Child and Adolescent Mental Health Services

introduction

Mental illness is referred to the health condition in which emotions, thinking ability and/or behaviour of a person is hindered due to abnormal functioning of the brain. The Child and Adolescent Mental Health Services (CAMHS) is a term often used for indicating the services that are provided to children as well as young people having difficulties with behavioural and emotional well-being. The specialists present in the multi-disciplinary team of CAMHS and NHS Mental Health Services includes nurses, social workers, psychiatrists, occupational therapist, psychological therapists and others (NHS, 2019). In this essay, the comparison between the local and national services related to Child and Adolescent Mental Health Services (CAMHS) is to be discussed with focus on the UK and London Borough of Barking and Dagenham. The key issues related to be CAMHS in the UK and the London Borough of Barking and Dagenham are to be discussed and analysed. The way change can be brought in the areas and the driving, as well as restraining forces in the area, is to be discussed by using Lewin’s Change model. The System Theory and Leadership theory is to be used for discussing healthcare management is to be done so that the key issues related to CAMHS can be resolved.

Rationale of the area chosen for the study

Mental illness is considered as one of the major health issue in England, UK both locally nationally. This is evident as in 2017 the mental health statistics informs that 1 in 10 school children in the UK and 1 in 8 school children in England who are within the age of 5-19 years are suffering from mental health condition. Moreover, it is reported that nearly 75% of the mental health issues within the population of the UK is established within 18 years of age (NHS, 2017; childrenssociety, 2018). The emotional disorder as the nature of mental health issue is found to be more prevalent (8.1%) among the 5-19 years individuals in the UK (NHS, 2017). The mental health issue statistics informs that 5.5% of children of age 2-4 years are suffering from mental disorders compared to 16.9% of 17-19 years old young (NHS, 2017). The statistics indicate that mental health issues are rising among young and children in the UK. Thus, evaluation of Child and Adolescent Mental Health Services (CAMHS) in the area is required to identify the major problems that are driving the rise of the illness in the nation.

The mental illness statistics related to children and adolescent in the London Borough of Barking and Dagenham informs that nearly 3.9% of the children between ages of 5-16 years have a prevalence of emotional disorder as mental condition compared to the national average of 3.6% in England. The prevalence of all nature of mental illness among 5-16 years of individuals in the London Borough of Barking and Dagenham is 10.4% compared to national average of 9.3% in England (lbbd, 2017). This informs that London Borough of Barking and Dagenham has more intense mental health illness prevalence among the young and children. Thus, the key issues faced by London Borough of Barking and Dagenham in relation to Child and Adolescent Mental Health Services (CAMHS) are chosen to be discussed to improve mental healthcare services in the area and reduce the prevalence of the illness.

Analysis of key issues

One of the key issue related to Child and Adolescent Mental Health Services (CAMHS) faced in the UK and the London Borough of Barking and Dagenham is lack of presence of adequate number of health professional and specialists. This is evident as in 1st quarter of 2018 within the UK it is reported that number of nurses working for the NHS to provide mental healthcare UK as well as locally reduced from 46,155 individuals to 39,358 people and the health professionals who are trained specially for offering psychiatric healthcare reduced from 3,187 to 2,588 individuals (theguardian, 2018). As asserted by Cusack et al. (2016), adequate number of mental health professionals is required to provide effective mental healthcare to the service users. This is because proper number of health professionals per patients would lower workload and efficiency at work making the professionals able to offer timely care to service users to improve their health. As argued by Memon et al. (2016), lower number of healthcare professionals per patient leads to create work pressure and make professionals offer delayed care. This is because a single professional in lower workforce condition have to attend more patients than normal making the patients wait longer to avail care.

