‘A lot of brilliant people leaving Child and Adolescent Mental Health Services’

Some of those working in the Child and Adolescent Mental Health Services (CAMHS) are “pessimistic” about its future and are frustrated with aspects of how it works.

A study also showed professionals working within CAMHS believe that the presentations of children and adolescents are now much more complex, that there are many more of them than before, and that self-harm, suicidal ideation, and difficulties in family relationships are key factors in that trend.

The study, entitled The experience of mental health professionals working in Child and Adolescent Mental Health Services in Ireland, was written by Eimear Ryan in the Department of Clinical Speech and Language Studies, School of Linguistic, Speech, and Communication Sciences at Trinity College Dublin.

It features interviews with six multidisciplinary professionals including a clinical psychologist, a social worker, and a speech and language therapist, working in CAMHS, in which “the over-arching feelings were those of frustration” and where “their experience of the elevated status of psychiatry leads to participants having to battle for their voices to be heard”.

There was also a level of pessimism among interviewees about the future of the services.

The current CAMHS system emerged out of the 2006 A Vision For Change document, but reviews since then have found a number of outstanding gaps and a lack of a system for monitoring outcomes, among other issues.

The research outlines how, as of the first quarter of 2017, there were more than 2,818 children and adolescents on the waiting list for an initial appointment in CAMHS, including 279 children and adolescents waiting more than 12 months, while only 69% of children who required in-patient mental health services were admitted to child and adolescent in-patient units.

According to the report, the general experience of working in CAMHS was summed up by a quote: “I think everybody’s finding it a challenge, to be honest.”

Those interviewed spoke about the positive aspects of working in a multi-disciplinary team but said that psychiatry appeared to be given the most status, with one interviewee stating: “There’s without a doubt, a very definite hierarchy.”

According to the report: “Unsurprisingly, the status of psychiatry can lead to tension and battles within the multidisciplinary team in CAMHS.”

Those interviewed also referred to changes to CAMHS itself. 

According to the report, there was “a collective feeling of frustration” among interviewees regarding CAMHS as “a numbers game” in which the focus was on seeing and then closing as many cases as possible.

“The emphasis on the number of appointments being offered and the number of referrals being seen has led to significant changes in service delivery.

For participants, this has resulted in a decrease in the quality of the service being provided by their multi-disciplinary team and a sense of frustration that there is less value placed on the quality of their work.”

One person said: “I see an awful lot of people leaving CAMHS.

“I see an awful lot of very very experienced, brilliant clinicians and therapists looking to get out, feeling that they don’t want to do the kind of work that CAMHS services are allowing them do.”


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