Children and Young People's Improving Access to Psychological Therapies: inspiring innovation or more of the same?

SummaryIn 2007 the UK Government announced a substantial expansion of funding for psychological therapies for those presenting with common mental health problems. This ‘Improving Access to Psychological Therapies’ (IAPT) project was widely welcomed, however, evidence backed, economic, and conceptual critiques were voiced from the start and the project remains controversial. In 2011, the UK government announced it was extending the IAPT project to encompass services for children and young people with the aim of ‘transforming’ the way mental health services are delivered to them. Here I critically reflect on the problems associated first with IAPT and then with CYP-IAPT and ponder whether CYP-IAPT is significantly different to the problematic adult IAPT project or more of the same.

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Unexpected deaths of children and young people in the UK

BJPsych Bulletin ◽

10.1192/pb.bp.114.049825 ◽

2016 ◽

Vol 40 (2) ◽

pp. 68-71 ◽

Cited By ~ 1

Author(s):

Paul Stallard ◽

Michelle Maguire ◽

Justin Daddow ◽

Rosie Shepperd ◽

Mike Foster ◽

...

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Young People ◽

Health Services ◽

Child Death ◽

National Data ◽

Children And Young People ◽

National Health Service Trust ◽

Incident Reports ◽

The Uk

Aims and methodTo review the deaths of children and young people who took their own life. We conducted a retrospective analysis of serious incident reports from a National Health Service trust and reviews by the child death overview panels of the local safeguarding children boards.ResultsWe identified 23 deaths, with annual rates varying considerably between local authorities and over time. Over half of the children (n = 13, 56%) were not known to specialist child and adolescent mental health services, with 11 having no contact with any agency at the time of their death. Hanging was the most common method (n = 20, 87%) and of these, half (n =11, 55%) were low-level hangings.Clinical implicationsTraining is required to improve awareness, recognition and the assessment of children at risk of taking their own life. Specialist child mental health services should directly assess plans or attempts at hanging and offer advice about the seriousness of attempting this. National data (by age) on children and young people who take their own life should be routinely published to inform clinical and preventive services.

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Looked after and Adopted Children: How Should Specialist CAMHS Be Involved?

Adoption & Fostering ◽

10.1177/030857591003400208 ◽

2010 ◽

Vol 34 (2) ◽

pp. 58-72 ◽

Cited By ~ 8

Author(s):

Pradeep Rao ◽

Alvina Ali ◽

Panos Vostanis

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Young People ◽

Health Services ◽

Mental Health Problems ◽

Service Planning ◽

Adopted Children ◽

Vulnerable Children ◽

Children And Young People ◽

Health And Social Care

Looked after children are at high risk of developing mental health problems and these are often complex and related to other needs and agency involvement. Consequently, there is increasing policy emphasis on the importance of joint service planning and implementation. In practice, however, the distinction between mental health needs, problems and disorders is not clearly defined. Therefore, there is considerable service variation, lack of models and consensus on which children and young people would benefit from specialist child and adolescent mental health services (CAMHS) input. Pradeep Rao, Alvina Ali and Panos Vostanis report on a study that aimed to compare the characteristics of looked after and adopted children referred to a designated CAMHS team, and to identify whether these fell within the perceived remit of specialist CAMHS. The referrals, over one year, were rated by an independent researcher using a checklist that contained details of the referrer, the child's placement and reason for referral, outcome and reasons for decisions. Children with indication of likely disorders were accepted, while there was less consistency on decisions related to attachment and behavioural problems, and the role of different agencies. Mental health and social care services for vulnerable children need jointly to develop clear care pathways, with definition of agency roles. The presence of behavioural and attachment problems per se should not justify referral to specialist CAMHS, which would depend on other concurrent mental health difficulties and risk factors involved. Implications for defining the role and components of mental health services for vulnerable children and young people are discussed.

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Recovery Star: validating user recovery

The Psychiatrist ◽

10.1192/pb.bp.111.034264 ◽

2012 ◽

Vol 36 (2) ◽

pp. 45-50 ◽

Cited By ~ 34

Author(s):

Geoff Dickens ◽

Judy Weleminsky ◽

Yetunde Onifade ◽

Philip Sugarman

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Internal Consistency ◽

Mental Health Problems ◽

Service Providers ◽

Mental Health Recovery ◽

Addictive Behaviour ◽

Health Service Providers ◽

The Uk

Aims and methodMental Health Recovery Star is a multifaceted 10-item outcomes measure and key-working tool that has been widely adopted by service providers in the UK. We aimed to explore its factorial validity, internal consistency and responsiveness. Recovery Star readings were conducted twice with 203 working-age adults with moderate to severe mental health problems attending a range of mental health services, and a third time with 113 of these individuals.ResultsMental Health Recovery Star had high internal consistency and appeared to measure an underlying recovery-oriented construct. Results supported a valid two-factor structure which explained 48% of variance in Recovery Star ratings data. Two Recovery Star items (‘relationships’ and ‘addictive behaviour’) did not load onto either factor. There was good statistically significant item responsiveness, and no obvious item redundancy. Data for a small number of variables were not normally distributed and the implications of this are discussed.Clinical implicationsRecovery Star has been received enthusiastically by both mental health service providers and service users. This study provides further evidence for its adoption in recovery-focused mental health services and indicates that items relating to addictive behaviour, responsibilities and work could be further developed in future.

