RQIA Independent Review of Child and Adolescent Mental Health ...


RQIA Independent Review of Child and Adolescent Mental Health ...

specialist CAMHS in some areas practiced as a generic team dealing with all CAMHS referrals coming into the service. This was

evident in the Northern, Southern and Western Trusts. Belfast Trust had a clearer interpretation of the role and function of Tier 3

CAMHS. It would be useful if there was a regional blueprint promoted at commissioning level, to reach a consensus across all

children’s services in order that greater consistency and clarity is achieved in relation to language, and approach to service

delivery model. The review team noted that underdevelopment of the tiered model was partly due to lack of resources.

The role of the Primary Mental Health worker (PMHW) is to provide training, advice, triage and prevent escalation of referrals. The

PMHW helps other professionals who have routine contact with children and young people who are at risk of developing mental

health problems. Bamford recommended that the role of the PMHW should be implemented and expanded.

Two trusts have developed the PMHW role. The Southern Trust has PMHWs however, the post holders have a caseload of young

people requiring ongoing clinical input. The Western Trust has PMHWs who work to the brief outlined above. However, they also

provide 8-10 sessions of therapeutic interventions and only refer to Tier 3 specialist CAMH services if longer term intervention is

deemed necessary. The referral coordinator in all trusts provides advice to referrers. The Belfast and Northern Trusts do not have

any PMHWs.

All trusts stated that they would like to develop the consultative role of the Primary Mental Health worker. All trusts indicated that

they are constrained by lack of investment and by the increasing demand for services which brings with it the need to deploy staff

in specialist assessment and treatment.

CAMHS have links with education services providing support, in educational settings with aspects of children and young people’s

learning and development. Three trusts (not Southern) have links with teams who provided a supporting role to CAMHS.

Two trusts are currently using the "Card Before You Leave" scheme for young people and adults. This is a new scheme

supported by the DHSSPS aimed at helping reduce the level of self harm and suicide used at the point of discharge from accident

and emergency departments and acute wards. The Southern Trust currently provides a direct emergency assessment by a

CAMHS practitioner to the young person in the accident and emergency department within 24 hours, during week days, weekends

and public holidays. Hence it is not recommended that any child or young person be sent home from the Southern Accident and

Emergency Departments if they require an emergency mental health assessment within 24 hours. Southern Trust arrangements

go further than the current "Card Before You Leave" scheme by providing a direct mental health assessment to children and young


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