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Select committee inquiry

Children's and adolescent mental health and CAMHS

Closed

Health and Social Care Committee · Opened 13 February 2014 · Closed 15 July 2014

21 recommendations · 5 conclusions
Inquiry on parliament.uk ↗

What the inquiry looked at

“Inquiry into children’s and adolescent mental health and CAMHS (Child and Adolescent Mental Health). Among other things, the inquiry considers: the current state of CAMHS, including service provision, access and funding; trends in children’s and adolescent mental health, including the impact of bullying and of digital culture; and preventative action and public mental health.”

The committee's words, from the inquiry page on parliament.uk ↗.

What it found

In the committee's words, from the summary of 3rd Report - Children's and adolescents' mental health and CAMHS ↗

There are serious and deeply ingrained problems with the commissioning and provision of Children’s and adolescents’ mental health services. These run through the whole system from prevention and early intervention through to inpatient services for the most vulnerable young people.

The Committee draws conclusions and makes recommendations for action in the following areas:

Information

• The lack of reliable and up to date information about children's and adolescents' mental health and CAMHS means that those planning and running CAMHS services have been operating in a “fog”.

• Ensuring that commissioners, providers and policy makers have up-to-date information about children's and adolescents mental health must be a priority for the Department of Health/NHS England taskforce.

Early intervention

• Compelling arguments have been made to this inquiry that the focus of investment in CAMHS should be on early intervention–providing timely support to children and young people before mental health problems become entrenched and increase in severity, and preventing, wherever possible, the need for admission to inpatient services. However in many areas these are suffering from insecure or short term funding, or being cut altogether.

• Health and Wellbeing Boards, and the transfer of public health budgets to local authorities, both represent significant opportunities for health issues to receive higher priority within local authorities. We have been told of some areas where these opportunities are beginning to be exploited, but this is patchy and progress remains slow. We have also heard that in times of financial constraint, some local authorities do not consider CAMHS early intervention services as “core business”.

• We recommend that, given the importance of early intervention, the DH/NHS England task force should have an explicit remit to audit commissioning of early intervention services in local authorities, and to report on how best to improve incentives in this area. They should also look at the best mechanisms to provide stable, long term funding for early intervention services.

What the government said

The government responded on 10 February 2015.

Summary written by Accountability Index from the government's response.

The Government agrees that child and adolescent mental health support "falls short" and accepts the need to improve the system, pointing to a Taskforce report due in spring 2015, while stating that the Taskforce will not audit services.

  • On data, the Government "fully accepts" that up to date information is critical. It anticipates publishing findings of a new national prevalence survey in 2017 and will seek to commission such surveys regularly, "subject to future spending decisions".
  • On early intervention and service audits, the Government accepts its importance, but says the Taskforce "will therefore not conduct audits of services". It says evidence on investment will be taken into account in the Taskforce's work.
  • On police cells, the Government "strongly agrees" that routine use for children is not acceptable and is "currently considering the need for legislative change". Next steps on legislative change depend on a timetable, impact assessment and funding being agreed between partners.
  • On education in inpatient units, the Government agrees that children should have access to education on a par with mainstream provision, and states that in 2015 the Department of Education "will undertake an audit" of provision in residential CAMHS settings.

Read the government's response ↗ Read the report ↗ Report an error

How the inquiry ran

Each dot is a dated item listed on this page, from the inquiry's opening on 13 February 2014 to 10 February 2015. Written evidence is not charted: only the latest 50 submissions are listed here.

