1. Mental Health of Children & Adolescents: The work of the Child and Family Consultation Service Dr. Joshua Westbury Consultant Child and Adolescent Psychiatrist Southend CFCS, South Essex Partnership NHS Trust July 2012

2. Introduction All of you are here because you already have some interest in, and some knowledge or experience of mental health issues Please ask questions Please tell me what you think

3. Mental health issues faced by young people

4. Are young people just little adults? YES Same species Live in same place Same body Same language* Accident and illness Adults were once children *LOL NO Developmental process Biological differences Attachment Growth spurts Puberty Dependence on adults Education Responsibilities

5. Can a four year old be depressed?

6. Controversial cases in media Depression is more than just unhappiness Low mood that is persistent over time and doesn’t lift when circumstances change Severe enough to affect thinking and biology – appetite, sleep, energy, concentration etc. Emotional development in early life poorly understood but four is probably lower limit

7. When is it “just bad behaviour?” Depression: can present with angry spells Anxiety: can cause fight or flight behaviours ADHD: not ‘bad’ behaviour but ‘impulsive’ Obsessive-Compulsive Disorder, autism, tic disorders: repetitive behaviours Alcohol and drugs Situational response and mimicry “Just bad behaviour”

8. “Isn’t it just bad parenting?” Anorexia nervosa – Any family Schizophrenia – Any family – Genetic factors – Environment factors Autism – Any family – Genetic factors ADHD – Any family – Genetic factors

9. FAMILY The child SCHOOL THE CHILD COMMUNITY

10. Examples of causes Genes Bereavements Change of school Bullying Trauma Loss Social and family stress Isolation Alcohol and drugs School exams Physical illness Being a child carer Environment No known cause

11. Impact of mental health issues Pain and distress Disability Can be stressful for whole families Impact on education Impact on social development “Missing out” Accidental or non-accidental harm Long term consequences

12. What helps? Exercise and diet Consistency, boundaries, encouragement School and social circle Listening! Support for parents Teams, clubs and societies Therapies for individuals, groups and families Medical interventions

13. Questions?

14. Child and Family Consultation Service

15. What is CFCS? CFCSChild and Family Consultation Service CAMHSChild and Adolescent Mental Health Service

16. Tiered care services Tier 1General Practice Tier 2Mental health workers in community settings PMHT Charity sector Tier 3Integrated generic mental health services e.g. CAMHS, CMHT Tier 4Inpatient services Highly specialized clinics e.g. eating disorders, Tourettes, OCD, autism

17. About CFCS The purpose of tier 3 is to provide an integrated service to patients and families with complex difficulties We are an outpatient clinic We offer direct face to face work with the patient and their carers, provided by one or more clinicians We provide carer support We provide liaison and consultation to other services We are multidisciplinary and can work using different approaches with the same family at the same time We are not focussed on a single diagnosis or other type of problem, or a single philosophical approach

18. South Essex CFCS teams

19. Who works at CFCS Child Psychiatrists Clinical Psychologists Social Workers Mental Health Nurses Family Therapists Art Therapists CAMHS Practitioners Administrators

20. Referrals GPs Schools Social Services CAF Single Gateway

21. Examples of presentations Changes in behaviour Changes in mood Changes in eating Developmental delay Not attending school Self harm

22. What do we offer? General and specific assessments Family support Individual therapies Medication Family therapy Groups

23. Working in the real world We are a small team One doctor Five to six (FTE) therapy team Covering a large area with a lot of needs Part of a NHS Trust that spans South Essex, Bedfordshire and Luton Commissioned to provide specific services

24. Working with other services Links with Tier 2 and Tier 4 services Therapist seconded to Paediatrics Therapist seconded to Youth Offending team Medical support to Early Intervention team Medical support to Drug and Alcohol Service Medical support to Learning Disability team Joint work with Crisis /Home Treatment team Social worker seconded to CFCS

25. Promoting recovery Where are you now? Where do you want to be? How can we help you get there? Shared expertise Shared responsibility

26. Role in child protection Same responsibilities as any agency working with children and families Act on concerns or to prevent danger Share information to prevent danger Work with families to resolve issues Maintain confidentiality Ensure our staff are checked and trained

27. Risk management We work with children who may present a risk to themselves or others Sometimes a mental health issue can be a life threatening illness

28. Risk management Suicidal behaviour Impulsive behaviour Self harm Self neglect Malnutrition, starvation Social exclusion Exclusion from school Aggressive behaviour Alcohol and drug use Excessive cleaning Absconsion Disinhibition Vulnerability to abuse

29. Risk management This is a whole day’s topic in itself... Assessing and making plans Involving young person and their family Working together with other agencies Knowing who can and who can’t help Taking “therapeutic risks” Risk is never zero: but it is our job to help manage risk as far as it is possible to do so

30. Questions?