Introduction
Nothing matters more to families than the health, welfare and future success of their children. Healthy children have more chance of becoming healthy adults, and much adult disease and many emotional and psychological difficulties may have their roots in childhood. For the first time, the demographic profile of England has changed, with a declining birth rate and more people living longer. Profound changes are occurring in our multicultural society with changes in the skills needed for employment and changes in family structure.
The term “CAMHS” (Child and Adolescent Mental Health Services) should be taken to mean any service provision whose aim is to meet the mental health and emotional well being of children and young people. A distinction can be drawn between CAMHS in its broadest sense, which includes services for whom this is an aspect of their work but whose primary role may be other, such as education or primary care services, and “specialist CAMHS” which refers to all those services for whom this is their prime role. Children and young people make up around one quarter of the total population of England. Their vulnerability and often their inability when young to articulate what they are feeling poses a challenge for all those involved in delivering health and social care services to meet their individual needs as effectively as for adult services. Every child will come into contact with some health or social care services, and these early experiences will influence their future attitudes and the use they make of these services.
In total, there are:
- 12 million children;
- 400,000 children in need;
- 59,700 Looked After Children;
- 320,000 disabled children;
- 600,000 live births a year;
- Approximately 1 million with mental health disorders.
CAMHS have historically been small, under-funded and fragmented. The new modernisation agenda for CAMHS and children’s services generally envisages substantial growth and change. The implementation of national guidance with its associated investment will be hindered by the difficulties in recruitment and retaining appropriately trained staff. These concerns will cut across Health, Education, SSD and all related services and have been highlighted with the development of multi agency strategies. Workforce planning is an extremely serious issue for child and adolescent mental health services. Specialist services for children with mental health problems and disorders need to be properly resourced with trained professionals and practitioners. There is currently a serious shortage of such professionals and an urgent need to train sufficient staff to deal with the complexity of children’s mental health problems. An adequate and competent workforce is fundamental to the successful delivery of The NHS Plan and the NSF. For certain staff groups, the predicted demand will outstrip the projected supply. If local funding and training capacity is available, increasing training places for these groups will go some way towards bridging the gap, but in its self is unlikely to be sufficient to meet demand.
Training more professional staff is a high priority, as is the retention of existing staff and recruiting staff. It is clear, however, that these initiatives will not be sufficient to meet demand. It is essential, therefore, to make best use of our highly trained professionals and, hence, to support them to work most effectively and efficiently. This requires existing and new staff to be flexible in reviewing and changing their roles. Furthermore, we should seek to recruit from a wider pool of the population into health and social care. We should draw on people without the present minimum qualifications and graduates in health and social sciences (for example, 13,000 psychology graduates are trained each year), who may not want to train in the traditional professions. In order to attract these people into the workforce and create career pathways, we must explore new roles to complement new service configurations.
Nearly every intervention set out in Every Child Matters and the Children’s NSF has implications for workforce. In order to improve outcomes for children and young people we require an adequately resourced, trained and motivated workforce. It is clear that across all of children’s services workforce capacity and capability is a significant issue with shortages and problems with retention being reported in many of the staff groups providing services to children. National support and guidance will be required to support the delivery of the Standards identified in these strategy documents, with local delivery based upon the development of an all-agency workforce, recruitment and retention strategies based upon an understanding of local population needs.
Information gathered suggests we face a number of strategic challenges. We need to ensure and articulate a shared vision for CAMHS across all agencies and organisations. National guidance is required to support local workforce design and planning. We need to explore new ways of working and the development of new roles within CAMHS if these better meet the needs of children and young people. Recruitment and Retention is a significant challenge, we need to recruit more people into the CAMHS workforce offering more flexible entry routes and build more rewarding careers to ensure retention of staff. To support the development of new models of practice, which are envisaged we will need to promote stronger leadership, management and commissioning and sustain these changes. Considerable work has been carried out nationally with regard to education, training and staff development within CAMHS, greater co-ordination of this is necessary to ensure that all those working with children and young people have the necessary knowledge, skills and competence required for the task they are required to do. It is clear that nationally there is a significant amount of good practice happening across the children’s workforce, effective ways of sharing the very best of current thinking and innovation will support service improvement and development.