  1. Oral evidence 5 sessions
  2. Report 5 Nov 2014
  3. Government response 10 Feb 2015

What it recommended 21 recommendations · 5 conclusions

1There are serious and deeply ingrained problems with the commissioning and provision of Children’s and...
Recommended (the committee's words)
There are serious and deeply ingrained problems with the commissioning and provision of Children’s and adolescents’ Mental Health Services. These run through the whole system from prevention and early intervention through to inpatient services for the most vulnerable young people. We welcome the announcement of the joint NHS England /Department of Health Children and Young People’s Mental Health and Wellbeing Taskforce, as it endorses one of our central conclusions, that problems with CAMHS are broadly based and not simply confined to inpatient Tier 4 services. Many of the recommendations in this report are therefore directed towards this taskforce as it begins its work. In addition to this, we recommend that the taskforce takes full account of the wealth of information contained in the written submissions received by this inquiry, including, in particular, submissions from service users, from their parents and representatives, from individual clinicians working in CAMHS, from provider organisations and from commissioners. We plan to review the progress of the taskforce early in 2015.
2The Committee is deeply concerned that the most recent ONS data on children’s and young...
Recommended (the committee's words)
The Committee is deeply concerned that the most recent ONS data on children’s and young people’s mental health is now ten years old, as up-to-date information is essential for the safe and effective planning of health services. We welcome the Government’s commitment, made during the course of this inquiry, to fund a repeat of the ONS prevalence survey. It is essential that this survey is not a one-off, but is repeated on an ongoing basis. We recommend that the Department of Health/NHS England taskforce adds the issue of the quality of ongoing data to its terms of reference.
3Not only is there a lack of data on children and young people’s mental health,...
Recommended (the committee's words)
Not only is there a lack of data on children and young people’s mental health, but also a worrying lack of comprehensive and reliable information about children’s and adolescents’ mental health services, including referrals, access and expenditure. In the words of the Minister, CAMHS services have been operating in a “fog”, and efforts to improve data availability have been subject to delays. This is unacceptable. Ensuring that commissioners, providers and policy-makers have access to up-to-date information about all parts of CAMHS services–from early intervention up to inpatient services–is essential. We recommend that this is a priority for the Department of Health/NHS England taskforce.
4Whilst most attention has so far centred on problems in accessing inpatient treatment, compelling arguments...
Concluded (the committee's words)
Whilst most attention has so far centred on problems in accessing inpatient treatment, compelling arguments have been made to this inquiry that the focus of investment in CAMHS should be on early intervention–providing timely support to children and young people before mental health problems become entrenched and increase in severity, and preventing, wherever possible, the need for admission to Children's and adolescents' mental health and CAMHS 99 inpatient services. It is clearly unacceptable if a child or young person cannot access a Tier 4 service close to their home, but for every child in this position, a further question needs also to be asked - has everything possible been done to prevent that child from becoming so unwell that they needed admission to inpatient services? The evidence we have received suggests poor provision of lower tier services may be increasing the number of children and young people requiring admission to inpatient services. This situation must be addressed by the Taskforce.
5We recommend that, given the importance of early intervention, the DH/NHS England taskforce should have...
Recommended (the committee's words)
We recommend that, given the importance of early intervention, the DH/NHS England taskforce should have an explicit remit to audit commissioning of early intervention services in local authorities, and to report on how best to improve incentives in this area. They should also look at the best mechanisms to provide stable, long term funding for early intervention services including those provided by voluntary sector partners.
6Whilst demand for mental health services for children and adolescents appears to be rising, many...
Recommended (the committee's words)
Whilst demand for mental health services for children and adolescents appears to be rising, many CCGs report having frozen or cut their budgets. CCGs have the power to determine their own local priorities, but we are concerned that insufficient priority is being given to children and young people’s mental health. We recommend that NHS England and the Department of Health monitor and increase spending levels on CAMHS until we can be assured that CAMHS services in all areas are meeting an acceptable standard. We welcome recent funding announcements for mental health services but we remain concerned and recommend that our successor committee reviews progress in this area.
7Commissioners of CAMHS services undoubtedly face a difficult task in collaborating across a complex web...
Recommended (the committee's words)
Commissioners of CAMHS services undoubtedly face a difficult task in collaborating across a complex web of other commissioners, and overseeing a varied patchwork of different types of providers to attempt to commission a seamless CAMHS service. They also face challenges in securing sufficient funding for this sadly de-prioritised service. However, CCGs hold ultimate responsibility for commissioning community CAMHS services, and we feel that there is a clear need for CAMHS commissioners to be given further monitoring and support from NHS England to address the variations in investment and standards that submissions to this inquiry have described. We recommend NHS England provides an action plan detailing how it plans to do this.
