'Working for Camhs is like living in a besieged city'

Child mental health staff are having to make life and death decisions without sufficient time, warns Dr Tara Porter

Tara Porter

Mental health services are under financial pressure

Dire headlines abound about child and adolescent mental health services (Camhs) again. 

This time it's that 25 per cent of mentally distressed young people are turned away from Camhs, despite increased funding. 

Questions are asked about whether this is in the best interests of young people or the best interests of the services. There are calls, God help us, for more data on why Camhs refuses these poor young people, which make Camhs workers sound heartless and exclusive. 

When I talk to teachers, in my mental health training role, the impression they give me is that Camhs is like an exclusive VIP party, where no one really knows how to get in. 

From inside Camhs, the reality is different. 

Crisis in mental health support

The feeling inside Camhs is of being in a besieged city, where all essential supplies are cut off and we are just surviving.

The young people are suffering, and the staff care deeply but are often overwhelmed by all the demands. They are having to make life and death decisions without sufficient time, discussion or thought, before moving on to some other equally difficult situation. 

Adam Kay’s book This is Going to Hurt, about the relentless pressure and the deprivation of basic amenities for medics in hospital, really rings true. Camhs in this country has been so chronically underfunded that it is hard to recruit the right staff, and we lack space and basic resources, like computers. Many, many times in my career I haven’t had a room to conduct therapy. Therapy in the NHS canteen, anyone? 

I am also aware that I work in eating disorders Camhs, which is the best funded of all the Camhs areas. Transformation funding has recently increased staff numbers and facilities for many of these teams. 

Pressure on Camhs staff

The call for further data particularly stings. In the 20 years I’ve worked in Camhs, the demands for us not only to work but also to justify and count our work has exploded exponentially, causing a complete jam on actually doing the work. 

I used to see patients every hour on the hour, without a break, quickly jotting some paper notes in the 10 minutes between patients. I used to find it enjoyable and satisfying. 

That is now impossible: patients have to be requested and logged, electronically generated packs have to be used and outcomes have to be completed by the end of the day. 

I am a psychologist, a scientist; I love data. But data without purpose or resources to complete it is just additional admin. It simply reduces the amount of work you are trying to measure.

The number of patients I can see in the time available is reduced by these constant data demands.

Stark facts

There is another issue, too. In my mental health in schools training work with the Anna Freud National Centre for Children and Families, we provide some stark facts about mental health with children and adolescents:

  1. There are not enough resources to meet need.
  2. Even if there were enough resources, at our current state of knowledge at least a third of people with significant mental health problems would still have the same level of difficulties or worse, even after the most evidenced-based and specialised input. 
  3. These two facts are unlikely to change in the near future.

Half of long-term mental health problems in adults start in childhood, before the age of 14. These adult illnesses have enormous personal, social and economic consequences for the individual and for society. 

Yet the investment in research in mental health overall is approximately 5 per cent of overall health research funding: mental health research is the Cinderella of research funding. 

Within the tiny amount allocated for mental health overall, and despite the fact that half of the problems start in childhood, child and adolescent funding runs at 5 per cent of that 5 per cent. 

We are Cinderella’s hearthside mouse in this analogy: at the very bottom of the research pile. We, therefore, do not have adequate research on what works for whom. 

I'd love to be out of a job

That leaves Camhs not only short of qualified staff and short of essential supplies, but short of treatments that work. When we make decisions about which referrals to accept and which to refuse, we know that we can’t help some young people. 

This isn’t to diminish their distress, but chronic underfunding of training staff and research has not provided the conditions to cope with this massive increase in mental health referrals. 

Camhs teams do their best under these circumstances. As in schools, Camhs workers are hugely committed to the young people they see, and work passionately and relentlessly to provide evidence-based treatments to relieve the suffering. 

Finally, and most importantly, Camhs is not the answer to the mental health crisis. Camhs may provide the (some of the) cures for the mental health problems. But, really, I’d like it if Camhs were redundant because young people weren’t suffering. I’d love to be out of a job. We don’t really want treatments – we want prevention. 

Building resilience

This needs to take at least two approaches.

Firstly, we need to help young people with their resilience and coping skills, so that they can manage the demands placed on them. We need to help them think about self-care, including sleep, physical activity, talking about their feelings and eating properly. The Anna Freud Centre is again strong on these issues. 

Secondly, we need to think, as a society, about why the current time is so toxic for young people. 

My personal take on this is that the relentless comparison culture – because of increased scrutiny and pressure in schools, and because of the internet – is increasing pressure to intolerable levels. 

Each of us can address this in our work today. As teachers and mental health professionals, we know the stress that relentless scrutiny causes. We know how we become worn down over time with more work, fewer resources and higher standards. 

Let’s not pass that scrutiny on to our patients and pupils. Let’s reach out, connect and think of the person and their education, not their potential or their grade. 

Dr Tara Porter is a clinical psychologist in the NHS and private practice. She also works at the Anna Freud National Centre for Children and Families, and is Tes' mental health columnist. She tweets as @drtjap. The views expressed are her own 

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