Submission by the Tavistock Centre for Couple Relationships to the Health Committee Inquiry on CAMHS
The experience of clinicians associated with the Tavistock Centre for Couple Relationships working in CAMHS is that cases are becoming increasingly complex and high risk, which is placing particular pressures on all four tiers responsible for the delivery of child and adolescent mental health services.
While TCCR would readily acknowledge that the commissioning of CAMHS has always been seen as a complex and sophisticated task, given the multi-agency and multi-disciplinary environment that characterise these services, the many organisational and structural changes that have taken place within the NHS and Local Authorities over the years have done little to help retain and sustain commissioning expertise. In addition, the lack of centrally driven policy development, performance management and targeted funding together with funding reductions both as a result of the efficiency drive with the NHS and the reductions in local authority budgets are, we feel, to a large extent responsible for the current challenges and difficulties in service provision. It is difficult therefore to imagine that improvements in children’s mental health and psychological wellbeing and the services required to meet children’s needs will not require a reiteration of the importance of CAMHS by central government, backed up by a new national programme of service development that is adequately resourced and effectively performance managed.
In line with this new CAMH service development programme, TCCR believes that CAMH services should be re-oriented so that they incorporate a central focus on the parental couple relationship as well as on the identified child. Evidence clearly demonstrates that intervention programmes that focus on the inter-parental relationship have the potential to rectify the negative consequences of family stress, family conflict and family breakdown on children and parents, and help prevent the intergenerational transmission of factors that lead to disrupted family relationships and family breakdown.
A move in this direction was signalled by the Department for Education in 2013 when it awarded TCCR a grant to train senior CAMHS practitioners to be equipped to think about the couple/parental relationship (particularly in relation to the transition to parenthood, couple conflict, and the usefulness of mentalization-based techniques with such couples); this award was a clear acknowledgement by Government of the importance of the CAMHS workforce being able to address couple relationship issues in the work it undertakes. This is an ongoing programme of training that gives us some insight into the lack of competence in this area.
However, we have significant concerns about the quality of work currently being carried out by CAMH services where such an understanding has not been incorporated into frontline work. The failure to address parental couple relationship issues in those cases where the real locus of the problem lies with the couple relationship rather than the child (who is presenting the symptoms) include the symptoms in the identified child becoming worse, or the treatment effectively missing the point. We strongly urge the committee to address this aspect of CAMHS provision in the recommendations of their inquiry, and would point the committee to a summary of evidence regarding the links between parental couple conflict and children’s outcomes ( ) which may be informative in this regard.