In 2018, the number of active referral of children and adolescent in the UK for availing healthcare was 389,727 which is 3 times higher than two years ago (theguardian, 2019c). Thus, the low number of mental healthcare professional and nurses is a major issue due to which CAMHS is not properly provided as fewer professionals are to attend more patients making them incapable to provide care to all. The increased waiting time is regarded as another issue related to CAMHS in the UK as well as in the London Borough of Barking and Dagenham due to which hindered healthcare is seen among patients. This is evident as per statistics in 2017-18 where it is informed that 539 children of the UK who required Tier-3 CAMHS support had to wait for nearly a year to initiate their treatment (theguardian, 2018b). In Barking and Dagenham, it is reported that average waiting time to receive CAMHS support has increased to 19.3 weeks and it continuing to increase each year (lbbd, 2017). This informs that fewer healthcare professionals per patients are also leading to increase waiting time to avail care for mental health among the children and young in the UK.

The increased waiting time to avail mental health care creates negative impact on the health of the individuals as the symptoms related to the illness become worst leading the patient experience deteriorated health condition (Mattheys, 2015). It is evident as 99% of the family doctors in the UK inform that young people under the 18 years of age have the potential to harm themselves due to delay in care (theguardian, 2018c). In relation to CAMHS support, it was reported that nearly 1,039 children living in England, UK have to travel more than 100 miles to allocated beds for their care. The children and young referred had major health issues such as severe depression, suicidal tendency, eating disorder and others (theguardianm 2018a). As mentioned by Hailemariam et al. (2016), travelling long distances to avail mental healthcare leads patients to experience hindrance in availing care and discontinue their care. This informs that there is lack of proper success of CAMHS support because they are unable to lead the patients to have care by travelling short distances, in turn, discontinuing or facing hindrance to avail services that have a negative impact on their health.

In the Barking and Dagenham, one of the key issues related to CAMHS support is lack of effective referral from school (lbbd, 2017). This creates problem for CAMHS support to be offered to the mentally-ill children in the area as the healthcare managers are unable to know which children require their assistance and care, in turn, worsening the mental health situation. The other key issue related to CAMHS support in the Barking and Dagenham is that is a nominal percentage of children and young people with diagnosed mental health condition are receiving care where a majority of them are deprived of proper care. This is evident as in 2016-17 it was reported that only 22% of the children and young people with diagnosed mental illness in Barking and Dagenham are receiving care (lbbd, 2017). Thus, it informs that there is hindered healthcare management to provided care to all children identified with mental illness in the area as a result of which such a situation has been raised.

In the UK as well as the Barking and Dagenham, the existence of stigma related to mental illness is one of the major issues that is hindering the effective establishment of CAMHS support for the children and young (lbbd, 2017). As commented by Eaton et al. (2016), mental health stigma leads the individuals suffering from mental illness to avoid coming out to access proper care services. This is because the people fear they may be harmed or abused by others as a result of their deteriorated mental health condition. As argued by Hassan et al. (2016), children suffering from mental illness are often discriminated at schools and society as they are regarded as vulnerable. This leads the children to be isolated which further negatively affects their mental health. As criticised by Martinez and Hinshaw (2016), families with children having mental illness are often isolated from society. This is because the people in the society regard them as vulnerable and fear they may cause harm to them. Thus, the existence of stigma regarding mental health in the UK as well as Barking and Dagenham may be leading families and children to openly avail CAMHS support for improving their healthy creating worst mental health prevalence locally as well as nationally.

Application of approaches

The three stages of Lewin’s theory include Unfreeze, Change and Refreeze). This three-step model of Kurt Lewin will give stakeholders and CAMHS services an idea regarding the way they are going to implement change in order to deliver proper care to the people. The 3 phases of the Kurt Lewin model informs the way to contribute to making the change.

