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

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 TrustJuly 2012

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

Mental health issues faced by young people

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

Can a four year old be depressed?

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

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”

“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

FAMILY

The child

SCHOOL

THE CHILD

COMMUNITY

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

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

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

Questions?

Child and Family Consultation Service

What is CFCS?

• CFCS Child andFamily ConsultationService

• CAMHS Child and Adolescent MentalHealthService

Tiered care services

• Tier 1 General Practice• Tier 2 Mental health workers in

community settingsPMHTCharity sector

• Tier 3 Integrated generic mental health services e.g. CAMHS, CMHT

• Tier 4 Inpatient servicesHighly specialized clinics e.g. eating disorders, Tourettes, OCD, autism

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

South Essex CFCS teams

Who works at CFCS

• Child Psychiatrists• Clinical Psychologists• Social Workers• Mental Health Nurses• Family Therapists• Art Therapists• CAMHS Practitioners• Administrators

Referrals

• GPs• Schools• Social Services• CAF• Single Gateway

Examples of presentations

• Changes in behaviour• Changes in mood• Changes in eating• Developmental delay• Not attending school• Self harm

What do we offer?

• General and specific assessments• Family support• Individual therapies• Medication• Family therapy• Groups

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

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

Promoting recovery

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

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

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

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

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

Questions?