Crisis in Child and Adolescent Mental Health Service – funding falls while young people’s mental illness and self harm rise

Calderdale Child and Adolescent Mental Health Service has suffered funding cuts at a time of increased referrals due to rising rates of mental illness and self harm among young people in Calderdale.

In 2013, one in five of Years 7/10 had self harmed, with rates highest among year 10 girls (one in three of whom had self harmed). In 2012/13, Calderdale hospital admissions for self-harm among young people between the ages of 10 and 24 were worse than the England average. [info source: CMBC  Plan for Commissioning Services for Children and Young People in Calderdale 2014-16]

A recent report from West and South Yorkshire and Bassetlaw Commissioning Support Unit (CSU) states that there is a high risk that the Child & Adolescent Mental Health Teams, run by the mental health Trust in Calderdale clinics since April 2013, may not be able to adequately meet patients’ needs.

The CSU says the problems with the service are long waiting times for treatment and patient dissatisfaction with the clinical team. It  blames this on:

“historical issues around the working practices and culture within the service that have recently been uncovered”.

But the CSU Report ignores the fact that this financial year Calderdale Clinical Commissioning Group is paying the Trust 1.5% less than it did in 2013/14.

This is despite the fact that the mental health Trust is seeing more patients than planned.

The CSU Report doesn’t investigate the effect of this funding cut on waiting times, or on CAMHS teams’ ability to deal effectively with rising numbers of patients.

In order to “control” the risk that CAMHS clinics (also known as Tier 3 CAMHS) will not meet patients’ needs, the NHS Commissioners have put a new clinical lead and management team in place and devised a recovery plan, along with a monthly review at a meeting of the service providers and the commissioners.

A programme of increased staff recruitment for Calderdale CAMHS clinics is underway.
It remains to be seen whether this will raise staff numbers to an adequate level.

Cuts to privatised CAMHS community services

As well as pressures from efficiency savings on the mental health Trust’s CAMHS clinics, there have also been cuts to some CAMHS community services in Calderdale.

These services (called Tier 2 services) are the responsibility of Calderdale Council and are jointly commissioned by Calderdale Clinical Commissioning Group and the Council.

From January 2014, the joint commissioners outsourced Tier 2 CAMHS to a charity, Leeds Counselling Services. The three year contract is worth £1.11m and is reviewed every quarter.

The NHS provider which had been delivering the CAMHS community (Tier 2) service gave notice that they no longer wanted to continue to provide Tier 2 CAMHS.  This triggered the commissioning process.

When it outsourced/privatised its Tier 2 CAMHS, Calderdale Council cut some services, because funding was no longer available for them.

According to a Calderdale Council document that the Council’s Children’s Commissioning Services has recently taken off the website because “things have moved on now” Sure Start Counselling Services for children, young people and parents stopped being available from 30th September 2013.

And some other services are now no longer free, but are:

available for commissioning or can be purchased by client, school or family”.

These are:

  • Calderdale Behaviour Support Service- Referrals from school staff with concerns about pupils’ social emotional and behavioural needs at school
  • Calderdale Parent Partnership Service- Trained counsellor who can offer service at a charge to schools.
  • Relate Time 2 Talk – a confidential counselling service for children and young people who are feeling unhappy, anxious or worried because of difficulties in their family, school or personal lives. Donations requested towards cost of services
  • Independent Counsellors- local qualified local counsellors listed on BACP  and British Association of Play Therapists

In reply to a Freedom of Information request, Calderdale Council said that the community CAMHS cuts and charges were made because some funding was no longer available – such as time limited grants (e.g. Targeted Mental Health in Schools funding). So it was not possible to continue all of this activity.

The Council was unable to say how much CAMHS tier 2 funding was cut in the new outsourced contract, or whether there has been a change in the take-up of services that used to be free but that users now need to pay for.

Karen Smith, Service Manager for Calderdale Council’s Children’s Commissioning Service, said,

“The numbers of children and young people using Tier 2 CAMHS prior to January 2014 is not information that the Council holds as this service was commissioned by NHS Calderdale Clinical Commissioning Group up until Leeds Counselling took on delivering the service in January.   It is therefore not possible for us to answer the question you raise about whether there has been an impact on numbers using Tier 2 due to the services mentioned in the document who ask for a donation or ask schools for a fee.”

