A child sits in front of you, tears falling, with their parent clutching their hand. You start to ask what their therapist has advised, but the parent interrupts – the child and adolescent mental health services (CAMHS) referral is still waiting to be triaged. Even though it was made at the start of the academic year. Even though it was marked as "urgent". No appointment has materialised.
How can this be possible? Exactly what does a child have to do in order to be seen by the Camhs team?
Here one Camhs therapist explains to Tes how this is really just a tiny drop in an ocean of problems and explains their side of the story and what schools could do to help.
We know it is frustrating for teachers to be left with a child in desperate need of help. But too often it is Camhs staff who bear the brunt of the anger, as if we are willingly turning children away. This is not the case.
Just like other areas of the NHS, Camhs is fined if children are on the waiting list for too long. As a consequence, children with complex and serious mental health problems are meant to be "sorted" in just six sessions. This means that pressure is put on therapists to push problems back on schools in order to avoid fines that they can't afford to pay. We are not even treading water, we are sinking under the weight of referrals.
Unfortunately, the waiting times are exacerbated by people trying to overcome those waiting times. Some parents have become aware of the sort of phrases they need to say in order to escalate their child to the top of the list. Consequently, therapists are faced with children with mismatched descriptions for their problems. These children obviously still need to be seen, but the therapist is now having to work extra hard to discover what is true, and what has been said by the parent to speed up their appointment time.
We are also seeing many children who have had normal feelings medicalised as something in need of diagnosis. A huge amount of a therapist's casework is made up of explaining to children that what they are feeling is a reasonable response to the situation they find themselves in. Children are presenting themselves with a self-diagnosis of depression, anxiety and stress when actually, following the death of a family member, for example, it is totally reasonable for a child to feel sad.
The nature of the problems Camhs are expected to deal with would shock most people: we are involved in supporting the children who have been targeted by gangs to run drugs using county lines, the children of the families targeted by "cuckoo" gangs, the children who have been raped when gangs have groomed them to become unwitting sex workers.
Stretched mental health services
Camhs workers also constantly see the work they do being almost immediately undone due to the home situation of their patients. You may have a child who has made good progress, and be ready to be discharged, only to leave their therapy session and walk into a volatile home environment. A physical fight ensues, the police are called and the child is now back in the system. Waiting lists get longer, the child’s problems become more severe, and the therapists' workload increases.
Due to the nature of some of the cases, therapists don’t just see the children; they’re also working with the parents. The stretched resources for adult mental health also impact upon Camhs, and therapists are expected to also deliver therapy to the parents because the mental health of the parents is impacting upon the child.
Schools can give a helping hand
Let me be clear: all children matter to Camhs. There isn’t a single person who works for Camhs who is deliberately doing a bad job, or who doesn’t care about children: everyone is just doing the best they can with what they’ve got.
What can schools do to make it better?
In an ideal world, we would have more clinicians, more therapists, better facilities. All schools would have an in-house therapist to get intervention as early as possible. Early intervention often means that problems never escalate to the levels where Camhs would ever have to intervene. But until that happens, here are five things that will help:
1. Provide more artistic opportunities
Too many students don’t have the opportunity to express themselves artistically, and are not given a creative outlet for their emotions. If schools could provide the opportunity for children to take part in the expressive arts, then they would find that this would help with the students who need to be supported for their mental health.
2. Better quality PSHE
Allowing students to have good quality PSHE that isn’t just shoehorned in, or takes the form of generic whole-school assemblies, could help to support pupils before their problems become too much for them to handle on their own.
3. Beware over-emphasising medical problems
Equally, telling children to watch out for symptoms of depression, without going into the nuance of "you can feel depressed without being depressed", can leave children bewildered. They can confuse their typical and normal feelings of sadness with a medical problem. In cases like these, doing something briefly but badly is far more damaging than not mentioning it at all.
4. Embrace mindfulness
Teachers should be trained in mindfulness – not just for their classroom practice, but for themselves. Teachers who appreciate the importance of good mental health are the best ambassadors for the children they teach.
5. Embed information on mental health in the curriculum
Schools can do simple things like using registration to "take a mindful minute". Use PE lessons to talk about the mental wellbeing that comes with exercise. Draw attention to how the brain copes with stress in science lessons. All of these things already exist on the curriculum – framing them with the perspective that they also help us to have good mental health can have a positive impact on your students.
The writer is a Camhs therapist who wishes to be anonymous