8We heard from witnesses that national service specifications are required, to set out minimum acceptable...
Recommended (the committee's words)
We heard from witnesses that national service specifications are required, to set out minimum acceptable levels of community CAMHS services, and we understand that Tier 2 and 3 service specifications are now being developed. We recommend that these specifications should set out what reasonable services should be expected to provide. They should cover specific clinical areas including ASDs, perinatal mental health, and eating disorders, as well services which currently fall between the Tiers, including out-of-hours, outreach and paediatric liaison. We recommend that the 100 Children's and adolescents' mental health and CAMHS taskforce should carry out and publish an audit of whether services are meeting these minimum standards.
9In addition to the universal concerns expressed about CAMHS services, we also received written submissions...
Recommended (the committee's words)
In addition to the universal concerns expressed about CAMHS services, we also received written submissions highlighting problems with CAMHS services being experienced by children and young people suffering from particular conditions, or from especially vulnerable groups of society. Specific conditions included OCD, ASDs, ADHD and Eating disorders; vulnerable groups included children and young people in the care system, and those who have been adopted or fostered; homeless young people, asylum seekers and recent immigrants; lesbian, gay, bisexual and transgender young people; and bereaved children and young people. The breadth of different conditions and different populations covered in our written submissions is indicative of the complexity but also the importance of the task facing CAMHS services. This inquiry does not have the scope to consider all of these issues individually, but again we recommend that the Department of Health/NHS England taskforce takes full account of the submissions we have received, and the wealth of information they contain.
10There is unacceptable variation in the provision of perinatal mental health services, and we recommend...
Recommended (the committee's words)
There is unacceptable variation in the provision of perinatal mental health services, and we recommend this is addressed urgently. Service specifications should make clear that these services must be available in every area.
11It is wholly unacceptable that so many children and young people suffering a mental health...
Concluded (the committee's words)
It is wholly unacceptable that so many children and young people suffering a mental health crisis face detention under s136 of the Mental Health Act in police cells rather than in an appropriate place of safety. Such a situation would be unthinkable for children experiencing a crisis in their physical health because of a lack of an appropriate hospital bed and it should be regarded as a ‘never event’ for those in mental health crisis. In responding to this report we expect the Department of Health to be explicit in setting out how this practice will be eradicated.
12Written submissions to this inquiry have described a situation where despite the move to national...
Concluded (the committee's words)
Written submissions to this inquiry have described a situation where despite the move to national commissioning over a year ago, NHS England has yet to ‘take control’ of the inpatient commissioning process, with poor planning, lack of co- ordination, and inadequate communication with local providers and commissioners. While many of the difficulties NHS England is now seeking to address may be a legacy from previous arrangements, it has not, in our view, sufficiently prioritised these problems. We note that in addition to the new capacity that is being funded, NHS England is recruiting more case managers to give them better control over the commissioning process, but we are disappointed that during its first year as a commissioner of inpatient services, many of the perceived benefits of national planning have not been realised, and NHS England has instead presided over a system which has resulted in children being sent hundreds of miles to access care. We intend to review NHS England’s progress addressing these problems early in
13As a first step in improving its commissioning of Tier 4 services, we recommend that...
Recommended (the committee's words)
As a first step in improving its commissioning of Tier 4 services, we recommend that NHS England should introduce a centralised inquiry system for referrers and patients, of the type that is already in operation for paediatric intensive care services.
14We believe that education is crucial to protecting the life chances of the especially vulnerable...
Recommended (the committee's words)
We believe that education is crucial to protecting the life chances of the especially vulnerable young people who need inpatient treatment for mental health problems, particularly as in some cases these admissions may last many months. It is essential that clear standards are set for the quality of education provision in inpatient units, and that there is clear accountability and ownership for ensuring that these standards are upheld. As a first step towards this, we recommend that OFSTED, DFE and NHS England conduct a full audit of educational provision within inpatient units as a matter of urgency.
15It is clear from the evidence we have received that commissioning extra inpatient capacity alone...
Concluded (the committee's words)
