Child and Adolescent Mental Health (CAMHs) for children and young people with learning disabilities (or lack of them): An update Sarah H Bernard Consultant Psychiatrist The Michael Rutter Centre

Overview The past What has changed? What else needs to change? How can a highly skilled, effective, evidenced based mental health service for children and young people with LD be provided?

Background Biblical times – infanticide….. Society became more caring….. Asylum Education for all….MHA….NHS Move from institutions to community care De-medicalization Child 1st approach (NSF)

What we know Children with LD Are at an increased risk of developing behavioural/mental health problems Are more likely to have co-morbidities Are more likely to have aversive psychosocial circumstances Are less likely to receive a service

Recent Developments CSIP Proxy target Program of activities Increase in provision But…….time of cuts, changes to commissioning…….

Current situation (London) Child 1 st model EI services being promoted CAMHS vs PND/community paeds IQ lottery Variable assessments Lack of resources for intervention

What do we need? Services for all Early identification Awareness of diagnostic overshadowing Appropriate assessments which inform intervention Effective liaison with education/social care

How might services be delivered? Identifiable care pathway Adequate resources Appropriate environment Skilled team Community based provision Access to emergency provision IP beds????

Assessment Comprehensive Involvement of family/carers Involvement of education/social care Psychometrics ASD assessment Access to paediatricians, paediatric neurologists, genetics…..

Intervention Behavioural Group work Medication Psychoeducation Home, school, respite

Also Safeguarding Medicolegal work Transition Training

What are the Pitfalls?! Unclear service remit Restrictions from commissioners Gaps in service Lack of planning Lack of respite Inadequate provision of care pathways for emergencies/crises

Good Practice Sally. 5yr old. Moderate LD. Recently started at MLD primary school Increasingly distressed. Sleep disrupted. Mild SIB Ref to CAMHS. Observed at home and school. Parents interviewed Sally interviewed Psychometry. ADI Genetics Outcome – to discuss

Less Good Practice Sally. 5yr old. Moderate LD. Recently started at MLD primary school Increasingly distressed. Sleep disrupted. Mild SIB Ref to CAMHS. CAMHS are not commissioned to see children at MLD schools Delays….then passed to education psych……family advised about how to manage Sally although not observed at home/school. Sally increasingly distressed. Escalation of SIB with lacerations Poor sleep, family exhausted……. Ref back to CAMHS…possible depression….. Still not seen…….

A Vision for the Future Comprehensive services for all children Timely assessments and interventions No discrimination Effective, respectful multiagency working