMHS is arbitrary. There needs to be more flexibility to allow the system to respond to individual needs. The step down in service provision from CAMHS to AMHS can be significant and this can be detrimental to the individual’s progress and long term needs. Providing better training, intervention and diagnosis education to GPs, such as talking therapies, would relieve pressure on CAMHS services and prevent young people from reaching the point of requiring intensive support.