by Tamsin Ford
Professor of Child and Adolescent Psychiatry
University of Cambridge
Prior to Lockdown, specialist Child and Adolescent Mental Health Services (CAMHS) were under severe strain with lengthy waiting lists despite rejecting 25% of referrals.1 Only a quarter2 of school-age children with impairing mental health conditions access CAMHS, while the most commonly approached mental health “service” is school.3, 4 Young people’s mental health has deteriorated since the Millenium,5 while the outcome of childhood mental health conditions seems worse for more recent cohorts.6
Children’s services had to dramatically adapt practice in response to Covid-19. Almost all face to face contact abruptly ceased at the beginning of Lockdown, with ongoing care offered by telephone or video conference.7 Despite evidence that remote consultation can be safe and effective,8 adoption in the UK was previously limited, not least due to practitioners’ concerns.9 Some concerns about remote therapeutic work will have been exacerbated by the relative isolation from colleagues due to the need to work from home.
We do not have to choose between remote OR face to face work once services reopen. A blended approach may offer benefits to many. Remote consultation may reduce travelling time and disruption for children and their families, but not everyone will want therapy in their home.10 Multi-agency discussions can be conducted via video-conferencing and reduced travelling may free up time for practitioners also, which could increase capacity. Concerns about safe-guarding, risk-assessment and confidentiality need exploring, and we should co-produce guidance on boundaries and best practice, coupled with training for practitioners.
While many services have adapted remarkably effectively,11 some children have less support than they are used to. CAMHS has also seen a huge reduction in the number new referrals,7 as has been seen for all age groups and many conditions.12 Children rarely refer themselves, and the take up of school places for vulnerable children has been low. Not only those known to be vulnerable are at risk and early indicators confirm deteriorations in children’s mental health during Lockdown.13,14 On-line services that young people can access themselves are showing increased contacts,15 but younger children will be less also to access and benefit from these approaches. Other services have managed this by phone calls to children and parents.11 We must incorporate the positive lessons arising from these adaptations to provide capacity to support the increasing number of children and young people in need.
Immediate action is needed to:-
- Open schools to all pupils to reduce educational, mental health and social risks of harm
- Regional and local multi-agency planning to support the mental health of those known to be vulnerable and to maximise capacity to meet increased need over the next few years
- Co-production of guidelines for best practice in remote mental health assessment and intervention
- Collation of routine data and service evaluations at regional and national level to clarify when remote ways of working might be most effective and appropriate