How to treat children with severe mental health problems? Those in need of immediate care.
Offer a ‘crisis’ service with a 24-hour wait?
How about an expensive private hospital bed, hundreds of miles away? There are none nearby in the NHS – and no support in the community to keep them at home, as any child should be.
Here’s an obvious alternative: a hotline with an experienced nurse at the other end. A rapid response: within the hour. Intensive professional care, in their home, and a bed, if essential, close enough for family and friends to visit each day.
Both kinds of scenario are familiar to doctors; which one we cope with depends on where we work.
Ending this unfair and harmful unevenness across England is a big challenge in CAMHS (child and adolescent mental health services).
Big contrasts in care are even found in relatively small areas, as I recently discovered in conversation with doctors at the West Lane Hospital, a CAMHS centre run by Tees, Esk and Wear Valleys NHS Foundation Trust.
The sliver of north-east England that is the trust’s patch was like a tale of two cities.
In the north, children had access to the ‘obvious alternative’: they had rapid access to crisis and community care and beds when required.
But its southern half lacked decent access to both, forcing unwell young people on to wards when they were best cared for at home, and into beds up in Scotland.
This trust has been able to do something about this predicament, thanks to its participation in an NHS England pilot, dubbed ‘new models of care’, as our piece on it shows.
But other corners of England aren’t quite so lucky. Only doctors in hospitals taking part in the pilot can influence CAMHS.
As obvious as it is, this care model for children in crisis, giving access to the most basic community services and beds, must be rolled out across England – and quickly.
NHS England should take a long hard look at itself, then tear down the barriers that prevent this from happening.
Getting a grip on the true size of the crisis in CAMHS would be a good start.
As our earlier investigation revealed, NHS England’s working definition of ‘out-of-area’ beds doesn’t work. It’s more ‘smoke and mirrors’ than sober assessment. Children can be sent 200 miles out of area for a bed and still considered ‘in area’.
Next, it should set out how and when it will roll ‘new models’ out nationwide, ensuring that basic community services are properly funded.
Ultimately, it should let trusts manage their own beds supply, a power it refuses to yield. Those involved in the pilot face an untenable financial future: expected to balance a budget for beds that NHS England still wants to control.
Such steps will help hospitals and doctors end the ‘tale of two cities’ in CAMHS for the obvious alternative: fair and national mental health services for children in urgent need of our help.
Gary Wannan is deputy chair of the BMA consultants committee and a consultant child and adolescent psychiatrist
As national director for MH in England I would like to say two things in response to this article. Firstly, thank you MBA for shining a light on the brilliant progress being made by the MH NCMs. I believe they are leading the way in redesigning care, putting local clinicians, managers and patients at the heart of service redesign of local care models. Places like TEWV NHS trust have done amazingly well in creating crisis and early intervention alternatives for CYPs. They were part of a wave one pilot which involved taking £350m of spec com monies and putting control,into the hands of six local provider-led collaborations such as TEWV NHS Trust. These pilots went live in April 2017.
Secondly, it is the NHS England plan to do more of this across the country. We have identified the next 11 NCM sites across the country. This will take us, by April 18, to 17 sites and circa £770m of spec com money in local hands. This is more than half of the MH spec com budget.
MH is leading the way. It's better for patients and the clinical leads of the NCMs have been phenomenal. So I think you've given me and my colleagues here at NHSE a slightly hard time here. We've worked hard to create the conditions and the opportunity for brilliant local services to care differently for local populations. We've moved fast in the past year and the early signs of success are phenomenal! Thank You