Many young people need help for a variety of mental health conditions and the treatment they require differs from what is offered to adults. CAMHS offers a range of both inpatient and outpatient services for people under the age of 18 who need clinical intervention to deal with a mental health problem.
At South London and Maudsley NHS Foundation Trust we have a strong tradition of evidence-based treatment; our clinicians and academics have contributed to many of the NICE guideline panels, including obsessive compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD) and conduct disorder.
Our clinics are equipped with some of the latest audiovisual equipment and videoconferencing facilities, which are used to link with national and international partner institutions, patients’ schools, and other clinics, in situations where assessment and treatment need to be delivered further afield.
Bruce Clark, Clinical Director of CAMHS and a child and adolescent psychiatrist, is responsible for the quality of the clinical care in services. Here he gives a brief low down on his work and the role of CAMHS.
What are the most common mental health conditions seen in children?
Attention deficit hyperactivity disorder (ADHD), eating disorders, conduct disorders (such as challenging behaviour), autism spectrum disorder (ASD), obsessive compulsive disorder (OCD), child sex abuse and trauma and mood disorders. We also see people with self harming behaviour, early onset psychosis, substance misuse issues and attachment problems.
How important is it that these conditions are treated at an early age?
If some of these conditions are treated within childhood a person may never suffer from them again, so we are always keen to intervene early wherever possible. With other conditions such as OCD or psychosis it is more common that the condition can become a lifelong disorder if it presents early in life. It is vital that parents seek help for their child as soon as possible for any illness. With early intervention and the right tools a condition can be treated.
How many patients come through the CAMHS service?
We have about 6,000 referrals a year but most are treated in the community.
What are the day to day functions of your job?
Two days a week I work in the OCD team as a consultant psychiatrist. The rest of the time I work within a variety of areas relating to clinical governance, finance, academic health science work and performance management. I am also partly responsible for all the appraisal job planning schemes for our senior medical staff including consultant psychiatrists in the CAG (Clinical Academic Group). I help manage relationships with the commissioners. I work very closely with the service director and academic director for CAMHS. We have a close working relationship and that's invaluable to the day to day functioning of the CAG.
On top of that I have hundreds and hundreds of emails to reply to, I do some lecturing and supervise junior doctors.
What are the biggest challenges of your role?
The disinvestment of hard pressed CAMHS services – this is disappointing and puts extra pressure on all staff. The cuts have been massive due to the way mental health services have been commissioned for children. We therefore try really hard to ensure that we maintain high quality of service in this changing financial environment.
It is also really difficult to see such children who are so unwell but equally it is very satisfying when they get better.
And what are the most rewarding parts?
There are a lot of rewarding parts of my job, especially the clinical work. I actually enjoy multi-tasking so combining my clinical work with overseeing the CAG is very rewarding in itself. Seeing the improvements in children and young people is a real motivator and a reminder of why we are here. I actually very much enjoy the balance of the clinical and managerial roles of my post.
What services do we offer which you are particularly proud of?
I work clinically in the national and specialist OCD team. We have a fantastic kids programme in OCD where we offer great evidence-based treatment. We offer cognitive behavioural therapy (CBT) either alone or with specific medication. I'm really proud to be part of that service and to work with such great colleagues. We are really lucky in SLaM to have such a great range of high quality teams and services.
At SLaM we are one of the first trusts in the country to run an Improving Access to Psychological Therapies (IAPT) programme for young people, it is currently available in Lambeth and Southwark. We are also rolling that programme out in both Croydon and Lewisham CAMHS teams. I am very proud to be part of this as it offers children greater access to talking therapies they need.
We have such a great programme of clinical innovation in the CAG. There are too many examples of clinical, research and educational excellence to list them all.
Some of my colleagues told me only this afternoon about a small grant they have to roll out the MyHealthLocker programme in CAMHS. This should facilitate greater engagement of the children and young people who use our services, in their care planning.
What are we really good at within CAMHS at SLaM?
We are a world leader in terms of research output in the field of child and adolescent mental health research. We have been at the vanguard of many clinical initiatives. We have worked really hard to collect data on the outcomes of our treatments. We now have the the largest in outcomes datasets from CAMHS Europe, possibly the world. This will allow us to continue to probe and examine the work we do.
What innovative clinical work is currently taking place?
We have a number of very exciting pieces of clinically orientated research and service development going on the CAMHS CAG. A few examples would include:
-Dialectical Behavioural Therapy (DBT), which is an intensive treatment programme for people with emerging borderline personality disorder (BPD), especially those with significant self-harming behaviour. DBT therapists use techniques to encourage people to change their behaviour and learn more effective ways of dealing with distress. This is exciting work and already the programme is showing excellent outcomes.
-We have a wide range of very innovative services for children and young people with eating disorders. The team has worked extremely hard to develop now models of care that are less reliant on lengthy in-patient stays and are focused on community based recovery.
-We are in the middle of the first ever trial for body dysmorphic disorder in children. The results of that trial should be available over the course of the next year.
-Our community services are excellent and we have specialist teams at the heart of our community CAMHS services. As I have explained above it is these teams that are often at the heart of the innovative care that we offer. We have through careful work been able to deliver high quality clinical outcomes in community CAMHS whilst keeping within an ever tighter financial envelope. Our rates and length of admissions for in-patient care are amongst the best in the UK.
What are the relationships like between staff and parents/family members?
The approach is varied but the families who use our services are at the heart of our thinking. We enjoy really good relationships with families and patients. Where there have been inevitable attention we are robust in trying to tackle those areas and improve. We have a colleague employed to underpin and support our on-going efforts in the area of public and service user involvement in the CAG. Some of the work that young people have done for us have been both profoundly moving and staggeringly helpful in designing and delivering services.