Policy context
The need for change in the way mental health services for children and young people are provided has been recognised for over eight years. In this period there have been a series of reports and policy initiatives which have made reference to or focused on child and adolescent mental health services (CAMHS) with the intention of providing direction and support for services and professionals working to meet the mental health needs of children and young people.
Partnership for Care: Scotland's Health White Paper 2003
This white paper set out to promote a new approach to improve Scotland'sHealth and proposed a wide range of measures. It specifically stated that joint working was particularly important in improving mental health services, and that young people with mental health problems would be the first to benefit from a national approach to integrated workforce development.
SNAP Needs Assessment Report on Child and Adolescent Mental Health 2004
This was an assessment of the mental health of Scotland's children and young people. The report suggested that mental health problems were on the increaseand highlighted the need to address the continuum of mental health - from preventing mental illness through effective mental health promotion, , to supporting, treating and caring for those children and young people experiencing mental health difficulties of all ranges of complexity and severity. It concluded that funding for CAMH services was not related to the level of need, that services were overstretched, and that there was "a significant mismatch between the level of mental health need and the capacity to work with that need".It identified a clear need to invest in and enhance the capacity of services.
Psychiatric In-Patient Services for Children and Young People in Scotland: A Way Forward 2004
This report, prepared by the Child Health Support Group, recommended aphased expansion of psychiatric inpatient services to 60 inpatient places foryoung people focussed around the three existing sites. The report alsorecommended that inpatient units should implement common admission criteria.
The Mental Health of Children and Young People: A Framework for Promotion, Prevention and Care 2005
This responded to the SNAP report by setting out recommendations for implementation, and providing a self assessment tool to be used by local agencies to support service planning and continuous improvement.It recommended that those commissioning mental health services for children and young people should consider the mental health needs of all young people under 18, in keeping with the provisions of the Children (Scotland) Act 1995. With regard to specialist CAMH services it concluded that there were significant shortages in the available workforce impacting on service capacity, and it also advocated the designation of one place within each psychiatric in- patient facility for emergency admissions of young people.
Mental Health (Care and Treatment) (Scotland) Act 2003 (operational 2005)
The 2003 Act, together with the codes of practice, makes a number of specific provisions to safeguard the welfare of any child or young person under 18. It requires anyone acting under the legislation to do so on the principle of what appears best to promote the child's welfare. It imposes a duty on NHSBoards to provide sufficient services and accommodation to meet the needs of any child or young person under 18 who is admitted to hospital. The code of practice says that it would be best practice for a person under 18 to be admitted to a unit specialising in child and adolescent psychiatry, and for their doctor to be a child specialist. It also gives very clear guidance about the special considerations which should be given if a young person is admitted to a non- specialist unit.
Getting the workforce right: a strategic review of the CAMH workforce
This report examined the workforce development that would be necessary to translate national policy for CAMH services into practice. It concluded that the current workforce was established at a level "well below that necessary" to meet demands, and that significant new additional investment would be needed to meet policy aims and agreed objectives.
Delivering for mental health 2006
This delivery plan established three key commitments for CAMH services:
- Ensuring that a named mental health link person is available to every school by 2008;
- Ensuring that basic mental health training is offered to all those working with, or caring for, looked after and accommodated children and young people by 2008;
- Reducing the number of admissions of children and young people to adult beds by 50% by 2009
It also re-affirmed a commitment to implementing 'A Framework for Promotion,
Prevention and Care' by 2015 with an annual increase in specialist CAMHS workforce capacity until that date.
Getting it right for every child 2006
This cross cutting programme has core components which apply to all services for children and young people whether universal or specialist. It promotes a co-ordinated approach to identifying concerns, assessing needs, sharing information and working jointly, and planning services. It also emphasises the need to have a skilled and competent workforce in all services, both general and specialist.
Looked after children and young people: we can and must do better 2007
This report highlighted the importance of physical mental and emotional health and wellbeing in facilitating positive outcomes for looked after children and young people. It agreed that looked after children generally experience poor mental health, and identified as a clear action point that there should be a new requirement that each NHS Board ensures that the health care needs of looked after children, including mental health needs, are assessed and met.
Delivering a healthy future: an action framework for children and young people's health in Scotland.
This report was produced by the Children and Young People's Health Support Group which was asked to develop a framework to capture the key actions needed to meet the challenges for children and young people's health. It emphasised that "mental health is a key determinant of health even in childhood" and that children and young people need age appropriate care, not care based on models of service provision designed for an adult population". It also stressed the need for the CAMH workforce to expand to meet demand and highlighted the key milestone, that there should be annual increases in the CAMHS workforce capacity until 2015.
Better health, better care: a national delivery plan for children and young peoples' specialist services in Scotland 2009
This document set out the plans of the new administration in relation to healthservice improvement and delivery. The report recognised that CAMHS was one of the areas requiring early investment to enhance rapid service development and improvement. It reiterated the actions in Delivering for mental health and
re-committed to delivering on the Framework for Promotion by 2015.
Audit Scotland: Overview of mental health services
This report, the first in a series of planned reports by Audit Scotland, looked atthe accessibility and availability of services provided by a range of organisations, with a view to highlighting areas for improvement and priorities for future audit work. It identified long waiting times for services for children and young people and made several specific recommendations about CAMH services, including one about ensuring that CAMH services are provided up to the age of 18.
Royal College of Psychiatrists: Safe and appropriate care for young people in adult mental health wards 2009
This is a tool for mental health professionals working with young people placed on adult wards in England and its purpose is to set standards for adult mental health wards for those occasions when young people under 18 are placed there. The guide may provide useful and practical information for adult mental health wards in Scotland, in considering what constitutes a safe environment for young people.
Taken together most of the above reports and policy documents paint a very consistent picture. Many of them emphasise that considerable numbers of children and young people have mental health problems that impact significantly on their daily lives, that specialist services need to be designed to meet these needs and that CAMH services are unable to meet current needs, far less anticipated future demands. Mental health though remains a national clinical priority, and the Framework for promotion, prevention and care published in 2005, remains the central reference for action relating to CAMH services. The Scottish Government has indicated it continues to expect the Framework to be implemented by the target date of 2015, with year on year increases in CAMH services until that date. A specific HEAT target for CAMH services was also announced for 2009-10, the target being to deliver faster access to services for children and young people.