It is clear from the evidence we have received that commissioning extra inpatient capacity alone will not be enough to alleviate the current problems being experienced in relation to Tier 4 services. Perverse incentives in the commissioning and funding arrangements for CAMHS need to be eliminated to ensure that commissioners invest in Tier 3.5 services which may have significant value in minimising the need for inpatient admission and in reducing length of stay. The Department of Health and NHS England must act urgently to ensure that by the end of this year all areas have clear mechanisms to access funding to develop such services in their local area, where this is appropriate.
16Looking beyond this, we agree with the Minister that the current fragmented commissioning arrangements make...
Recommended (the committee's words)
Looking beyond this, we agree with the Minister that the current fragmented commissioning arrangements make “no sense”, and are “dysfunctional”. A key responsibility for the newly set up Taskforce will be to determine a way in which commissioning can be sufficiently integrated to allow rational and effective use of resources in this area, which incentivises early intervention. The Government has recently announced extra funding for early intervention in psychosis services and crisis care, which could include liaison services in A&E departments, and crisis resolution home treatment teams. We recommend that the Government ensures that a substantial proportion of this new funding is directed towards services for under- 18s.
17We consider that awareness of mental health issues, including their relationship to normal child development,...
Recommended (the committee's words)
We consider that awareness of mental health issues, including their relationship to normal child development, conduct issues, and impact on education, is important and we recommend the Department for Education looks to including a mandatory module on mental health in initial teacher training, and should include mental health modules as part of ongoing professional development in schools for both teaching and support staff.
18.
Recommended (the committee's words)
. We recommend that the Department for Education conducts an audit of mental health provision and support within schools, looking at how well the guidance issued to schools this year has been implemented, what further support may be needed, and highlighting examples of best practice. OFSTED should also make routine assessments of mental health provision in schools.
19We recommend that the Department for Education consult with young people, including those with experience...
Recommended (the committee's words)
We recommend that the Department for Education consult with young people, including those with experience of mental health issues, to ensure mental health within the curriculum is developed in a way that best meets their needs.
20We have not investigated the issue of internet regulation in depth.
Recommended (the committee's words)
We have not investigated the issue of internet regulation in depth. However, in our view sufficient concern has been raised to warrant a more detailed consideration of the impact of the internet on children’s and young people’s mental health, and in particular the use of social media and the impact of pro-anorexia, self-harm and other inappropriate websites, and we recommend that the Department of Health/NHS England taskforce should take this forward in conjunction with other relevant bodies, including the UK Council for Child Internet Safety.
21We recommend that the Department of Health/NHS England taskforce should also investigate and report on...
Recommended (the committee's words)
We recommend that the Department of Health/NHS England taskforce should also investigate and report on the most effective ways of supporting CAMHS providers to do this.
22We recommend that as part of its review of mental health education in schools, the...
Recommended (the committee's words)
We recommend that as part of its review of mental health education in schools, the Department for Education should ensure that links between online safety, cyberbullying, and maintaining and protecting emotional wellbeing and mental health are fully articulated.
23We recommend clear pathways are identified for young people to report that they have been...
Recommended (the committee's words)
We recommend clear pathways are identified for young people to report that they have been sent indecent images of other children or young people, and that support is provided for those who have been victims of image sharing. Pathways should also be established for children and young people who have experienced bullying, harassment and threats of violence.
24We ask Health Education England, together with the GMC and relevant Royal Colleges, to provide...
Concluded (the committee's words)
We ask Health Education England, together with the GMC and relevant Royal Colleges, to provide us with a full update on their plans for GP training in children’s and adolescents’ mental health.
25It is clear that there are currently insufficient levers in place at national level to...
Recommended (the committee's words)
It is clear that there are currently insufficient levers in place at national level to drive essential improvements to CAMHS services. These have received insufficient scrutiny from CQC and we look to review progress in this area following their new inspection regime. The Minister has argued that waiting time targets will improve CAMHS services but we recommend a broader approach that also focuses on Children's and adolescents' mental health and CAMHS 103 improving outcomes for specific conditions in children’s and adolescents’ mental health.
26We recommend the development, implementation and monitoring of national minimum service specifications, together with an...
Recommended (the committee's words)
We recommend the development, implementation and monitoring of national minimum service specifications, together with an audit of spending on CAMHS. We recommend that the Department of Health/NHS England taskforce look to remove the perverse incentives that act as a barrier to Tier 3.5 service development and ensure investment in early intervention services. There must be a clear national policy directive for CAMHS, underpinned by adequate funding.