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The divide between child and adult mental health services: points for debate

The British Journal of Psychiatry ◽

10.1192/bjp.bp.112.119206 ◽

2013 ◽

Vol 202 (s54) ◽

pp. s41-s44 ◽

Cited By ~ 30

Author(s):

Clare Lamb ◽

Margaret Murphy

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Young People ◽

Health Services ◽

Discussion Paper ◽

Adult Mental Health ◽

The Uk

SummaryThis discussion paper outlines our personal views for debate on some of the complexities inherent in the crucial task of improving mental health services for young people in the UK.

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Mapping UK mental health services for adults with attention-deficit/hyperactivity disorder: national survey with comparison of reporting between three stakeholder groups

BJPsych Open ◽

10.1192/bjo.2020.65 ◽

2020 ◽

Vol 6 (4) ◽

Author(s):

Anna Price ◽

Astrid Janssens ◽

Tamsin Newlove-Delgado ◽

Helen Eke ◽

Moli Paul ◽

...

Keyword(s):

Mental Health ◽

Attention Deficit Hyperactivity Disorder ◽

Mental Health Services ◽

Young People ◽

Health Services ◽

Attention Deficit ◽

Full Range ◽

Hyperactivity Disorder ◽

Stakeholder Groups ◽

The Uk

Background UK clinical guidelines recommend treatment of attention-deficit hyperactivity disorder (ADHD) in adults by suitably qualified clinical teams. However, young people with ADHD attempting the transition from children's to adults’ services experience considerable difficulties in accessing care. Aims To map the mental health services in the UK for adults who have ADHD and compare the reports of key stakeholders (people with ADHD and their carers, health workers, service commissioners). Method A survey about the existence and extent of service provision for adults with ADHD was distributed online and via national organisations (e.g. Royal College of Psychiatrists, the ADHD Foundation). Freedom of information requests were sent to commissioners. Descriptive analysis was used to compare reports from the different stakeholders. Results A total of 294 unique services were identified by 2686 respondents. Of these, 44 (15%) were dedicated adult ADHD services and 99 (34%) were generic adult mental health services. Only 12 dedicated services (27%) provided the full range of treatments recommended by the National Institute for Health and Care Excellence. Only half of the dedicated services (55%) and a minority of other services (7%) were reported by all stakeholder groups (P < 0.001, Fisher's exact test). Conclusions There is geographical variation in the provision of NHS services for adults with ADHD across the UK, as well as limited availability of treatments in the available services. Differences between stakeholder reports raise questions about equitable access. With increasing numbers of young people with ADHD graduating from children's services, developing evidence-based accessible models of care for adults with ADHD remains an urgent policy and commissioning priority.

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Incidence of anorexia nervosa in young people in the UK and Ireland: a national surveillance study

BMJ Open ◽

10.1136/bmjopen-2018-027339 ◽

2019 ◽

Vol 9 (10) ◽

pp. e027339 ◽

Cited By ~ 2

Author(s):

Hristina Petkova ◽

Mima Simic ◽

Dasha Nicholls ◽

Tamsin Ford ◽

A Matthew Prina ◽

...

Keyword(s):

Mental Health ◽

Anorexia Nervosa ◽

Mental Health Services ◽

Young People ◽

Health Services ◽

Young Women ◽

Adolescent Mental Health ◽

Child And Adolescent ◽

Surveillance Study ◽

The Uk

ObjectivesThis study aimed to estimate the incidence of DSM5 anorexia nervosa in young people in contact with child and adolescent mental health services in the UK and Ireland.DesignObservational, surveillance study, using the Child and Adolescent Psychiatry Surveillance System, involving monthly reporting by child and adolescent psychiatrists between 1st February 2015 and 30th September 2015.SettingThe study was based in the UK and Ireland.ParticipantsClinician-reported data on young people aged 8–17 in contact with child and adolescent mental health services for a first episode of anorexia nervosa.Main outcome measuresAnnual incidence rates (IRs) estimated as confirmed new cases per 100 000 population at risk.Results305 incident cases of anorexia nervosa were reported over the 8-month surveillance period and assessed as eligible for inclusion. The majority were young women (91%), from England (70%) and of white ethnicity (92%). Mean age was 14.6 years (±1.66) and mean percentage of median expected body mass index for age and sex was 83.23% (±10.99%). The overall IR, adjusted for missing data, was estimated to be 13.68 per 100 000 population (95% CI 12.88 to 14.52), with rates of 25.66 (95% CI 24.09 to 27.30) for young women and 2.28 (95% CI 1.84 to 2.79) for young men. Incidence increased steadily with age, peaking at 15 (57.77, 95% CI 50.41 to 65.90) for young women and 16 (5.14, 95% CI 3.20 to 7.83) for young men. Comparison with earlier estimates suggests IRs for children aged 12 and under have increased over the last 10 years.ConclusionThese results provide new estimates of the incidence of anorexia nervosa in young people. Service providers and commissioners should consider evidence to suggest an increase in incidence in younger children.Trial registration numberISRCTN12676087.

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