Social workers and lawyers despair at CAMHS’ refusal to assess or treat young people placed in short-term care
“How
can a child who is psychologically in a very bad place settle unless
they get mental health support?” asks independent reviewing officer
Sukhchandan Kaur. She is talking about a 15-year-old boy who was
neglected for years and slipped through the social care net until his
early teens and has been placed with several foster carers who have been
unable to manage his behaviour. Child and adolescent mental health
services (Camhs) will not work with him.
“I’ve appealed twice,” she says in despair. “They’ve not even
assessed him. For him to be assessed, he would have to be accepted as a
referral. And they won’t.”
Kaur’s role is to act as an advocate for children looked after by her
local authority, and she is furious she cannot secure the mental health
treatment this boy needs. “I am banging my head against a brick wall,”
she says.
Camhs’ refusal to assess and treat children who are removed from
families into state care before they are in a settled placement was
criticised in a recent Education Select Committee report on mental health services for children in care.
The report pointed out that the mental health of looked after
children is significantly worse than that of their peers. Almost half of
children in care have a diagnosable mental health disorder, and they
are four times more likely to have a mental health condition than those
not in care.
The MPs’ investigation found that there were “serious and deeply
ingrained problems with the commissioning and provision” of Camhs” for
children in state care. Neil Carmichael MP, select committee chair, told
the Guardian: “We were concerned at the lack of speed regarding
diagnosis, and lack of appropriate response thereafter.”
As complex trauma in childhood is likely to affect looked-after
children into adulthood, Carmichael is pushing for Camhs to be available
for care leavers up to the age of 25.
Camhs
is reluctant to assess and treat children who have suffered extremes of
neglect and abuse unless they are settled in a permanent placement.
This, as the report pointed out, is contrary to statutory guidance
“which states that looked-after children should never be refused a
service on the grounds of their placement”.
Nevertheless, Camhs’ refusal to accept any referral before a
permanent decision about a child’s future has been made has become so
absolute that family lawyers acting for young people in care proceedings
say they’ve given up asking. “We’re so used to them saying no that we
don’t even refer any more,” says Emily Boardman, head of the family
department at Turpin Miller solicitors in Oxford.
Once settled, a looked after child may be granted an assessment but
will not be accepted for therapeutic treatment unless they meet a high
threshold of need. Natasha Finlayson, chief executive of the Who Cares? Trust
which works with care leavers, says: “Young people [have to] present
with a psychiatric illness. If you can see the blood running down their
arms from self harming, or if they’ve [attempted] suicide, then they’ll
get access.”
Finlayson is scathing about the standardised, off-the-shelf
treatments that tend to be offered which, she says, stand little chance
of long-term success for this most vulnerable group of children. “We
need expertise in and help around sexual abuse, early trauma, domestic
violence, attachment, and for children who’ve experienced multiple moves
within the care system, compounding their sense of abandonment and
loss,” she says.
The medical model Camhs has operated does not work for the sorts of
mental health issues these young people have, she adds. There are
therapists who specialise in supporting looked-after children with
complex trauma, but with cuts now biting deep, some specialist teams
have lost staff or been disbanded.
Lack
of a permanent placement “cannot be and should not be” a barrier to
young people in care being able to access Camhs, says Sally Holland, the
children’s commissioner for Wales. The Welsh Assembly, she says, has
just created strict new targets for Camhs services in Wales: an urgent
referral must now be seen for assessment in 48 hours, and a non-urgent
one in 28 days.
Holland insists that more thought must be given to how therapeutic
treatment is presented to children so they feel more willing to engage.
“There’s not nearly enough alternative or earlier help. There should be
primary care teams delivering help at a much earlier stage, and we need
to keep putting a lot more resource into those and supporting carers,
foster carers and teachers.”
Finlayson believes that Camhs needs to change its approach to young
people in care. Of Camhs’ blanket refusal to treat children until they
are in a stable placement – a process that still, typically, takes from
six months to a year, and even upwards – she says the clinical position
is “misguided” and “totally unsuitable”.
Holland agrees: “Looked after children and children adopted from
care may have many issues, none of which hits a threshold, but taken
together, cause them significant difficulties,” she says. “We should not
be putting up artificial institutional barriers: it should not be ‘do
they meet our criteria’ but ‘what do they need?’ They should be getting
accelerated help, rather than being banned from help.”
The Education Select Committee recommended that looked after children
should have priority access to mental health assessments on entering
care. It’s not enough, says Jackie Sanders, director of public affairs
at the Fostering
Network: “We were very disappointed that the report fell short of
recommending that looked after children should also have priority access
to subsequent treatment … A prioritisation of looked after children for
assessment but not treatment will have little or no impact on their
access to mental health services.”
Whatever
happens in future to change the delivery of mental health care to
children in council care, the damage has been done for Kaur’s young
charge. Despite some difficulties, she says, he was bright and doing
well at school, but his behaviour after several placement moves has
deteriorated to the point no school will take him. The effect of Camhs’
refusal to offer treatment is, Kaur says, “devastating”.
“Those repeated rejections means he’s now losing hope,” she says.
“How can I help him to get that mental health support he needs to
overcome this sense of despair?”
No comments:
Post a Comment