‘Children’s mental health is far too important for it to be a Cinderella service’

What first drew you to a career in Psychology?

Something that sticks in my mind to this day is the MV Jupiter cruise liner disaster of 1988. It was a liner that sunk in Athens Harbour, and I remember listening to the accounts of the people on that ship, including British children and their teachers. I watched the TV and wondered how that experience would affect those people. It was intriguing that people could go through the same experience and respond differently, some developing mental health difficulties and some not. I think after that, I became interested in psychology.

In my teens, I remember writing to the BPS and asking for information from them… they sent me lots of different leaflets for different careers and I was immediately attracted to clinical psychology.

You mentioned thinking of the children on that boat: is this when you decided to work with children, or did that come later?

During my clinical training, I really became interested in working with children and families. I just felt it was a really good fit for me. I like working systemically and that's how it works in children's services. You look at the individual and use a child-centred approach whilst also seeing the importance of recognising the impact of the wider picture and how it interplays and influences the child. Working with children also lets you work more creatively and innovatively; it's looking at the person in front of you and thinking about how to modify and adapt to help them and maximise the impact of an intervention for them. When you work with a child, you have that longitudinal vision in mind. You consider their journey through life and the adult they become.

What do you mean by a longitudinal vision for children?

It's the idea of being able to help a child… helping them at an early stage means you can potentially break patterns, cycles and unhelpful behaviours. Doing this early maximises well-being in later life. Being involved in this process is incredibly valuable and satisfying, supporting a child to find a new path, to lead a life with greater well-being and enhanced experiences.

It sounds like you've always been passionate about working with children; what does your career path to CAMHS look like?

I completed my undergraduate in Manchester, before moving to London, where I worked as an assistant psychologist. I wanted to broaden my experiences so I worked across different specialist client groups. After that, I completed my clinical training at the Institute of Psychiatry. It was an amazing place to train and a fantastic three years. There was a real focus on the reflective scientist-practitioner model, and I just loved it. 

After my training, I felt confident and ready to start my career, it set me up professionally really well. Since then, I've always worked within children and family services, mostly in primary and secondary services. I've also worked in specialist CAMHS services and allied services with local authorities, like youth offending and SEN provision. Having that breadth and depth of experience has been incredibly helpful, especially when standing back and having a broad perspective from which to understand children's mental health provisions

When working across all those areas, has there been a particular one you've most enjoyed working in?

There hasn't been a particular area, but something I'm incredibly passionate about is recognising the importance of early identification of need and early intervention. I was involved in the 'Sure Start' programmes which were part of an important labour party initiative in 1997. The programmes looked to provide a range of support for young families within local communities. They provided a supportive holistic context for families to come to, to support children with their development, their physical and mental health, their emotional well-being and cognitive development. Getting it right in those early years is so important, especially for those most vulnerable.

Who do you mean by the most vulnerable?

It's the families in the most deprived wards, often where there are significant generational or social difficulties. The 'Sure Start' initiative was meant to support these people and make a difference. There were so many of these families that benefited, so many children that engaged and it's unfortunate that these programmes became children's centres and then many of them closed. This vital investment in young children and their families is now lost.

Why do you think the programmes didn't continue?

I think it's partly because it's difficult for the government and politicians to take the 'longitudinal view' that I mentioned earlier. To reap the success from these programmes you need to think long-term and realise you won't get quick results from the children of now, but you will from the adults of tomorrow. Financially, I think the 'Sure Start' programme and similar programmes are really good investments… but as I mentioned, I think governments find it difficult to commit to that long picture over several years.

So in an ideal world, if you could bring 'Sure Start' programmes back would you?

Yes, I definitely would. There has been lots of research over the years regarding children's services and it has provided some great policy documentation, but actually implementing it on the ground is a different story. We need to invest in the early years in terms of mental health and well-being, as well as in secondary care CAMHS. We need to put money into all of this, if all of children's services were comprehensively commissioned and resourced, CAMHS wouldn't be such a 'reactive-only' service.

