Tag Archives: cuts

But At Least the Bins Are Being Emptied

People with mental health problems being tossed to the wolves by welfare reform.

The NHS hurtling into a cash crisis.

Social care services slashed in Kent.

A thousand Navy personnel handed their P45s.

Maternity units are becoming even more understaffed than they already are.

But at least the government is making sure bins get emptied weekly instead of fortnightly.

Glad to hear that priorities still matter.

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The Cuts Begin to Bite

We hear the talk in the corridors and in team meetings. From speaking to colleagues in other NHS trusts, they’re hearing the same talk in their own workplaces.

Talk of recruitment freezes, of posts being deleted when people quit, constant memos offering voluntary early retirement schemes, offers to “buy” extra annual leave in exchange for a pay cut. No talk of actual redundancies…yet.

In the run-up to the general election we heard lots of nice-sounding manifesto pledges to protect the NHS from the public sector cuts. In reality, “protect” seems to mean “a bit less awful”.

Social services? They’re being hit worse than we are. Ditto voluntary agencies. Likewise education.

There’s a real sense at the moment that the cuts are starting to kick in. We’re going from hearing the headlines about it to actually seeing services shrinking or disappearing. My guess is that this is just the start.

Expect to see more headlines in the coming months of lengthening waiting lists for treatment. Of services that just aren’t there any more. Maybe the odd Baby P or two that got missed by already-overstretched child protection services being stretched even further.

We’re in for a bumpy ride.

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.

Retreat into the Medical Model

Like just about everywhere else in the public sector, we’re feeling the effects of the cuts. Jobs are having a nasty habit of not getting re-advertised when people leave.

Particularly vulnerable to the cuts are the psychotherapists – psychodynamic therapists, family therapists, art therapists, play therapists. There aren’t many of them employed in CAMHS, but their influence extends beyond their numbers. I’ve had some fascinating conversations with our psychodynamic therapist who keeps “accidentally” leaving papers on attachment theory on my desk. The opportunity to co-work with systemic and family therapists has genuinely transformed the way I conduct my clinical practice. They don’t just change kids and families. They change their colleagues too.

We get a complex mix of cases coming through our doors. Kids with neurological disorders such as ADHD and autism. Kids who have been abused, neglected or traumatised. Young carers to physically or mentally ill parents. Families under enormous strain, or with tortuous family dynamics. Educational issues. Child in need/child protection issues. It can be a bewildering variety of problems. To navigate it requires an eclectic mix of clinical models in your toolbox – medical, psychosocial, cognitive-behavioural, systemic, psychodynamic.

In hard times, it seems to be the psychotherapists – with their specialist outlooks and long, arduous training – who are most likely to be for the chop. My worry is that as we retreat to a core of doctors, nurses, psychologists and social workers, we’ll also retreat into a more narrow view of what CAMHS is for and what it does. Possibly diminishing into simply a medication and CBT service.

Don’t get me wrong, I’m not anti-medical model. I’ve worked with plenty of kids who’ve genuinely benefited from a bit of methylphenidate or fluoxetine. I’m not anti-CBT either, though I don’t think it’s the panacea cure-all it’s sometimes touted as. But one of the reasons I chose to work in CAMHS is because of its wide mix of models. Seeing it become narrower before my eyes is something that worries me.