One of the mantras that mental health services are supposed to live by is that there should be joined-up working between the NHS and social services. How’s that working out with children and adolescents?
In adult services, clinicians and social workers both work in Community Mental Health Teams (CMHTs). The CMHT will often have CPNs and social workers sharing offices, so that they can work closely together. In Child and Adolescent Mental Health Services (CAMHS) that’s not a given. Under the pressure of the cuts, quite a few areas have seen a loss of social workers. Social services departments who’ve been told they have to shed posts will often cut the staff over at CAMHS rather than the ones in their own office.
At the same time, both CAMHS and social services are under caseload pressures. Their resources are shrinking, but their caseloads aren’t. The talk in both camps is how to focus on their “core” clients, and who should be seen by other agencies.
Relations between CAMHS and social services have historically been fairly poor. As the gulf widens, this relationship can only get worse. The risk is that it can turn into a game of pass-the-parcel with children. As soon as one service accepts responsibility for a child, the other service steps back.
Here’s a couple of (fictional, but based on the real world) examples:
1. A child being seen by CAMHS is absconding from the family home and placing himself in risky situations. The parents don’t seem able or willing to enforce proper boundaries around his absconding behaviour, and appear rather unconcerned. CAMHS put in a child protection referral.
“Well, it’s obviously part of his mental health problem, isn’t it? And if the parents aren’t engaged, surely they can do some family work with them? Referral not accepted.”
2. A looked-after child is self-harming and describing nightmares and flashbacks of their former abuse. The social worker puts in a referral to CAMHS requesting a screening for PTSD and some harm reduction work around the self-harm.
“Well, it’s a looked-after child, so that would be an attachment problem rather than a mental illness. They’re in care so it’s social services responsibility. If they think the child needs therapeutic input they should fund it. Referral not accepted.”
Multi-agency working? Whassat?
This isn’t spoken out loud, but there’s a sense if this trend continues we could move closer to an assumption that if a child is seeing CAMHS, they can’t have a social worker. And if they’re under the care of social services, they can’t have a service from CAMHS.
What’s the name of that guidance we’re all supposed to follow? Ah yes, Working Together to Safeguard Children.