Burnout in consultants in child and adolescent mental health services (CAMHS) in Ireland: a cross-sectional study

Physician burnout has reached epidemic levels in many countries, contributing to adverse personal, patient and service outcomes. Adverse socioeconomic conditions, such as the economic downturn in the Ireland post 2008, contribute to a situation of increased demand but inadequate resources. Given a recent unprecedented increase in referrals to Irish child and adolescent mental health services (CAMHS), coupled with a fragmented and poorly resourced service, it is important to reflect on consultant child psychiatrists’ well-being.ObjectivesTo report on the level of burnout among consultants working in CAMHS in Ireland using a cross-sectional design.SettingCommunity CAMHS in Ireland.ParticipantsAn online questionnaire was sent to all consultant child psychiatrists registered with the Irish Medical Council (n=112). Fifty-two consultants replied (46% response rate).Primary outcome measuresQuestions assessed demographic and occupational details, career satisfaction and perceived management, government and public support. The Copenhagen Burnout Inventory measured personal, work and patient-related burnout.ResultsThe prevalence of moderate or higher levels of work-related and personal burnout was 75% and 72.3%, respectively. Fewer (n=14, 26.9%) experienced patient-related burnout. There was a strong correlation between work burnout and personal (r=0.851, n=52, p<0.001) and patient-related burnout (r=0.476, n=52, p<0.001). Lack of confidence in government commitment to investment in CAMHS (p<0.001) and perceived ineffective management by health authorities (p=0.002) were associated with higher burnout scores. Few consultants (n=11, 21%) felt valued in their job. The majority (n=36, 69%) had seriously considered changing jobs, and this was positively associated with higher burnout (p<0.001). Higher burnout scores were present in those (n=15, 28.8%) who would not retrain in child psychiatry (p=0.002).ConclusionThe high level of burnout reported by respondents in this study, and ambivalence about child psychiatry as a career choice has huge professional and service implications. Urgent organisational intervention to support consultant psychiatrists’ well-being is required.

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Consultant responsibilities in child and adolescent mental health services teams: a systems dilemma

Psychiatric Bulletin ◽

10.1192/pb.27.2.68 ◽

2003 ◽

Vol 27 (2) ◽

pp. 68-70 ◽

Cited By ~ 1

Author(s):

Peter Reder

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Adolescent Mental Health ◽

Child And Adolescent ◽

Clinical Implications ◽

Ultimate Responsibility ◽

Legal Responsibilities ◽

Definition Of ◽

Child Psychiatrists

Aims and MethodsA number of relevant professional bodies were invited to state their views on the responsibilities of consultant child psychiatrists within multi-disciplinary teams in order to ascertain whether there was any consensus on the issue.ResultsLittle consensus or clarity emerged, save for agreement on child psychiatrists' expertise with medical matters. Only medical organisations believed in a notion of the consultant holding ultimate responsibility, although definition of this remained elusive.Clinical ImplicationsConsultants may need to seek clarity about their clinical and legal responsibilities from their employing Trust. However, there are many other dimensions to responsibility which have relevance for the training of child psychiatrists.

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Delphi study to identify key features of community-based child and adolescent mental health services in the East of England

BMJ Open ◽

10.1136/bmjopen-2018-022936 ◽

2019 ◽

Vol 9 (6) ◽

pp. e022936 ◽

Cited By ~ 1

Author(s):

Emma Howarth ◽

Maris Vainre ◽

Ayla Humphrey ◽

Chiara Lombardo ◽

Ainul Nadhirah Hanafiah ◽

...

