CAMHS in a Time of Austerity

Mind Uncut (no relation to the charity Mind) asked me to comment on the effect of the public sector cuts on CAMHS, so here goes.

As I mentioned last week, the most vulnerable jobs for the chop are those that are seen as highly specialist. Say, a systemic and family psychotherapist or an eating disorders nurse specialist. It’s more attractive to hire a jack-of-all-trades generalist – say, a CPN or a clinical psychologist. Patients can still be seen by those clinicians, but obviously there’s a drop in the level of expertise available. Remember, that’s not just expertise in terms of what can be offered to patients and their families, but also of who the generalists can turn to for advice if they get stuck.

When people leave their jobs, there’s a nervous wait to see whether the post will be re-advertised, or just disappear into the ether. If it is re-advertised, sometimes it will be at a lower pay band – say, band 6 instead of band 7. Sometimes this can result in the post not being filled because those with the skills to apply for the job have no incentive to do so. Why take on more responsibility if they’re not going to pay you any more?

As the cuts bite deeper, there’s more pressure to stick to a narrower definition of who CAMHS can offer a service to, and to do more signposting to other services. A child has a mentally ill mother – could they be seen by a young carers service instead? Somebody just wants talking therapies – why not point them to a school counsellor? Which is fine until you remember that all those other services are also dealing with shrinking budgets.

With increasing pressure to do more signposting, there’s more risk of services playing pass-the-parcel with their clients. This tends to happen regularly between CAMHS and social services. CAMHS insist it’s a child-in-need issue. Social services say no it’s not, it’s a mental health issue. The two services argue, letters go back and forth, and the child is left waiting for somebody to provide an actual service.

Occasionally we hear that we’re supposed to do more with less. I suspect in reality we may well just wind up doing less.

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