Child and Adolescent Mental Health (CAMHs) for children and young people with learning disabilities (or lack of them): An update

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Child and Adolescent Mental Health (CAMHs) for
children and young people with learning
disabilities (or lack of them) An update

• Sarah H Bernard
• Consultant Psychiatrist
• The Michael Rutter Centre

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Overview

• The past
• What has changed?
• What else needs to change?
• How can a highly skilled, effective, evidenced
  based mental health service for children and
  young people with LD be provided?

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Background

• Biblical times infanticide..
• Society became more caring..
• Asylum
• Education for all.MHA.NHS
• Move from institutions to community care
• De-medicalization
• Child 1st approach (NSF)

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What we know

• Children with LD
• Are at an increased risk of developing
  behavioural/mental health problems
• Are more likely to have co-morbidities
• Are more likely to have aversive psychosocial
  circumstances
• Are less likely to receive a service

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Recent Developments

• CSIP
• Proxy target
• Program of activities
• Increase in provision
• But.time of cuts, changes to commissioning.

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Current situation (London)

• Child 1st model
• EI services being promoted
• CAMHS vs PND/community paeds
• IQ lottery
• Variable assessments
• Lack of resources for intervention

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What do we need?

• Services for all
• Early identification
• Awareness of diagnostic overshadowing
• Appropriate assessments which inform intervention
• Effective liaison with education/social care

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How might services be delivered?

• Identifiable care pathway
• Adequate resources
• Appropriate environment
• Skilled team
• Community based provision
• Access to emergency provision
• IP beds????

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Assessment

• Comprehensive
• Involvement of family/carers
• Involvement of education/social care
• Psychometrics
• ASD assessment
• Access to paediatricians, paediatric
  neurologists, genetics..

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Intervention

• Behavioural
• Group work
• Medication
• Psychoeducation
• Home, school, respite

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Also

• Safeguarding
• Medicolegal work
• Transition
• Training

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What are the Pitfalls?!

• Unclear service remit
• Restrictions from commissioners
• Gaps in service
• Lack of planning
• Lack of respite
• Inadequate provision of care pathways for
  emergencies/crises

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Good Practice

• Sally. 5yr old. Moderate LD.
• Recently started at MLD primary school
• Increasingly distressed. Sleep disrupted. Mild
  SIB
• Ref to CAMHS. Observed at home and school.
• Parents interviewed
• Sally interviewed
• Psychometry.
• ADI
• Genetics
• Outcome to discuss

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Less Good Practice

• Sally. 5yr old. Moderate LD.
• Recently started at MLD primary school
• Increasingly distressed. Sleep disrupted. Mild
  SIB
• Ref to CAMHS.
• CAMHS are not commissioned to see children at MLD
  schools
• Delays.then passed to education psychfamily
  advised about how to manage Sally although not
  observed at home/school.
• Sally increasingly distressed. Escalation of SIB
  with lacerations
• Poor sleep, family exhausted.
• Ref back to CAMHSpossible depression..
• Still not seen.

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A Vision for the Future

• Comprehensive services for all children
• Timely assessments and interventions
• No discrimination
• Effective, respectful multiagency working