Developing CAMHS for Children and Adolescents with Learning Disability

Sarah Bernard

Consultant Psychiatrist

The Maudsley Hospital

National Services Framework – Children should be able to access a range of mental health services whether or not they have a developmental disability

Clinical Need/Lack of Services Risk factors

Epidemiological studies confirm increased risk of psychiatric/behavioural disorder

Co morbidity

Diagnostic overshadowing

Fewer protective factors

Long term disorders

Lack of Services

CAMHS mapping (London)

Approx 50% indicated lack of appropriate service provision

Lack of expertise Fragmented services Insufficient resources

THE PLAN

CSIP (DoH) – priority area Mapping exercise Proxy targets “Champions” identified Raise awareness/improve confidence Optimise existing provision

HOW WAS IT DONE?

Aimed at boroughs showing “red” “Champions” to lead (clinicians) Steering group (MDT) Series of conferences Toolkit Clinical skills tutor Master classes Evaluation

The Conferences

Aimed at Commissioners/managers CliniciansContent Theoretical overview Demonstration of need Assessment vs management Models of service

The Toolkit

Multi Author/MDT

Developing Mental Health Services for Children and Adolescents with Mental Health Problems and Learning Disability – A Toolkit for Clinicians

Eds Bernard and Turk RCPsych Publications 2009

FREE DOWNLOAD FROM RCPsych WEBSITE!

The Clinical Skills Tutor

Nursing background Band 8A Secondment 1 year To support service development across

London

FAILED; unable to appoint suitable person

The Master Classes

17 boroughs (of 33)

One day event

am- teaching

pm- consultation

Attended by MDT: 3-10 people

Teaching topics Service development Aetiology and syndromes Mental health assessment Psychopharmacology Legal and ethical issues Parents with LD The high risk patient Multi agency working

Complex cases with diagnostic/management issues Safeguarding Management of risk Family Functioning When to stop Role of IP services

CLEAR

Children with Learning disabilities Evaluation of Accessible Resources

National evaluation Ongoing Identification of appropriate outcomes to be

evaluated pose a challenge

What Next?

Some money still available! “Feel good” factor vs true benefit

More Master Classes? Road shows? “Help line”

Has this been worthwhile? PositivesValued by local servicesMore CAMHS-LD services being developedMore referrals to tier 4Toolkit:+ve reviews NegativesEvaluation not completedTier 3 services want more supportLack of “new” money

Conclusions

IQ lottery cannot continue

A comprehensive CAMHS must be truly comprehensive

Resources will be required in order to ensure needs met