So placing more emphasis on the child and child services would be a better approach?

Yes, and it's not just getting them support, it's getting them the right type of support. If we took on more commissioning and funding there'd potentially be less demand on adult services, as we know many difficulties faced by adults, often begin as mental health difficulties in childhood. We'd have less adults with mental health issues, less adults with addiction, more adults in work and more adults with better physical health. Unfortunately, CAMHS is sometimes referred to as a Cinderella service, which is such a shame. Children's mental health is far too important for this to be the case.

Can you explain what is meant by a Cinderella service?

It's about pots of money. If you think about Cinderella, she's at the bottom of the pile. Lots is expected of her and she's got very little. There has been such a high increase in demand on CAMHS meaning it's so overstretched and there's just not enough funding to resource it effectively to meet the need.

You mentioned the increasing demand on CAMHS. How different is the service now from when you started?

Well, as of two years ago, I no longer work in CAMHS. However, yes, from when I started til when I left, it was very different. When I first qualified, every Monday the team would meet and go through the previous week's referrals, we'd look at availability and we'd look at risk. You'd look at a child's presenting needs and challenges and match them to a clinician or service. Now, you simply can't do the matching process, there's too many referrals and not enough time. Entry is more streamlined than it was, as we have single point of access teams to review referrals and signpost them as appropriate for CAMHS, but because this is done outside, although it's streamlined, it can feel a little detached.

Would you say things have changed for the worse?

There's some great, great things that go on in CAMHS and there are some fantastic clinicians working in the service. There are people that work incredibly hard and do an amazing job and I've had the pleasure of working alongside those people. So there has been some good developments over the years, some national-led improvements that have built more consistency across services. A young person may come into the service on a pathway of care based off best practice guidelines, and that provides practitioners with a great framework to support their practice. It's a service that just needs more money, better and more comprehensive long-term commissioning.

Also, we need to think about skilling up the workforce and making sure we have a broader range of interventions and a broader scope of knowledge. It would be wonderful to have a service where every CAMH team across the country has a play therapist, a music therapist, art therapist, CBT therapist and family therapists. Having that range is so, so important…. it better meets the needs of the diverse group of children that require support.

Other than what you've mentioned, what do you think has changed for the better?

The things I've mentioned like pathways of care, more consistency and more training are all great. Practitioners now are encouraged to have more accountability and transparency and there are user-led initiatives where a practitioner works collaboratively with families. Overall, the service has some amazing pockets of work, it's just we need more consistency in that. We shouldn't have this 'postcode' lottery.

I also think there needs to be a recognition of the importance of mental health provisions in schools. There needs to be more consistent funding available for all schools to develop a more comprehensive mental health support system, allowing children to be better supported in an educational context. Some of the research I have undertaken in my past at the University of York, is with teachers who report feeling out of their depth when trying to support the children at school. Sometimes they're left with some really risky kids and they're struggling to get them into CAMHS. There needs to be better work done here in terms of strengthening and securing school provision. But there are other groups too that need additional support developed, such as those with speech and language difficutlies with mental health needs, those children who have experienced trauma and adversity and need specialist support.

CAMHS waitlists are also notoriously long – is there anything you think could be done to reduce them?

To be honest, I think commissioning those early intervention services would. There's a lot more we could do to catch and prevent difficulties early on before they become entrenched. There needs to be more done to develop more comprehensive support around CAMHS, so we can identify those who most need secondary care CAMHS and those young people who could be better supported within primary services. Ultimately, it all comes down to funding.

Having worked in CAMHS for so long, are there any fundamental beliefs or particular values that you think are at the centre of CAMHS?

Plenty of research has been undertaken to actually look into this, identifying the specific skills, competencies and knowledge that those working with children and young people should demonstrate. I remember an article that had asked children about the qualities and behaviours they wanted to see in CAMHS practitioners, it would be interesting for CAMHS to revisit these from time to time to help guide practice and provision. They were identifying things like talking in a way that helped the child understand, or being flexible and responsive to the child's individual needs, letting them make their own decisions with help and support, believing in them and asking CAMHS not to give up on them when things were complex and difficult.

