Many children and young people
accessing CAMH services will not have a definitive
diagnosis
. We have tried to reflect this within the
standards by highlighting the need to also consider and record
assessment
and
formulation
information. These standards advocate the use of
evidence-based therapies
and
treatments
. We recognise, however, that the evidence
base in CAMH is currently limited. There are some therapies that do
not have a strong evidence base but are commonly accepted practice
and may benefit some children and young people. Delivering care
through an ICP should not stifle innovation; the clinical
judgement, experience and knowledge of the CAMH practitioner will
always have a bearing on any decisions regarding the best treatment
option for a child or young person. ICPs use
variance
analysis as a tool for service improvement.
It is important to acknowledge that not all variance is bad, for
example in the context of clinical judgement in the assessment and
treatment process.
Children and young people who are
experiencing mental health problems may be in contact with a number
of services and practitioners, often spanning more than one service
tier. Practitioners within Tier 1 services are generally in more
regular contact with the child or young person. This is
particularly the case for education staff, as most children and
young people spend a significant proportion of their time in
school. It is important that mechanisms are established for
specialist CAMH services to input to the care and support of the
child or young person. This may be through liaison,
consultation
, support and training for staff working
in Tier 1.
Additional complexities must also be
considered. These can include children and young people with both
mental and physical health conditions, those with a primary
diagnosis of learning
disability
and those who are
looked after
. Services also have to be aware of, and
provide appropriate services for, any children and young people who
are subject to the provisions of the
Mental Health (Care and Treatment) (Scotland) Act
2003
or the
Adults with Incapacity (Scotland) Act 2000
which is
applicable to people aged 16 years and over who lack capacity to
act or make some or all decisions for themselves because of mental
disorder or inability to communicate due to a physical
condition.
We also recognise that the age range
for
referral
to, and treatment by, specialist CAMH
services varies across NHSScotland, and within NHS boards. In
recognition of this, these standards make no specific reference to
age.
Involvement of children, young
people and their parents/carers
Children and young people with
experience of mental health services, and their parents/carers were
involved in the development of these standards. They helped us to
make sure that the standards are centred on the child or young
person and reflect what they, and their parents/carers, see as
important and helpful.
To help us to contextualise how it
feels and what helps from the perspective of those accessing CAMH
services, we asked a wider range of children and young people about
their experiences. Thirty young people, from across Scotland, aged
between 7–18 years of age, completed our ‘Your Story’ consultation
tool. A separate report of the feedback received will be
produced.