Mental Health of Children & Adolescents: The work of the Child and Family Consultation Service

1. Mental Health of Children & Adolescents: The work of the Child and Family Consultation Service Dr. Joshua Westbury Consultant Child and Adolescent Psychiatrist Southend CFCS, South Essex Partnership NHS Trust July 2012

2. Introduction • All of you are here because you already have some interest in, and some knowledge or experience of mental health issues • Please ask questions • Please tell me what you think

3. Mental health issues faced by young people

4. Are young people just little adults? YES • Same species • Live in same place • Same body • Same language* • Accident and illness • Adults were once children *LOL NO • Developmental process • Biological differences • Attachment • Growth spurts • Puberty • Dependence on adults • Education • Responsibilities

5. Can a four year old be depressed?

6. Can a four year old be depressed? • Controversial cases in media • Depression is more than just unhappiness • Low mood that is persistent over time and doesn’t lift when circumstances change • Severe enough to affect thinking and biology – appetite, sleep, energy, concentration etc. • Emotional development in early life poorly understood but four is probably lower limit

7. When is it “just bad behaviour?” • Depression: can present with angry spells • Anxiety: can cause fight or flight behaviours • ADHD: not ‘bad’ behaviour but ‘impulsive’ • Obsessive-Compulsive Disorder, autism, tic disorders: repetitive behaviours • Alcohol and drugs • Situational response and mimicry • “Just bad behaviour”

8. “Isn’t it just bad parenting?” • Anorexia nervosa • Any family • Schizophrenia • Any family • Genetic factors • Environment factors • Autism • Any family • Genetic factors • ADHD • Any family • Genetic factors

9. The child SCHOOL FAMILY THE CHILD COMMUNITY

10. Examples of causes • Genes • Bereavements • Change of school • Bullying • Trauma • Loss • Social and family stress • Isolation • Alcohol and drugs • School exams • Physical illness • Being a child carer • Environment • No known cause

11. Impact of mental health issues • Pain and distress • Disability • Can be stressful for whole families • Impact on education • Impact on social development • “Missing out” • Accidental or non-accidental harm • Long term consequences

12. What helps? • Exercise and diet • Consistency, boundaries, encouragement • School and social circle • Listening! • Support for parents • Teams, clubs and societies • Therapies for individuals, groups and families • Medical interventions

13. Questions?

14. Child and Family Consultation Service

15. What is CFCS? • CFCS Child and Family Consultation Service • CAMHS Child and Adolescent Mental Health Service

16. Tiered care services • Tier 1 General Practice • Tier 2 Mental health workers in community settings PMHT Charity sector • Tier 3 Integrated generic mental health services e.g. CAMHS, CMHT • Tier 4 Inpatient services Highly specialized clinics e.g. eating disorders, Tourettes, OCD, autism

17. About CFCS • The purpose of tier 3 is to provide an integrated service to patients and families with complex difficulties • We are an outpatient clinic • We offer direct face to face work with the patient and their carers, provided by one or more clinicians • We provide carer support • We provide liaison and consultation to other services • We are multidisciplinary and can work using different approaches with the same family at the same time • We are not focussed on a single diagnosis or other type of problem, or a single philosophical approach

18. South Essex CFCS teams

19. Who works at CFCS • Child Psychiatrists • Clinical Psychologists • Social Workers • Mental Health Nurses • Family Therapists • Art Therapists • CAMHS Practitioners • Administrators

20. Referrals • GPs • Schools • Social Services • CAF • Single Gateway

21. Examples of presentations • Changes in behaviour • Changes in mood • Changes in eating • Developmental delay • Not attending school • Self harm

22. What do we offer? • General and specific assessments • Family support • Individual therapies • Medication • Family therapy • Groups

23. Working in the real world • We are a small team • One doctor • Five to six (FTE) therapy team • Covering a large area with a lot of needs • Part of a NHS Trust that spans South Essex, Bedfordshire and Luton • Commissioned to provide specific services

24. Working with other services • Links with Tier 2 and Tier 4 services • Therapist seconded to Paediatrics • Therapist seconded to Youth Offending team • Medical support to Early Intervention team • Medical support to Drug and Alcohol Service • Medical support to Learning Disability team • Joint work with Crisis /Home Treatment team • Social worker seconded to CFCS

25. Promoting recovery • Where are you now? • Where do you want to be? • How can we help you get there? • Shared expertise • Shared responsibility

26. Role in child protection • Same responsibilities as any agency working with children and families • Act on concerns or to prevent danger • Share information to prevent danger • Work with families to resolve issues • Maintain confidentiality • Ensure our staff are checked and trained

27. Risk management • We work with children who may present a risk to themselves or others • Sometimes a mental health issue can be a life threatening illness

28. Risk management • Suicidal behaviour • Impulsive behaviour • Self harm • Self neglect • Malnutrition, starvation • Social exclusion • Exclusion from school • Aggressive behaviour • Alcohol and drug use • Excessive cleaning • Absconsion • Disinhibition • Vulnerability to abuse

29. Risk management • This is a whole day’s topic in itself... • Assessing and making plans • Involving young person and their family • Working together with other agencies • Knowing who can and who can’t help • Taking “therapeutic risks” • Risk is never zero: but it is our job to help manage risk as far as it is possible to do so

30. Questions?