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Delphi Study ◽

Well Being ◽

Adolescent Mental Health ◽

Child And Adolescent ◽

Eastern Region ◽

Community Based ◽

The Public

ObjectiveTo identify priorities for the delivery of community-based Child and Adolescent Mental health Services (CAMHS).Design(1) Qualitative methods to gather public and professional opinions regarding the key principles and components of effective service delivery. (2) Two-round, two-panel adapted Delphi study. The Delphi method was adapted so professionals received additional feedback about the public panel scores. Descriptive statistics were computed. Items rated 8–10 on a scale of importance by ≥80% of both panels were identified as shared priorities.SettingEastern region of England.Participants(1) 53 members of the public; 95 professionals from the children’s workforce. (2) Two panels. Public panel: round 1,n=23; round 2,n=16. Professional panel: round 1,n=44; round 2,n=33.Results51 items met the criterion for between group consensus. Thematic grouping of these items revealed three key findings: the perceived importance of schools in mental health promotion and prevention of mental illness; an emphasis onhowspecialist mental health services are delivered rather thanwhatis delivered (ie, specific treatments/programmes), and the need to monitor and evaluate service impact against shared outcomes that reflect well-being and function, in addition to the mere absence of mental health symptoms or disorders.ConclusionsAreas of consensus represent shared priorities for service provision in the East of England. These findings help to operationalise high level plans for service transformation in line with the goals and needs of those using and working in the local system and may be particularly useful for identifying gaps in ongoing transformation efforts. More broadly, the method used here offers a blueprint that could be replicated by other areas to support the ongoing transformation of CAMHS.

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Innovations in Practice: Feasibility of the development and well-being assessment as an adjunct to clinical assessment in child and adolescent mental health services

Child and Adolescent Mental Health ◽

10.1111/camh.12017 ◽

2013 ◽

Vol 19 (2) ◽

pp. 142-146 ◽

Cited By ~ 7

Author(s):

Anna Last ◽

William Henley ◽

Shelley Norman ◽

Robert Goodman ◽

Tamsin Ford

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Clinical Assessment ◽

Well Being ◽

Adolescent Mental Health ◽

Child And Adolescent

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WARRN – a formulation-based risk assessment procedure for Child and Adolescent Mental Health Services (CAMHS): the view of clinicians

Journal of Forensic Practice ◽

10.1108/jfp-06-2019-0025 ◽

2019 ◽

Vol 21 (4) ◽

pp. 228-239 ◽

Cited By ~ 1

Author(s):

Nicola S. Gray ◽

Jacqui Tiller ◽

Robert J. Snowden

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Well Being ◽

Adolescent Mental Health ◽

Child And Adolescent ◽

Research Network ◽

Assessment Procedure ◽

Evaluation Instrument ◽

Content Type

Purpose Wales Applied Risk Research Network (WARRN) is a formulation-based technique for the assessment and management of serious risk (e.g. violence to others, suicide, etc.) for users of mental health services which has been adopted across most Child and Adolescent Mental Health Services (CAMHS) across Wales. The paper aims to discuss this issue. Design/methodology/approach An online survey was disseminated to National Health Service clinicians in CAMHS to evaluate their perceptions of the use and effectiveness of WARRN. Data from 88 clinicians were analysed with both quantitative and qualitative methods. Findings Clinicians reported increased clinical skills, increased confidence in their assessment and management of risk and in safety planning, the increased safety of service users and the general public, and a belief that WARRN had saved lives. The qualitative data showed that clinicians thought a common risk evaluation instrument across Wales and different agencies had created a common language and understanding that improved communication. Practical implications WARRN appears well accepted in CAMHS services with the view that it is having a very positive effect on service user well-being and safety and could be implemented in other services. Originality/value This is the first report of a formulation-based approach to the management of serious problem behaviours in CAMHS services.

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Consultant responsibilities in child and adolescent mental health services teams: a systems dilemma

Psychiatric Bulletin ◽

10.1192/s0955603600001446 ◽

2003 ◽

Vol 27 (02) ◽

pp. 68-70

Author(s):

Peter Reder

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Adolescent Mental Health ◽

Child And Adolescent ◽

Clinical Implications ◽

Ultimate Responsibility ◽

Legal Responsibilities ◽

Definition Of ◽

Child Psychiatrists

Aims and Methods A number of relevant professional bodies were invited to state their views on the responsibilities of consultant child psychiatrists within multi-disciplinary teams in order to ascertain whether there was any consensus on the issue. Results Little consensus or clarity emerged, save for agreement on child psychiatrists' expertise with medical matters. Only medical organisations believed in a notion of the consultant holding ultimate responsibility, although definition of this remained elusive. Clinical Implications Consultants may need to seek clarity about their clinical and legal responsibilities from their employing Trust. However, there are many other dimensions to responsibility which have relevance for the training of child psychiatrists.

