Specialist services for children and young people with mental health difficulties have gone from strength from strength during the COVID19 pandemic, with staff going above and beyond the call of duty to ensure safe and timely services for families.
Members of Cwm Taf Morgannwg UHB’s Children and Adolescent Mental Health Services (CAMHS) have changed working practices – including transforming a number of rooms and waiting areas into ‘clean’ areas and increasing the number of virtual appointments available – to make sure they can continue to offer the right support at the right time.
The most at-risk patients were prioritised and crisis teams reinforced, while a single point of entry was established for referrals – all at a time when staff were battling high sickness levels due to COVID19 and rapidly introducing new technology such as videoconferencing, which was previously not available.
As a result, the majority of meetings held since the start of lockdown have taken place over the phone or by video, although staff have also continued to see families face to face where appropriate – wearing PPE and maintaining social distancing – to provide a range of services including cognitive behaviour therapy (CBT) and family therapy.
Consultant child and adolescent psychiatrist Cara Maiden said: “Our main challenge was to provide therapeutic interventions that met children and young people’s needs without being able to see them face to face in clinic due to the lockdown. Most of the therapies and monitoring of medication is based on research using face to face contact.
“CAMHS professionals had to adapt these interventions using telephone contact and videoconferencing, but our service was not prepared technologically to offer care to patients remotely. During lockdown we also had to follow government guidance with regards to social distancing and shielding, which was a major obstacle to providing clinic-based appointments.”
As a result, the team developed protocols for safe working for patients and staff, adapting the clinic environment to meet COVID19 safety standards and developing resources and innovative ways of remote working – all in a matter of weeks. Some core and crucial staff were redeployed and others faced redeployment, which had a big impact on resources and staff morale.
Dr Maiden added: “Our own staff sickness rate went up to 40% due to COVID19-related symptoms and shielding, while some staff were moved to cover emergency work and other vacancies within CAMHS and even hospital wards. This meant that staff had to be very flexible and some didn’t know where they would be working from one day to another.
“We started to create resources and self-help materials for families, while clinicians reviewed their entire caseloads to identify their most at-risk patients, who were prioritised and monitored. We also provided all stable patients on medication with three months’ worth of prescriptions.”
Many of the examples of good practice introduced during lockdown can now be retained as services are gradually reintroduced, such as the Attend Anywhere scheme. This enables patients to access services virtually, with the Community Intensive Therapy team (CITT) chosen as one of the Cwm Taf Morgannwg services to take part in a pilot.
Dr Maiden said: “The feedback has been that families were grateful to be contacted during lockdown, as they were not expecting it. We were surprised to learn of some misinformation about CAMHS and what we do, largely as families were not aware we were doing first assessments and that we remained opened to referrals.”
Consultant child and adolescent psychiatrist and Fellow of the Royal College of Psychiatrists Antonio Munoz-Solomando said: “People often assume that waiting lists are a year or even two, when actually our latest data shows that more than 80% of specialist CAMHS and 90% of primary CAMHS patients are seen within the 28-day target, which is an achievement reflecting on the service.
“Staff have worked really hard throughout COVID19 to make sure we can still see families face to face, personally cleaning rooms and corridors to turn some spaces into clean areas. Some families have been afraid to go to their GP, while not being in school has made some children very anxious – and anxiety is the reason for the majority of referrals. But we’ve been coming up with innovative solutions to make sure no one falls through the net and our message is that it’s safe for patients to come in and that staff are more than happy to see them.”
The CAMHS team helps children and young people with a range of issues and conditions, including depression, anxiety, eating disorders, OCD, psychosis and drug and alcohol related problems. The team provides consultation to the Eye to Eye and ExChange school counselling services, while the CRISIS liaison service is in place to respond to mental health emergencies.
Support is available to children and teenagers up to the age of 18 and their families living in Bridgend, Rhondda Cynon Taf and Merthyr Tydfil, with referrals coming from GPs, Children’s Services, Paediatrics and Educational Psychology, as well as out of hours services and A&E. All referrals are made through the Tonteg Hospital site near Pontypridd. Find out more here.
Photo: Specialist nurse therapist Fiona, one of the CAMHS team making services safe for families during COVID19.