Evidence

Oral evidence sessions 5

Written evidence 162 submissions

Listed here by submitter; the evidence itself is on Parliament's website. Showing the latest 50 of 162 recorded submissions. Browse the inquiry on Parliament.

  • 14 Nov 2014West Midlands Camhs Learning Disability Psychiatry Peer GroupCMH0106Full text not held
  • 10 Nov 2014Northern, Eastern & Western Devon Clinical Commissioning GroupCMH0198Full text not held
  • 10 Nov 2014UkcpCMH0084Full text not held
  • 29 Oct 2014Howard LeagueCMH0232Full text not held
  • 29 Oct 2014NHS EnglandCMH0233Full text not held
  • 29 Oct 2014Department Of Health - Rt Hon Norman Lamb MPCMH0234Full text not held
  • 29 Oct 2014CQCCMH0235Full text not held
  • 29 Oct 2014Department For EducationCMH0236Full text not held
  • 29 Oct 2014Royal College Of NursingCMH0223Full text not held
  • 29 Oct 2014South London And Maudsley NHS Foundation TrustCMH0227Full text not held
  • 29 Oct 2014The Beat Bullying GroupCMH0228Full text not held
  • 29 Oct 2014Royal College Of PsychiatristsCMH0229Full text not held
  • 29 Oct 2014Oxford Health Nhs Foundation TrustCMH0230Full text not held
  • 29 Oct 2014Adoption Leadership BoardCMH0231Full text not held
  • 16 Oct 2014Personal experiences of CAMHSCMH0237Full text not held
  • 6 Oct 2014North East London Nhs Foundation Trust Mental Health ServicesCMH0221Full text not held
  • 21 Aug 2014Child Outcomes Research ConsortiumCMH0141Full text not held
  • 9 Jul 2014Tavistock And Portman Nhs Foundation TrustCMH0074Full text not held
  • 18 Jun 2014South Staffordshire & Shropshire Healthcare Nhs Foundation TrustCMH0171Full text not held
  • 14 May 2014West Sussex County CouncilCMH0219Full text not held
  • 14 May 2014Care Quality CommissionCMH0218Full text not held
  • 14 May 2014Wave Trust (On Behalf Of The Appg For Conception To Age 2 - The First 1001 DaysCMH0214Full text not held
  • 14 May 2014North West London Commissioning Support UnitCMH0211Full text not held
  • 14 May 2014The Association Of Directors Of Children's Services (Adcs) LtdCMH0210Full text not held
  • 14 May 2014Dr Gwen AdsheadCMH0208Full text not held
  • 14 May 2014Independent Mental Health Services AllianceCMH0207Full text not held
  • 14 May 2014Foxhills SchoolsCMH0203Full text not held
  • 14 May 2014Sussex Partnership Nhs Foundation TrustCMH0200Full text not held
  • 14 May 2014Andrew GregoryCMH0199Full text not held
  • 14 May 2014Leicester City Psychology ServiceCMH0197Full text not held
  • 14 May 2014Sheffield CamhsCMH0195Full text not held
  • 14 May 2014BrookCMH0194Full text not held
  • 14 May 2014Derbyshire County Council Children & Younger Adults Dept.CMH0192Full text not held
  • 14 May 2014Derbyshire Healthcare Nhs Foundation TrustCMH0191Full text not held
  • 14 May 2014Cornwall Partnership Foundation Nhs TrustCMH0189Full text not held
  • 14 May 2014Meningitis Research FoundationCMH0187Full text not held
  • 14 May 2014Marie JohnsonCMH0186Full text not held
  • 14 May 2014Wiltshire Parent Carer CouncilCMH0184Full text not held
  • 14 May 2014Cyp Iapt North East CollaborativeCMH0183Full text not held
  • 14 May 2014Warwickshire County CouncilCMH0182Full text not held
  • 14 May 2014Cfcs/Camhs East London Nhs Foundation TrustCMH0180Full text not held
  • 14 May 2014The Huntercombe GroupCMH0179Full text not held
  • 14 May 2014Cernis LimitedCMH0178Full text not held
  • 14 May 20144ChildrenCMH0176Full text not held
  • 14 May 2014Royal College Of Paediatrics And Child HealthCMH0174Full text not held
  • 14 May 2014Sandwell Metropolitan Borough CouncilCMH0172Full text not held
  • 14 May 2014Tees, Esk And Wear Valleys Nhs Foundation TrustCMH0170Full text not held
  • 14 May 2014Cant Go Wont GoCMH0168Full text not held
  • 14 May 2014Walsall JcuCMH0167Full text not held
  • 14 May 2014Black Country Partnership Nhs Foundation TrustCMH0166Full text not held