Single points of contact and joint working 'making a real difference' in CAMHS

A new report shows that children’s access to support with their mental health was improved when partners worked together effectively, prioritised children’s mental health and built a skilled and knowledgeable workforce.

The Feeling Heard report, published by Ofsted, CQC and other partner agencies, was ‘a deep dive’ investigation into the experiences of children in need who live with mental ill health.

Six local authorities took part in the joint targeted area inspections (JTAIs) carried out between September 2019 and February 2020. The six local authorities inspected were Bexley, East Sussex, Milton Keynes, Plymouth, Portsmouth and Sefton.

The report finds that restructures of child and adolescent mental health services (CAMHS), along with a concerted effort by agencies to work together, has broadened the help available for a range of mental health needs. This has also led to more timely identification, referrals and support.

Despite improvements in partnership working being made in some areas, the report finds that specialist CAMHS are still limited in some areas and resources are overstretched. Some of the most vulnerable children had to wait ‘far too long’ for their mental health needs to be identified and to get access to specialist services. This includes children with autism, ADHD, some children on child in need and child protection plans, and children in care.

In many cases, professionals are knowledgeable and can recognise the signs of mental ill health. A single point of access for specialist advice on mental health is helping professionals respond more effectively, as are co-located services and improved involvement of voluntary and community sector organisations.

Victoria Watkins, Deputy Chief Inspector of Primary, Integrated and Children’s Health Services at CQC said that the evidence of strong partnership working was ‘encouraging’ and showed that agencies had the needs of the child at their heart.

“This is a testament to the tireless effort of people working in the system to improve the experience of children and young people with mental health needs.”

The report warned, however, that although much progress had been achieved, good work was ‘not universal’, with some agencies needing to get better at identifying children suffering from mental ill health. In some cases, professionals were still focusing on presenting issues, and not looking beyond them for possible risks of mental ill health.

Partners in the report said this applied to some staff even in circumstances where a child has self-harmed or behaved in a way that indicated they had suffered trauma. They also highlighted that a child’s mental health problem was often first picked up when they entered the youth justice system.

Amanda Spielman, Ofsted’s Chief Inspector, said: “Single points of contact, accessible services and strong joint working make a real difference for children. But it’s also vital that each partner recognises their own role and knows when to seek specialist advice so that children get the right support at the right time. Given the added pressures that the pandemic is placing on mental health services, it would be tragic if these improvements were lost when they are needed more than ever.”

Schools were also said to have an important role to play in supporting children’s mental health, but they cannot do it alone. Where schools are supported well by partners, children get specialist help when they need it. Again, however there was wide variation in the quality of support that children receive from school nurses. Nursing services in half of the areas visited did not have the systems in place nor the capacity to identify children with mental health problems, meaning that opportunities to spot issues early were missed.

Many police forces in areas visited have well-developed training and support for officers to recognise and help children with mental ill health, but this is not consistent in all areas. Inspectors saw too many examples of children being kept in custody overnight and who were not helped to get the support that they needed with their mental health.