Staffing levels and staff training
Within the specialist CAMHS units nurse staffing ratios are generally good..The multidisciplinary teams within these units also include a wide range of skills, including clinical psychology, dietetics, occupational therapy, family therapy, social work and teaching staff. Some units also had psychotherapy services as part of the core multidisciplinary team. However, the level of clinical need can be very high within the units as there are no intensive psychiatric care unit beds for young people in Scotland. As a result, staff may be nursing individuals with complex needs and particularly challenging behaviours in these services.
Staff training is given a high priority and as well as access to support and advice from colleagues within the multidisciplinary team we found staff access a wide range of training opportunities, from the national programme of New to CAMHS training through to specialist training in family therapy, Dialectical Behaviour Therapy and Eye Movement Desensitivisation and Reprocessing resulting in staff feeling skilled and confident in their ability to work effectively. This is in direct contrast to the situation within the non-specialist wards which we looked at.
We visited 12 non-specialist wards which had admitted young people during the previous year.Of these, three were designated as wards which young people would be admitted to when required.Between them these designated wards had admitted 14 young people during the year,The other 9 wards had one or two admissions each.Surprisingly, none of the staff in the non-specialist wards, including the designated wards, had undergone any training to equip them to meet the specialist needs of young people.One of the designated wards had previously had a nurse with specialist training which they had found enormously helpful, this individual has since left and there are no plans to replace her with another CAMH trained nurse.
Within the non-specialist wards access to specialist CAMH services varied greatly across the country. Some areas reported being well supported by the CAMH service which provided a consultant as RMO and who attended case conferences.Other units reported that they could access up to three direct contacts a week with members of the CAMHS team for the young person and had readily available telephone support.However, some units reported inadequate levels of access to CAMH services including having access to telephone support only and experiencing delays in obtaining a response from CAMH services.There was no evidence that access to CAMH services was better within designated wards than in other non-specialist facilities.
Given the lack of specialist training within the staff group caring for these young people it is important that there are systems in place to ensure that specialist advice and supervision is readily available to all wards where young people are admitted.
Several NHS board areas have taken a decision to identify a specific adult ward to which a young person would be admitted if in-patient treatment is necessary and has to be provided in a non-specialist facility. Several other health boards have aspirations to introduce this arrangement.We support this model of working, however our experience is that designated wards have not as yet made use of the opportunities to develop closer liaison with CAMH services and designated status has not improved access to education for the young person or the provision of targeted training and supportfor nursing staff to enable them to develop skills in working with young people.
Recommendation
To maximise the potential benefits of designating beds in adult wards for care and treatment of younger people NHS Boards must ensure there are systems in place to ensure ready access to support from CAMH services, clear protocols for joint working and the provision of specialist training opportunities for staff, such as that provided by theNew to CAMHS training programme.
