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7. Improving Service Equity

7.1 While there are many groups of children and young people who require a range of specialised services, there are particular groups whose needs have not been met well by recent service provision. Young people aged sixteen and seventeen years and children with both a learning disability or pervasive developmental disorder and mental health problems have not received sufficient input from CAMHS.

7.2 Local needs assessment may identify other groups of children and young people for whom service development is required e.g. looked after children, where there has been recent significant improvement in provision, children with conduct disorder or severe behavioural problems, children and young people who are homeless, young people in young offenders institutions and asylum seeking children, where expertise is not readily available.

Primary Care Trusts and Local Authorities ensure that both the commissioning and delivery of services are informed by a multiagency assessment of need that is updated on a regular basis. See section 10 Planning and Commissioning

Services for Young People of Sixteen and Seventeen Years of Age

7.3 Traditionally, CAMHS have been resourced for young people up to sixteen years of age or up to school-leaving age, although about half now offer services up to the eighteenth birthday. There is a broadly held view and concern that many young people of sixteen and seventeen years of age are not receiving the services they require since they fall into the gap between child and adult services, the latter tending to have a lower age threshold for their services of eighteen years.

7.4 There is normally a wide variation in the age when young people achieve maturity and independence, especially for those with learning disability and other impairments. For the majority of sixteen and seventeen year olds for whom admission becomes necessary, admission to a young people's unit is the appropriate and preferred option. However, for some young people who are living away from the family home or those with certain types of clinical need, an adult facility may be more appropriate. A degree of flexibility is clearly required to ensure that young people receive treatment in an environment that promotes their engagement and responds to their developmental needs. This will mean that some young people may wish to exercise choice about which service feels most appropriate for them.

7.5 The impact of extending the age range for CAMHS at local level will need to take account of the resources required to meet the increasing incidence of severe mental illness in late adolescence and the inevitable refocusing of services that will be necessary to meet their needs. This will include ensuring that there is a strong focus on vocational and social issues in order to ease young people's transition into adulthood and reduce the likelihood of social exclusion, so often a secondary consequence of mental illness. (8)  See Standard 4

Primary Care Trusts and Local Authorities develop a long term strategy to ensure that young people under eighteen years of age are provided with services which meet their developmental needs. This will require planning: to address the increase in the capacity of the workforce; training; and developing the infrastructure.

Primary Care Trusts and Local Authorities ensure that local agreements are in place for handling referrals of young people to ensure that there are no gaps in service provision and to allow some degree of choice and flexibility.

Services ensure that young people experience a smooth transition of care between child and adult services and protocols are in place to ensure a flexible and organised approach is taken and that a developmental perspective is incorporated into staff training. See Standard 4

Services ensure that attention is paid to the child protection needs (in line with ACPC policies) (see Standard 5) and the dignity and safety of young people cared for in adult psychiatric beds.

Primary Care Trusts and services are involved in the collaboration between CAMHS and adult mental health services to develop early intervention teams for young people with early onset psychosis.

The Care Programme Approach is used on discharge from in-patient care and on transition from child to adult services.

Services for Children with Learning Disabilities

7.6 One third of NHS specialist CAMHS provide specific services to children and adolescents with learning disabilities. Services are also provided from within lifespan learning disability services and in child health services. Many paediatricians have considerable expertise and experience in this field. Nevertheless, it is inappropriate that they should be expected to cover the broad range of mental health difficulties for those with learning disabilities. Given that some forty per cent of children with learning disabilities have a diagnosable mental disorder and this rate is even higher in those with severe learning disabilities, the low level of resources available to the children and their families represents serious inequity and a significant challenge for the development of appropriate services.

7.7 There is a need to ensure that children and young people with learning disability who require psychiatric care have access to appropriate services which meet their needs and that they are not disadvantaged because of their disability.

7.8 The development of services for children with learning disabilities will require a workforce with the competencies and knowledge of working with children and young people with complex, severe and multiple disabilities (especially those with moderate or severe learning disabilities) and their families. Co-ordination of learning disability CAMHS with other services should be achieved through partnerships which preserve and enhance the quality and effectiveness of specialist provision already in place. See Standard 8

Primary Care Trusts and Local Authorities ensure that children and young people with learning disabilities receive equal access to mental health services at all Tiers (1-4) of CAMHS. This includes:

  • Mental health promotion and early intervention (including attention to attachment and parenting issues);
  • Training and support to front-line professionals, in particular in the recognition of normal development and developmental delay;
  • Adequately resourced Tiers 2 and 3 learning disability specialist CAMHS with staff with the necessary competencies to address mental health difficulties in children and young people with learning disabilities or pervasive developmental disorders. Currently, there is a shortfall of staff with the specific competencies to work with learning disabled children with mental health difficulties. This requirement for training will need to be addressed through initiatives such as the sharing of expertise by continuing professional development (CPD), consultation and supervision and the development of clinical networks, and
  • Access to Tier 4 services providing in-patient, day-patient and outreach units for children and adolescents with learning disabilities and severe and complex neuro-psychiatric symptomatology.

Commissioners ensure that joint agency planning and commissioning takes place between health, social services, education and voluntary service organisations at a local level, for those children and adolescents with learning disabilities who have severe, complex and enduring needs, and those with difficult to manage behaviour.

Partnership working at local level between service providers ensures that a coordinated and integrated package of care is available for children and young people.

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