How We Engaged

We organised and facilitated an engagement meeting with voluntary sector providers and contacted a number of groups to arrange to engage with young people and parents to discuss their views of what worked, what needs to be better and what is needed for a new service delivery model for the Children and Adolescent Mental Health Service, (CAMHS) to improve services and outcomes for young people.

The Bolton CVS e – bulletin was sent to all those registered onto our database promoting the voluntary sector event, additional engagement opportunities arranged by CCG and offering to visit groups to engage with them on their experience of CAMHS.

Bolton CVS compiled a short questionnaire, Bolton CVS Engagement Team contacted a number of groupsdirectly to arrange an engagement visit but due to the short timescale and last minute cancellations we were only able to engage with The ‘Handful Group’and unable to engage with further groups. See Appendix One for groups that we contacted and the outcome. Despite the relatively low numbers who engaged those who did contribute provided significant and insightful input.

Who We Engaged With

Engagement with Voluntary Sector and Thrive Partners

29 representatives from the following organisations attended the engagement meeting:

Handful / Headspace
MHIST x 2 / Time 2 Talk mediation
Bolton CAMHS steering group / Home for Good Bolton
BAND x 5 / Bolton Interfaith Council
The Children’s Society / BWCT
Bolton CAMHS steering group / Fort Alice
Bolton Council / Bolton Lads and Girls Club x 2
Bolton LGBT+ / Lagans Foundation
Westhoughton Active Volunteer Enterprise / YMCA
Contour Homes / Emmaus
Bolton Unemployed Advice Centre x 2 / Birtenshaw x2

Handful – Engagement session

12 people attended (9 parents/carers and 3 young people). From the total 41 attendees at both engagement sessions 32 people completed the demographic forms from which the following information is taken

Gender / Age Range
Female / 19 / Under 16 / 2
Male / 13 / 16- 25 / 2
Ethnic Origin / 26 - 49 / 15
White British / 30 / 50 - 60 / 7
Asian/Asian British / 1 / 61 - 70 / 5
Other White / 1 / 71+ / 1

People’s Involvement with CAMHS

  • Parent of Child/Children who have received treatment from CAMHS
  • Child receiving treatment
  • Professional working with children and young people
  • Volunteer working with children and young people
  • Youth worker
  • Facilitator of support groups
  • Work in preventing self harm/suicide
  • Provider of mental health support services
  • Refer to CAMHS Service

People’s Personal Experience of CAMHS

Key Themes from those accessing the service

Professionals experienceof accessing CAMHS

  • Young People not meeting threshold of service
  • Limited engagement from CAMHS. Should be two way process with professionals.
  • Waiting list/accessing service is not always easy for young people and their families.
  • No services available for those who need it most.
  • The transition from child to adult services needs to be more effective. Need to ease into it.
  • High demand-low staff.
  • Schools are unaware of CAMHS - it is hard to be referred.
  • Won’t work with children who still are in abusive situations such as Domestic Abuse.
  • Children must be in crisis-serious self-harm or suicidal, psychosis in order to be offered the service.
  • No one knows what support is out there, this includes professionals.
  • Lots of referrals to other services from CAMHS as they are unable to offer support.
  • Representatives very keen to see evidence of how provider and service user engagement has shaped and influenced changes to service delivery.

What worked well when accessing CAMHS?

Staff

  • Once you have accessed the service young people receive great support from clinical staff.
  • Staff advocating well for them.
  • Some staff are brilliant, understanding, honest and approachable.
  • Welcoming and informative
  • Once known to services the support provided is quite easy to communicate & access.
  • When my daughter accessed CAMHS for panic attacks the lady who looked after my daughter did worry warrior sessions and was excellent with both my daughter and me. She understood us both and had us both up and running around to show my daughter how the body responded. She encouraged us both, telling me she loved our sessions as we both took part and as I had a former bad experience with CAHMS this was a refreshing change. Unfortunately, she left just after our final session.

Content of Sessions

  • Worry warriors should be taught in every school. I think it would help many young people as I also work in a primary school and I know this program would help prevent rather than cure.

What could have made the experience better? What was missing?

Waiting Times

  • Shorter waiting time, earlier intervention.
  • Open access for those who have been discharged from CAMHS
  • Long waiting times leads to a need for crisis intervention

Consistency of staff approach

  • Staff judgmental
  • Can be intimidating due to number of “professionals” in meetings with parents. Child not able to be as open as they would like to.
  • Less Medical Jargon used.
  • Less narrow minded staff - e.g. not all clients specific to one condition
  • More support and information about the progress.
  • Treating people as individuals. Not trying to fit cases into categories.

