Youth mental health service aims to help families to support their child

Rather than allowing emotional wellbeing and mental health conditions to go un-treated, CAMHS endeavour to support children and young people (up to 18 years) who have emotional, behavioural and mental health difficulties.“Why leave it to adulthood to try to address these challenges? Why not work with young people when their cognitive and psychological spaces are at their most flexible?” asks Dr. Wylie. By this she means that we tend to learn best emotionally and cognitively when we are young and particularly prior to advancing into adulthood.

Outlining the CAMHS service, they explain that Tier 2 (Primary Mental Health) covers the entire southern sector population and is presently staffed by a Lead Nurse, A Senior Social Worker and a Mental Health Practitioner. This portion of the CAMHS service works very closely with GPs and “aims to get in quickly and do short pieces of work to reduce the severity of the problems”. This involves rigorous assessments because “not every child who presents with an emotional difficulty requires input from Tier 3, which prioritises its limited resources for more complex cases,” Mr. McGuigan says.

CAMHS also has two Tier 3 teams covering the southern sector of the Western Trust: the Fermanagh team and the Omagh Team. Both are multidisciplinary teams consisting of a Consultant Child and Adolescent Psychiatrist (Dr. Iris Wylie in Fermanagh and Dr. Maura McDermott in Omagh), a Clinical Psychologist, a Social Worker and Clinical Nurse Specialists. In keeping with other Trusts, Tier 3 CAMHS involves specialist diagnostic assessment and the provision of psychological, systemic and, only as clinically indicated, pharmacology therapy.

Overall, CAMHS is a child and family service aiming to “support families to support their child”.

“Children do not exist in isolation,” Dr. Wylie states, “and are rather surrounded by a variety of systems - family, education, social network etc. If we only worked with the child, we might not get very far and so it is essential to work closely with parents/carers and families to promote recovery.” Group work is also on offer within CAMHS. Multi-family groups for instance have been successful, particularly with eating disorders, and CAMHS would like these groups to become more commonplace.

“Research shows that multi-group work does work, not just for eating disorder but for ADHD too,” Mr. McGuigan notes. “Families tend to get a lot of support from one another and adopt a: ‘We are in this together’ approach. It’s the solidarity of the group that makes you feel less isolated.” The CAMHS service works closely with other agencies such as Educational Psychologists, Social Services and other health care agencies such as Paediatrics and A+E. CAMHS staff on occasion hold Professional Only Consultations with the other agencies involved in a child’s care (with the consent of the child’s parents) in order to hear about their past professional involvement and decide whether input from CAMHS indicated and if so what our role might involve.

Prior to January 2010, CAMHS looked after five-16 year olds. Since then it has taken on 16-18 year olds. “That extra age group has created additional demand given that is the age group which appear more prone to mental health conditions, self-esteem problems, emotional challenges, and self-harm” At present CAMHS (all Tiers) operate on a Monday to Friday 9-5 basis. There has however been recent developments beyond the traditional working hours of the service. Mr. McGuigan explains: “The Card Before You Leave scheme, which is a regional initiative, for instance allows for young people who have been assessed as ‘Low Risk’ following attendance at local A+E departments to be allocated a next day appointment with CAMHS.” CAMHS staff are now available beyond Monday to Friday 9-5pm on a Saturday and Sunday and on Bank holidays from 9am-1pm. For the medium and high risk cases, Dr. Wylie says: “It remains our view that these young people should be admitted to hospital as a place of safety for them and their families, where they will be referred by Hospital staff for a Liaison Assessment with an experienced CAMHS staff member making a hospital-based assessment.” These assessments presently are only done within normal working hours and often involve tandem input from colleagues in Social Services in accordance with Trust protocols and procedures around self harm in this age group.

Referrals to CAMHS are made through GPs, Educational Psychologists, Social Workers and Paediatric Care. “We do not take self-referrals into our service. We require that young people are assessed by the referral agent,” the pair state. The referrals are carefully screened and scrutinised by senior staff and signposted to other services, or prioritised for initial assessment with CAMHS (Tier 2/Tier3) accordingly. The referrals are prioritised according to the concerns identified and any associated risks. They fall into the categories of Routine (normally seen within nine weeks in accordance with DOH Ministerial guidance), Urgent (seen within two weeks) or Emergency which require a more immediate response. For the Emergency cases CAMHS aim to provide an appointment within 24 hours. Dr. Wylie states that most Fermanagh and Omagh cases are given an appointment on the same day.

CAMHS Tier 4 is confined to the 14-18 year old age group who are presenting with significant emotional issues, serious mental health issues, eating disorders (including Anorexia Nervosa) etc. This part of the service is currently staffed by two Community Intensive Practitioners and an Eating Disorder Specialist and has Dr Wylie as its Clinical Lead. These young people are potentially in need of hospital treatment in Beechcroft (the Regional Child and Adolescent In-Patient facility in Belfast) where the WHSCT has direct access to a commissioned cohort of inpatient beds. The aim of the Tier 4 portion of the service is to, as best possible, prevent the need for hospitalisation by providing an intensive, flexible community based approach, or if hospitalisation is required on clinical grounds that the service can support the inpatient treatment and provide highly intensive post discharge support for both the young people and their families.

CAMHS have an “on-call” mechanism whereupon if a professional eg GP/Social Worker, is concerned about a young person’s wellbeing they can make contact and acquire advice in relation to that young person. “We are able to help the referral agent create a safety path for that child and prioritise their assessment within our service” stated Mr McGuigan.

Stigma around serious mental health disorders such as bipolar and paranoid schizophrenia “is still palpable”, they have found. As part of their work, CAMHS staff endeavour to be promoting of their client’s strengths and encourage understanding of difference. In sum the staff I interviewed identified Advocacy on the part of their clients and families as an important part of their therapeutic role.

Asked for their view on the prevalence of suicide in Fermanagh, Dr. Wylie stated that “suicide is a very complicated situation. It’s a multi-factorial problem”. They both identified the stress that the economic downturn has placed on families and individuals, the rural isolation of Fermanagh, the political climate and history of Northern Ireland as additional relevant factors on top of the other long established risk factors of family history, co-morbid drug and alcohol misuse etc.

In addition they commented about being “always struck nowadays by the pressure that young people seem to put on themselves and is put on them in relation to schooling and academic performance”. “It is not uncommon for us to see young people putting themselves under huge academic pressure and their emotional well-being is beginning to suffer because they can’t possible have a healthy work-life balance,” Dr. Wylie says. “Getting out and about with friends, getting adequate exercise and in sum creating an adequate work-life balance is essential in promoting positive mental health.” Mr McGuigan has also witnessed “some very sad and disturbing cases of bullying on social networking sites” and “we have seen children respond very negatively to what have been very severe and very derogatory remarks being made about them”. The pair were also aware of cases where a young person’s emotional and mental health had been compromised by other internet related issues such as exploitation and grooming.

Dr. Wylie and Mr.McGuigan were both eager to promote an awareness within the local community and professional base that there is indeed a CAMHS service available within Southern Sector of the WHSCT, concluding: “If a parent is worried about their child or if a young person is worried about themselves then the first port of call is with their GP or Social Worker who can ensure that the initial assessment is undertaken at a Primary Care Level to decide on whether onward CAMHS (Tier 2 or Tier 3) referral is appropriate or if other non-CAMHS services are better placed to meet the needs of that young person at that time.”