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Variation in spend on young mental health across Clinical Commissioning Groups in England: a cross-sectional observational study

BMJ Open ◽

10.1136/bmjopen-2019-030011 ◽

2019 ◽

Vol 9 (10) ◽

pp. e030011 ◽

Cited By ~ 1

Author(s):

Stephen Rocks ◽

Mina Fazel ◽

Apostolos Tsiachristas

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Physical Health ◽

Adolescent Mental Health ◽

Child And Adolescent ◽

Young Person ◽

Cross Sectional ◽

Adult Mental Health ◽

Children In Care

ObjectivesTo investigate whether the rate of spend on child and adolescent mental health is influenced by demand for other competing services in local commissioning decisions.DesignAnalysis of spend data by Clinical Commissioning Groups (CCG), including other publicly available data to control for variation in need.SettingLocal commissioning decisions in the National Health Service.ParticipantsCommissioning of health services across 209 CCGs.Main outcome measuresAssociation between the rate of child and adolescent mental health spend and demand for child and adolescent mental health services (CAMHS), adult mental health services and physical health services after adjusting for confounding factors.ResultsAn additional percentage point in the proportion of children in care is associated with 4% higher child and young person mental health (CYP MH) spend per person aged 0–18 (ratio of means: 1.04; 95% CI 1.00 to 1.07). Spending £100 more on physical health services was associated with 9% lower spend in CYP MH per person aged 0–18 (ratio of means: 0.91; 95% CI 0.84 to 0.99).ConclusionsHealthcare commissioners in England face a challenge in balancing competing needs. This paper contributes to our understanding of this by quantifying the possible extent of the trade-off between physical health and CYP MH when allocating budgets. Any attempt to explain the variation in CAMHS spend must also take account of demand for other services.

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Primary consultation clinics in child psychiatry: an evaluation of referrers' views of the service

Psychiatric Bulletin ◽

10.1192/pb.bp.107.014944 ◽

2008 ◽

Vol 32 (3) ◽

pp. 90-92

Author(s):

Puru Pathy ◽

Neleema Yanamani ◽

Aristos Markantonakis ◽

Paul Wilson ◽

Russell Mason

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Child Psychiatry ◽

Adolescent Mental Health ◽

Child And Adolescent ◽

Clinical Implications ◽

Direct Involvement ◽

Feedback Data

Aims and MethodTo collate referrers' views on primary consultations in child psychiatry, feedback data were collected by questionnaires over a 12-month period.ResultsReferrers found reports clearly written, informative and helpful, but wished for further, more direct involvement, support and follow up, and also for a clear plan of action for the children referred.Clinical ImplicationsPrimary consultation clinics should be further developed and audited in the future, in view of the recent changes in child and adolescent mental health services.

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Making sense of child and adolescent mental health services (CAMHS): An audit of the referral journey and the use of routine outcome measures (ROMS)

Clinical Child Psychology and Psychiatry ◽

10.1177/1359104521999709 ◽

2021 ◽

pp. 135910452199970

Author(s):

Naomi Gibbons ◽

Emma Harrison ◽

Paul Stallard

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Outcome Measures ◽

Adolescent Mental Health ◽

Child And Adolescent ◽

Completion Rates ◽

Making Sense ◽

North East ◽

Over Time

Background: There is increased emphasis on the national reporting of Routine Outcome Measures (ROMS) as a way of improving Child and Adolescent Mental Health Services (CAMHS). This data needs to be viewed in context so that reasons for outcome completion rates are understood and monitored over time. Method: We undertook an in-depth prospective audit of consecutive referrals accepted into the Bath and North East Somerset, Swindon and Wiltshire (BSW) CAMHS service from November 2017 to January 2018 ( n = 1074) and April to September 2019 ( n = 1172). Results: Across both audits 90% of those offered an appointment were seen with three quarters completing baseline ROMS. One in three were not seen again with around 30% still being open to the service at the end of each audit. Of those closed to the service, paired ROMS were obtained for 46% to 60% of cases. There were few changes in referral problems or complexity factors over time. Conclusion: Understanding the referral journey and the reasons for attrition will help to put nationally collected data in context and can inform and monitor service transformation over time.

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