The theory informs that the first stage is preparing the stakeholders for the change in CAMHS services both national and local because the services provided is not meeting its purpose. Therefore, something new in term of working is needed to come in force. In order to resolve the present problem CAMHS faced, for examples, the longer waiting time to access services, young people find it difficult to self-referral, and they feel they must get worse before they can be taken seriously, (I-THRIVE 2019). However, to bring about this change manager will implement new processes and re-assign tasks, but change will only be effective if the people involved embrace it and help to put it into practice it, (Scragg, 2014). Change can be difficult because stakeholders are used to the old ways of working and implementing change can be difficult. However, ones the reason for the proposed change and aim are clear and understood by those who will be affected, decisions need to be made about how staff are encouraged with the change, (Scragg, 2014). The Unfreezing stage is regarded as significant as the stage indicates readiness to make the change. This stage includes getting proper understanding of the change and identifies its necessity of moving away from the current way of working. It involves getting to a point of understanding that change is necessary and getting ready to move away from the existing ways of working. Therefore, for CAMHS services to be effective both locally and national a new implementation must take place to replace the old ways of working. Some of the problems faced with young people according to Nuffield Trust (2019) are barriers in accessing CAMHS both locally and nationally. These barriers can be lifted if the change is effective across the stakeholders. In addressing these issues, the managers of these organisations can bring about change as this stage will prepare the organisation and the set the team to identify with what is not working and preparing to make that change, (Change Management Coach, 2019).

The second stage is change or transition, this is central to Lewin’s model and it is a confusion period as this may be an emotional level for employees (Change Management Coach, 2019). Implementing this new change, CAMHS stakeholders will get unfrozen and required to be able to follow the new direction of working to show better care. In this stage, one of the main goals of this transition stage is for managers to make employees be unfrozen in accepting the change. In doing that employees will initiate to resolve their uncertainty and identify ways in which new directions can be adopted (Paton & McCalman, 2008). In practical step, proper communication, as well as empowerment, are important as well as management is to inform staff regarding whatever is happening. The third stage is the part where all is getting shape and subordinates have accepted the new ways of protocol allowing the organization to refreeze (Paton & McCalman, 2008). In practical step, the organization is required to stick to the changes in culture and establish proper feedback system.

System Theory

The study by Best et al. (2012) informs that according to Large System Transformation Theory in healthcare the five key principles to be followed for creating better healthcare management are blending designed leadership with the distributed leadership, developing feedback loops, identifying healthcare history, engaging physicians and involving patients as well as families in care. The blending of designed leadership with distributed leadership can be executed by framing conceptual as well as analytical approach regarding the way leaders are to work together in a complex organisational context (Jones and Harvey, 2017). This informs that leaders are to share their responsibilities effectively at the management level so that each of them can work collaboratively to establish improvement and change.

In order to resolve school referral issues for mental healthcare and improve CAMHS support, the leaders of the healthcare organisations, schools, child protection authorities, health professionals and others are to work together and share responsibilities among them. This is because such an approach would make the leaders in each institution help one another to develop active steps in identifying and referring mentally-ill vulnerable children and young to receive healthcare (Sanchez et al. 2018). For instance, the leaders of healthcare organisation, child protection agency and schools by sharing their roles and responsibilities with one another would be able to help the schools regarding the way to determine which child is facing mental health condition and the way the individual can be protected as well as where to be referred for CAMHS support to ensure their well-being.

The feedback loops in mental healthcare help the managers to understand the impact of the care services provided to the patients and the changes to be made for its improvement (Breuer et al. 2018). This is because feedback of the patients mentions the needs and demands which are fulfilled as well as not fulfilled through the services informing the health professionals and managers regarding the way unfulfilled needs and demands are to be approached to create better healthcare scenario. In case of CAMHS support, the feedback loops are going to aware the health professional and healthcare organisation to what extent the services are reaching the service users and what problems are being faced in relation to current condition that is to be resolved. For instance, the feedback loops are going to inform the healthcare agencies that increased waiting time is continuously being faced as issues of CAMHS support for the services users. This is going to make them aware to take steps to increase professionals per patients so that the waiting time can be reduced.