People often say there are more children now with mental health difficulties or neurodivergence than there's ever been. Do you have any thoughts on this?

I think generally, there has been an increase in mental health difficulties for children and young people across the board; research shows us that children with SEN are at a much greater risk of developing mental health problems than non-SEN children. Also, the government has dedicated money into developing specific assessment services, such as those for ADHD or Autism, so perhaps more children are being referred for assessment than before. This often means however, that many children are being diagnosed without effective support and follow-up.

Overall, I just don't think there is a quick answer to why there are more children with these difficulties. It's very complex and multi-layered to unpack. We now have more knowledge on the breadth of spectrum of presenting challenges, and we understand more about how people can sometimes 'mask' their challenges, and we are more aware of gender differences in how individuals can present. Now I suppose we have more knowledge on the spectrum of presentations and challenges, now we know people can mask and we're aware of gender differences. Life maybe feels more complicated than it was 25 years ago, the presence of social media, its more stimulating and potentially invasive.

What do you think the public's opinion of CAMHS is, and are you happy with it?

There are some anecdotal comments I have heard from families and professionals which are hard to hear and saddens me. But I'm passionate about the service, the people working in it work hard and there is great practice that does happen. So when I hear frustrations that some of the workers in CAMHS aren't able to understand or respond to the complexity of their child, I can see how families and children feel misunderstood and isolated. You don't want them to feel let down. CAMHS is just so overstretched, it's not about the individual practitioners on the ground and a lack of willingness from them to help and support. 

What would you like the public opinion to be?

You want families and their children to feel listened to and understood, ultimately, you want them to feel supported. You want service users to feel the practitioner they're working with really understands them and cares for them, and demonstrates a genuine interest in the child. It should be regarded as a service that can help and support all the people it works with, with appropriate time and space to complete the work, and a breadth of skill mix within the service to meet the diversity of complexity and need in its service users.

Is there anything that you're particularly passionate about in CAMHS?

Other than what I've mentioned, I'm really passionate about preventative care. It's the idea that we can catch things early, identify those at increased risk, and be more proactive and targeted with help and support to prevent difficulties building. CAMHS is largely reactive in its work, but there is tremendous opportunity to develop more proactive and preventative activities. If you identify something early, you can build emotional well-being and strengthen resilience and I think that's so important. Hopefully, this would reduce the amount of children needing secondary care CAMHS, because then not all of these children would go on to develop a mental health difficulty that requires specialist CAMHS input.

You mentioned that you left CAMHS a few years ago.

Yes, and I now hold an academic post at the University of York and I teach a module on Child and Adolescent Mental Health, but I still do some clinical work. Now, I see my role as giving children, young people and their families a voice through my research activities. I will interview them and complete thematic analysis. Writing for journal publications places a spotlight on these children and their families, on their lived experiences, thoughts, feelings and perceptions and I hope we can learn from that.

Do you believe your career will always reside in child, adolescent and family services?

I think I'll always be an advocate for vulnerable children, young people and their families. At the minute, however, I'm actually working with a women's charity. Some of the adults in my group are parents who have young children, so I can see I'm indirectly impacting and supporting them through working with their parents. If children can experience greater emotional well-being because of the work I have been completing with their parents, that just has to be a positive. So it might be indirectly at the moment, but yes, I'll always have something to do with children and young people.

Lastly, what advice would you give to someone starting their career in CAMHS?

I would say that for anybody considering a career generally in clinical psychology that they should absolutely go for it. It's enjoyable, it's satisfying and despite the challenges it's so unique. The positives in my opinion outweigh the negatives, but you need to have determination, perseverance and self-belief. In terms of working in CAMHS, you need to be true to yourself and learn what you're interested in and what you're passionate about and go for it. You need to be someone who likes to be busy and likes working within a team. Working in CAMHS is a real privilege, you're going to be part of somebody's journey to well-being. If all that sounds like a good fit for you, then CAHMS is definitely the place to be!