Community paediatricians’ experience of joint working with child and adolescent mental health services: findings from a British national survey

Abstract

ObjectivesChildren and young people (CYP) presenting to paediatric or child and adolescent mental health services (CAMHS) often have needs spanning medical and psychiatric diagnoses. However, joint working between paediatrics and CAMHS remains limited. We surveyed community paediatricians in the UK to inform better strategies to improve joint working with CAMHS.MethodsWe conducted an online survey of community paediatricians through the British Association for Community Child Health (BACCH) on how much joint working they experienced with CAMHS, any hindrances to more collaborative working, and the impact on service users and service provision. This paper is based on thematic analysis of 327 free-text comments by paediatricians.ResultsA total of 245 community paediatricians responded to the survey (22% of BACCH members). However, some responses were made on behalf of teams rather than for individual paediatricians. The following were the key themes identified: a strong support for joint working between community paediatrics and CAMHS; an acknowledgement that current levels of joint working were limited; the main barriers to joint working were splintered commissioning and service structures (eg, where integrated care systems fund different providers to meet overlapping children’s health needs); and the most commonly reported negative impact of non-joint working was severely limited access to CAMHS for CYP judged by paediatricians to require mental health support, particularly those with autism spectrum disorder.ConclusionThere is very limited joint working between community paediatrics and CAMHS in the UK, which is associated with many adverse impacts on service users and providers. A prointegration strategy that includes joint commissioning of adequately funded paediatric and CAMHS services that are colocated and within the same health management organisations is crucial to improving joint working between paediatrics and CAMHS.

How clinical psychologists respond to child safeguarding dilemmas: A qualitative study

“…Several studies with other professionals have noted limitations with the CAMHS model and commissioning practices particularly pertaining to diagnostically oriented pathways, unclear eligibility criteria and long waiting times (e.g., Ani et al, 2022; Coughlan et al, 2022; Godar, 2017). In general, there was a sense that psychologists in this study were cognisant and sympathetic to these critiques of CAMHS.…”

“…Child safeguarding in CAMHS is likely further complicated by a range of service‐level factors related to the existing CAMHS model, such as issues with inequalities in patient access (Griffin et al, 2022), lengthy waiting times (The Lancet., 2020) and unclear eligibility criteria (Ani et al, 2022). To date, there is a paucity of qualitative work examining how clinical psychologists working in this context reason about child safeguarding issues.…”

Commentary: Bringing together lived experience, clinical and research expertise – a commentary on the May 2022 debate (should CAMH professionals be diagnosing personality disorder in adolescence?)

“…CAMHS are currently not adequately meeting the needs of many young people (Ani, Ayyash, & Ogundele, 2022; Scottish Association for Mental Health, 2017; All-Party Parliamentary Group on Suicide and Self-Harm Prevention, 2020; Young Minds, 2018) but the causal link with a 'lack' of PD diagnosis has not been evidenced. We do know, however, that diagnosis does not necessarily equal treatment and can in fact lead to 'off-rolling', denial of care and iatrogenic harm (Wrenaves, 2020).…”