The identification of healthcare history of the area helps the healthcare managers understand the prevalent issues existing in the society which is hindering health progress regarding certain illness (Fekadu et al. 2016). This is because history of healthcare informs the causes and risk factors that have been prevalent for years which are affecting the illness to be prevalent in the area. It indicates that by analysing the history of mental healthcare in the UK and the Borough of Barking and Dagenham the healthcare managers can identify the issues that are leading the prevalence of mental health stigma in the society and develop ways to can be resolved so that effective CAMHS support can be provided. The inclusion of families and patients along with physicians are required in creating a change in healthcare because the patients and families inform the reason behind their ordeal of accessing healthcare whereas the physicians inform the resources required to deliver better healthcare (Vermeir et al. 2015). Therefore, the inclusion of families and patients in creating change to resolve issues regarding CAMHS support is needed as they are going to inform their ordeal faced in travelling long distances to avail care. This would lead the healthcare managers to understand the reason behind long-distance travel for availing CAMHS support to be avoided as well as develop strategies based on the information provided by patients regarding the way they can be made to continue their care even going long distances. Moreover, the involvement of the physicians is going to help the healthcare managers understand the resources required which are presently lacking to deliver effective CAMHS support to the children and adolescent.

Leadership

The leadership is referred to the process through which an executive actively direct, influence and guide the behaviour of others working to accomplish a certain goal in a specific situation (Jones et al. 2018). The transformational leadership informs that leaders are to encourage, motivate and inspire staffs for making innovation and creating a change which is going to allow the organisation to grow and achieve success (Farahna et al. 2019). According to transformation leadership, the organisation leaders acting to provide CAMHS support are to inspire and motivate their staffs to act innovatively to resolve the issues experienced in providing care to deliver better services. For instance, the leaders at school are to inspire and motivate the teachers in taking up responsibilities by following innovative ideas such as weekly analysis of mental health of children for effective identification and referral of children suffering from mental health condition to CAMHS support. The transformational leaders are those who are seen to be open in communication and develop effective cooperation with staffs (Lin et al. 2015). The organisation leaders offering CAMHS support by using transformational leadership can be able to understand the issues faced by professionals which are hindering the services and increasing waiting time for availing care by the children as they would be able to have open communication with the staffs to understand their problems in providing services.

Area for change

The “No Health without Mental Health” has the main aim towards promoting good mental health by preventing mental illness to ensure the well-being of the individuals. The coalition government in the UK apart from taking this strategy also developed framework regarding the six objectives in the strategy can be fulfilled. The key part of the framework is that it will impact the adolescent involved in self-harm to have early intervention in resolving their health issues. The schools are going to act in promoting effective mental health for young individuals and children (Department of health, 2011).

The UK government is seen to be working in partnership with organisations like "Time to Change" for improving outcomes of mental illness and lowering social barriers for individuals suffering from mental health problems. The Department of Health is the first organisation who have partnered with the "Time to Change" scheme. The key focus on the scheme is to avoid discrimination regarding mental health in society. The scheme has developed an advertisement where it is promoted that it is acceptable to talk regarding mental illness and it is not required to be kept secret (time-to-change, 2008).

Conclusion

The above discussion informs that area chosen to identify issues regarding CAMHS support are the UK and the London Borough of Barking and Dagenham. This is because nationally there is high prevalence of mental health issues in the UK and locally there are improper services being provided in relation to CAMHS support in the London Borough of Barking and Dagenham. The key issues related to CAMHS support are longer waiting time, less number of professionals per patient, the prevalence of mental stigma, long-distance travelling to avail care and others. The system theory informs that physicians, families and patients are to be involved along with feedback loop regarding CAMHS support are to be created to resolve issues related to it. The Lewin’s change model informs that healthcare managers are to reassign and delegate tasks within health professionals so that they can have proper time to attend all patients within time in turn acting to reduce waiting time for the patients. The transformation leadership is to be used to inspire health professionals and schools to work attentively so that better CAMHS support can be provided to the children by identifying them.

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