Choice of Type of Intervention

  • More holistic approach.
  • Not always black & white (complex cases don’t always fall under the ‘norm’)
  • Better provision for teenagers who are going through enough changes in their lives to be told to talk to a relative about what’s wrong with them “mentally” - they just don’t want to do it. . He then wouldn’t sit in group sessions due to sharing stuff so was discharged at a most vulnerable time in his life
  • Counseling services needed for children who may not need to be seen by CAMHS.
  • Focusing on needs and abilities of child/young person
  • Take whole family approach where possible

Improved Communication

  • Engaging with parents to find out what is needed/missing
  • Single Point of Contact – similar to One Point
  • Better sharing whilst considering data protection issues.
  • Medical, social and educational services and different organizations need to be more joined up and work together along with parents for the benefit of the children, young people and adults.
  • On line information and maybe outline of referral process. We would normally be referred back to the GP.
  • Information about voluntary organisations attached to CAMHS website would be useful.
  • Regular updates whilst on the waiting list
  • Improve communication between professionals and parents

Better Awareness

  • More awareness through engagement with the public.
  • More informal events.
  • Talking about mental health
  • Transparent criteria to access services.
  • All information to be made aware to the public for input/consultation.
  • More attendance – engaging through community events.
  • Self-referral for parents to be then further managed and directed.
  • Generalised mental health sessions in community, youth clubs etc.
  • More awareness in nursery, schools about ASD/ADHD
  • Less misrepresentation by the media causing fear. Ignorance in the general public.
  • Better education by the government and health professionals.
  • More use of social media particularly for children to access.
  • Phone app
  • Common set of resources
  • Better informed GPs

Earlier Intervention

  • Triage service before getting to CAMHS. Identifying what is needed sooner rather than waiting weeks – Might need only low level support.
  • Less criteria to get support.
  • Allow referrals before child is in crisis.
  • Need earlier intervention – prevention is better than cure
  • Referral process too tight, not given any leeway for issues that are not classed as serious enough.
  • What about before the Young Person is in crisis? what is available before they get to this point?

Improved Training

  • Better training for professionals which will lead to improved recognition.
  • Better recognition of various disabilities and early diagnosis.
  • More training for educational organization workers.
  • Start early - should be part of education within schools

Transition

  • Provision of a clear transition from child to adult services. We asked what happened to my son when he turned 16, how did adult services get involved, to be hit by a blank wall. My son ultimately went into crisis a year later and was told he couldn’t access CAMHS as he was over 16 but didn’t qualify for adult services.

Premises

  • Other premises that are not so formal.
  • Varies-dependent on child.
  • Several people aware of situations where children have been refused support because the child won’t attend CAMHS and CAMHS won’t come to the community.
  • Needs to be offered in several settings in different ways.
  • Where they feel safe and comfortable, somewhere familiar.
  • Community based relaxing setting, where staff are familiar and understanding about various conditions and the ways in which this affects the young people. The young people need to feel confident that they will be listened to and understood even when they are in extreme distress.

What We Need to Get Right

To Improve Mental Health Services for Young People

  • Non-judgmental to young person and family.
  • Person Centred – tailored to individual needs.
  • Clearer transition process to adult services. Should extend the age group from 16, ideally up to 25 within education, and health and care plans in school.
  • Clear pathway from early start at low level to complex needs/support.
  • More support for carers/parents/siblings
  • Peer support/ mentors/Child mentors
  • Redesign of whole service
  • Allocation of greater resources for staff and services
  • Accessibility to services and reduced waiting lists
  • Better communication (multi-disciplinary)
  • Wider offer of counseling services to children and young people
  • Early intervention. Be more proactive rather than reactive.
  • Better use of community services

What a Successful Model will look like – The Essential Ingredients

Appendix One – Groups Contacted:

Urban outreach Booked / cancelled /contacted them again a few times to rearrange, difficult to get YP/parents together

YMCA Booked/ cancelled/ flexibility offered to work around their availability, e.g., evening, weekend etc.

Heart lift Booked/Cancelled due to sickness

Bolton Employability: The 3 students who were present at Bolton Employability all had severe learning difficulties and could not understand the questions.

Brownlow College: No established relevant group.

Bolton Enterprise Centre: They did not think their clients would have experience of CAMHs.

BYPHS: Unable to confirm a time to conduct engagement within timescales

Various Children’s Centers: don’t have any groups of parents that have specifically attended CAMHS and the number of families who may have accessed CAMHS would be very low

Have weekly CAMHS session on a Monday but these are 1 to 1 appointments with Doctor Harrison from CAMHS that any consultation with these families would need to be done directly with CAMHS.

We also contacted following other groups but were unable to arrange visits to lack of availability or young people/parents not wishing to engage on this subject.

Bridge Water, Firewood School, Probation service, The Well, Healthy Schools, Fort Alice, Bolton Deaf Society Liver Park School