Child and Adolescent Mental Health Services

Background

Improving mental health and wellbeing is a major public health challenge.  In part, this is because the underlying issues tend to be complex, and people’s needs can be different.  Evidence suggests that mental health problems in childhood and adolescence have a significant impact on physical health, education and on the ability to find and sustain employment.    

The Government of Jersey has stated in the Government Plan 2022-2025 that ‘the physical, emotional, and mental health of the Island’s children and young people remain of the highest priority.’ 

Child and Adolescent Mental Health Services (CAMHS) comprises specialist mental health services for children and young people (up to the age of 18) and their families.  CAMHS provides a range of services including assessment, diagnosis and treatment for children and young people experiencing: 

• emotional difficulties  
• behavioural difficulties  
• relationship difficulties; and  
• developmental difficulties. 

CAMHS also provides specialist community-based services for those experiencing specific mental health issues such as psychosis and eating disorders.  Services include individual therapy, family therapy, parent counselling and group therapy (where children, young people or carers with similar difficulties are seen together in groups). 

The number of referrals to CAMHS has risen over recent years and there continues to be a high level of demand for CAMHS. 

The Government Plan 2022-2025 includes planned investment of over £8 million for the implementation of a new model of care for children and young people’s emotional wellbeing and mental health. As part of this new model of care, CAMHS is being redesigned.  

Scope

The review has evaluated: 

• overall governance arrangements for CAMHS, including consideration of: 

• how recommendations made in the C&AG Report Governance Arrangements for Health and Social Care – Follow up (2021) that are relevant to CAMHS are being monitored and implemented 
• whether responsibilities and accountabilities are clearly set out and agreed, including in transition services between CAMHS and Adult Mental Health Services (AMHS) 
• how the oversight of performance information drives improvement; and 
• how performance improvement is being overseen 

• service design including consideration of: 

• the range of services offered 
• how the range of services has been designed to meet known and anticipated need 
• the design of transition services between CAMHS and AMHS 
• how learning from previous reviews has helped to shape the range of services offered; and 
• the engagement of multi-agency partners in the design of services 

• referrals management including consideration of: 

• who can make referrals 
• how pathways from all referrers are set out and communicated; and 
• how criteria for referral acceptance are agreed and implemented 

• service delivery: how does the service as delivered: 

• compare with the service as designed and with best practice; and 
• maximise the use of available resources 

• service resourcing: how do resourcing decisions: 

• work across States of Jersey departments; and 
• ensure a joined-up service for children, young people and their family and carers 

• the effectiveness of commissioning and partnership arrangements, including consideration of: 

• how decisions are made on which services to commission, which services are provided by Government and which services are provided in partnership with third sector organisations 
• how the commissioning of services compares to best practice; and 
• how partnership arrangements compare to best practice 

• performance management and oversight, including consideration of: 

• how the services are monitored and reported 
• whether the targets and measures being monitored are designed to ensure better outcomes for children and young people 
• the current and planned performance against key indicators 
• how performance and targets compare with best practice 
• how services are benchmarked; and 
• how partnership performance indicators are measured, managed and monitored. 

The review has considered all aspects of CAMHS provision including services delivered by partners both on and off-Island.   It has focussed on the responsibilities of the Children’s Health and Wellbeing Service within the Integrated Services and Commissioning function of CYPES.  It has not considered the work of other CYPES functional areas such as children’s social work or child and family support. 

Conclusions

The Government has committed to investment in the Children’s Health and Wellbeing Transformation Programme, including CAMHS, through the Government Plan 2022-2025.  This investment is supported by a robust Strategy launched in February 2022. 

Governance, data collection, risk and performance management for CAMHS have been weak.  For the Strategy to lead to a step change in service quality and range of provision it will need to be supported by stronger and more effective governance and other arrangements and more specific and detailed implementation plans.