Calderdale Council also explained once the CAMHS Tier 2 contract was outsourced, funding came to an end for some CAMHS Tier 2 services because,

“Prior to 2014, funding under the CAMHS banner was from a number of sources and actually in some cases involved client groups outside the CAMHS target groups. The commissioning exercise carried out in 2014 offered an opportunity to combine the funding into a more targeted contract.”

I think this means they put all their eggs into one basket for the new community CAMHS services run by Leeds Counselling Services.

Calderdale Council told Plain Speaker,

“Children and young people who are in need of support can access it through the funded services delivered by Leeds Counselling and through the Tier 3 CAMHS provider South West Yorkshire Partnership NHS Foundation Trust.

There is no direct replacement for the Sure Start counselling service, although the Children’s Centres continue to offer a range of support services for parents including peer support and parenting programmes.

Parents can also of course continue to access support via their own GP.”

In Kirklees, Tier 2 services have been outsourced to another private provider, the charity Northorpe Hall.

The problem isn’t unique to Calderdale – nationally, CAMHS is in crisis

The national CAMHS crisis led to an inquiry this year by the House of Commons Select Committee on Health. The inquiry aimed to investigate concerns about:

“the extent to which children and adolescents are affected by mental health problems and difficulties with gaining access to appropriate treatment”

The Select Committee inquiry confirmed that the CAHMS problems are due to cuts to mental health funding, together with rising levels of mental illness and self harm among children and young people.

It has taken evidence from a range of professionals working in the field of child and young people’s mental health,  who have reported that CAMHS’  local authority funding and services have been cut year on year since the comprehensive spending review, while referrals have soared and mental illness rates and self harm for children and young people continue to rise.

According to the panel who gave evidence to the Select Committee on 1st April, there are various causes for the soaring rates of mental illness and self harm for children and young people, but a key cause has been economic hardship since 2010.

That panel also repeatedly stressed that cuts to CAMHS Tier 1 and Tier 2 services meant that often young people weren’t supported in the early stages of experiencing mental health problems. So they got worse, without support, until young people needed help from Tier 3 clinics.

This has fuelled pressure on the CAMHS Tier 3 clinics.

If adequate support had been available in the community, when problems started, the need for treatment at CAMHS clinics would be much less.

However, Karen Smith, Calderdale Council’s Service Manager for the Children’s Commissioning Service, said:

“The Children’s Commissioning Service is leading on a project funded by the NHS Calderdale Clinical Commissioning Group to look at early intervention support for children’s emotional wellbeing.”

Nationally, half of early intervention services for young people have been scrapped. Over a fifth of doctors say they have sent a mentally ill child over 200 miles away from their parents for treatment.

Northern councils are far more short of money than the south – cuts to local authorities’ budgets have been much bigger in the north than the south.

The House Of Commons Health Select Committee on CAMHS has been told that Yorkshire and Humberside is among the most under-resourced areas for Tier 4 (inpatient) CAMHS beds. There are none at all in Calderdale or Kirklees.

So Calderdale CAMHS has to use beds out of area for inpatients. It can use the paediatric wards for short term use but there are no mental health beds for CAMHS patients.

Tier 4 are highly specialised services with a primary purpose of the assessment and treatment of severe and complex mental health disorders in children, that cannot be provided for by Tier 3 community services. Nationally, around 2,500 children access the service each year.

Privatisation leads to fragmentation of services and increased contract procurement and management costs

As a result of the handover of Tier 2 contracts to two different charities,  Calderdale and Kirklees CAMHS staff are having to deal with the fragmentation of the service.

Calderdale Council Director of Children’s Services (the Lead commissioner for the Tier 2 contract) has written to the mental health Trust (South West Yorkshire Partnership Foundation Trust) about the impact on Tier 2 services of the issues in the mental health Trust’s Tier 3 services.

A senior member of the Clinical Commissioning Group’s Contract Management Group has been given the task of managing the NHS mental health trust Tier 3 services and the privately run Tier 2 services.

CAMHS is another NHS service that is vulnerable to privatisation

Despite a parent’s legal challenge to the privatisation, the whole of CAMHS in Devon is now being delivered by Virgin Healthcare. This is the direction the CAMHS service is going in.

With CAMHS privatisation come changes in working practices, with an emphasis on ‘turnover’ and time-limited work that runs against  the long term and complex nature of many young people’s mental health difficulties.

Information about Calderdale CAMHS here

Information about Calderdale CAMHS Tier 2 services here

Updated 7 October with additional information from Karen Smith, Calderdale Council’s Service Manager for the Children’s Commissioning Service

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