Developing CAMHS for Children and Adolescents with Learning Disability Sarah Bernard Consultant Psychiatrist The Maudsley Hospital

National Services Framework – Children should be able to access a range of mental health services whether or not they have a developmental disability

Clinical Need/Lack of Services  Risk factors Epidemiological studies confirm increased risk of psychiatric/behavioural disorder Co morbidity Diagnostic overshadowing Fewer protective factors Long term disorders

Lack of Services  CAMHS mapping (London) Approx 50% indicated lack of appropriate service provision  Lack of expertise  Fragmented services  Insufficient resources

THE PLAN  CSIP (DoH) – priority area  Mapping exercise  Proxy targets  “Champions” identified  Raise awareness/improve confidence  Optimise existing provision

HOW WAS IT DONE?  Aimed at boroughs showing “red”  “Champions” to lead (clinicians)  Steering group (MDT)  Series of conferences  Toolkit  Clinical skills tutor  Master classes  Evaluation

The Conferences Aimed at  Commissioners/managers  Clinicians Content  Theoretical overview  Demonstration of need  Assessment vs management  Models of service

The Toolkit  Multi Author/MDT Developing Mental Health Services for Children and Adolescents with Mental Health Problems and Learning Disability – A Toolkit for Clinicians Eds Bernard and Turk RCPsych Publications 2009 FREE DOWNLOAD FROM RCPsych WEBSITE!

The Clinical Skills Tutor  Nursing background  Band 8A  Secondment 1 year  To support service development across London  FAILED; unable to appoint suitable person

The Master Classes 17 boroughs (of 33) One day event am- teaching pm- consultation Attended by MDT: 3-10 people

Teaching topics  Service development  Aetiology and syndromes  Mental health assessment  Psychopharmacology  Legal and ethical issues  Parents with LD  The high risk patient  Multi agency working  Complex cases with diagnostic/management issues  Safeguarding  Management of risk  Family Functioning  When to stop  Role of IP services

CLEAR Children with Learning disabilities Evaluation of Accessible Resources  National evaluation  Ongoing  Identification of appropriate outcomes to be evaluated pose a challenge

What Next?  Some money still available!  “Feel good” factor vs true benefit  More Master Classes?  Road shows?  “Help line”

Has this been worthwhile?  Positives Valued by local services More CAMHS-LD services being developed More referrals to tier 4 Toolkit:+ve reviews  Negatives Evaluation not completed Tier 3 services want more support Lack of “new” money

Conclusions IQ lottery cannot continue A comprehensive CAMHS must be truly comprehensive Resources will be required in order to ensure needs met