Contemporary Issues in Health & Social Care

This essay discusses the contemporary issues related to policy and practice of Child and Adolescent Mental Health Services (CAHMS) at both national and local level. It explores the challenges faced by CAHMS, such as limited capacity, waiting times, and lack of provision for crisis support. The essay also suggests theories like Lewin's change model and Fayol Management theory to improve the effectiveness of CAHMS services and management.

Contemporary Issues in Health &
Social Care

Table of Contents
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................1
Overview of Child and Adolescent Mental Health Services (CAHMS) Practice..................1
Contemporary issues in CAHMS Policy................................................................................2
Theories to improve CAHMS services and management......................................................3
CONCLUSION................................................................................................................................7
REFERENCES................................................................................................................................8

INTRODUCTION
Today, in provision of health care services, multidisciplinary or interdisciplinary team
contributes an important role, for well-being of patients (McGovern and et. al., 2016). This team
compromises with highly expert professionals and workers, that specialises in different-different
fields. Child and Adolescent Mental Health Services (CAHMS) is one of the multidisciplinary
team, that actively work in liaison for providing mental and physical health interventions to
children and young people. This NHS service is organised around 4-teir system, where Tier 1
includes general treatment and advice to those children and young people who face less severe
mental health problems and get services by non-mental health specialists such as GP, social
workers, school nurses and voluntary agencies (Stafford and et. al., 2016). Under Tier 2,
specialists mainly work in primary and community care who provides counselling to youths who
are experiencing mental health related issues. Similarly, Tier 3 consists multi-disciplinary team
of professionals that provides specialised services to patients with most severe disorders. Other
than this, the Tier 4 gives a highly specialised services to people with high mental disorders by
outpatient teams, in-patient units and other (Abrines-Jaume and et. al., 2016). These types of
services support people who are facing such issues at early age and provides specific treatment
for well-being. But apart from various advantages, yet there are number of factors present that
decreases the effectiveness of CAHMS service of NHS both at local and national level
(McGovern and et. al., 2016).
The present essay is going to highlight the contemporary issues related with policy and
practice of CAHMS, at national and local level. For this purpose, different articles and journals is
taken to evaluate the issues and how the same can be resolved. For analysing at local level,
London Borough of Camden is chosen, where the way effectiveness of CAHMS practice can be
increased, different models like Lewin's change model, Fayol Management theory, quality
approaches, knowledge of driving and restraining force, regarding with CAMHS etc. are
demonstrated under this essay.
MAIN BODY
Overview of Child and Adolescent Mental Health Services (CAHMS) Practice
Mental health at early childhood consider as same as solid social or passionate
development, that include things like identifying how to express feelings, developing secure
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relations or connections with individuals etc. (Porter and et. al., 2017). Therefore, establishment
of service to support such individuals for well-being taken as early childhood social as well as
passionate improvement. Mental and physical health related problems among children and young
people, have been recognized as major one, where the single way by which it can be addressed is
integration of psychiatric as well as paediatric services (McDougall and Ryan, 2016). For overall
development of an individual, mental health is considered as an important part, but at an early
age, if symptoms of any disorder is not recognised or addressed, then it highly affects the same.
Early detection of such disorder with proper treatment is essential for proper development of
physical and mental growth of a person. Child psychiatrists are mainly work within paediatric
liaison settings, are argued that there are a mental health related problems are mostly developed
between age of 5 to 15 years (Jacobs and et. al., 2016). Therefore, concerning on well-being of
child and adolescent as a priority, NHS has been established a new policy as CAMHS. This
policy includes practices or services that provide support to those children and young people who
are facing difficulties for behavioural emotional well-being.
Contemporary issues in CAHMS Policy
By giving priority to improve services, NHS has states that over next 5-years, additional
funds will be allocated for the same (Hayes, 20180. As per Government Public Accounts
Committee of UK, it has been identified that demand for mental health support is continuously
increases where, only a quarter access the services as per need. Therefore, limited capacity has
been analysed as the main factor that hampered the effectiveness of CAHMS at both local and
national level. As per report of Scottish Government, other main issues which reduces the
effectiveness of CAHMS includes waiting times for accessing the specialist services; gap in
community services for supporting children and young people having milder mental health
problems; and lack of provision or crisis support (Mummah and et. al., 2016). These challenges
have assisted NHS to transform the approach to deal with this growing problems. The main aim
behind establishment of CAMHS is to deliver services to those children and young people who
are facing the most serious mental health problems (Berry, Broadbent and Otley, 2019).
Therefore, interdisciplinary team plays an important role in supporting such patients for well-
being. This inter or multidisciplinary teams combines professional team of psychiatrists,
psychologists, nurses, social workers and others (Allen, 2016). But waiting time and inpatient
activity, due to increase in demand, delivery of quality service has much affected and either
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patients have to wait for longer period to get treatment or they may referral. As per Scottish
Government, about local borough of UK like London Borough, concerning from a range of
individuals and organisations related to number of redirected or rejected referrals to Tier 2, 3 and
4 services of CAMHS, it has been evaluated that one in every five patients (children and young
people) referrals either rejected or redirected by CAHMS services, due to increase in demand
(Child and Adolescent Mental Health Services (CAMHS) in Scotland: Waiting Times and
Inpatient Activity and CAMHS Workforce in Scotland, 2019).
The United Kingdom, has a decentralised system to provide healthcare facilities, that
reflects that most of the local areas commission have their own health services. It includes
hospital care, rehabilitation centre, mental health and other emergency services (McDougall and
Ryan, 2016). NHS England has also assigned a budget which is based on total estimation of
needs as per area, but it is only up to only clinical commissioning groups decide how much fund
need to spend. These spending decisions sometimes biased as per rules of rescue i.e. cases like
life-threatening or high mental disorder will be given priority, for providing health care services
(Jacobs and et. al., 2016). This would have left others who are experiencing less mental
disorders, that ultimately affects their future. According to Dmytro Zinkevych (2019), it has been
evaluated that services for mental health of young people and children are only accounted to near
about 1% of total NHS spending. While, in context with CAHMS service, it also accounts only
for 7% of total mental health budget of NHS. Therefore, due to lack of fund facilities, in UK two
in every three people with experience of mental disorders, do not support of NHS for well-being
(The UK doesn’t spend enough on the mental health of young people – we found out why, 2019).
They have to wait for longer period to get specialised services, which shows a high disparity
between their needs and resources that dedicated to mental improvement of them. Therefore, in
order to provide better services and accomplish objectives of CAHMS policy, multidisciplinary
team members want new technologies for creating innovations like instruments and drugs, taking
therapy by labour intensive and more. But shortage of funding creates difficulties in adoption of
same, that lead to reduce effectiveness of CAHMS and other mental health related services both
at national and local level like in London Borough.
Theories to improve CAHMS services and management
Mental development of children alludes to changes which happen as connection with others,
for being physically solid, sincerely sound, socially skilful and rationally caution, for preparing
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to learn (Hayes, 2018). It has been considered that initial five years of life of youngsters are on a
basic level of paramount, which shapes their future health, development, bliss and
accomplishment of learning at school. At this stage, child understand how to involve with others.
In this regard, any kind of mental disorder at this stage, creates a large impact on their future life
(Allen, 2016). Therefore, if they do not get support at early childhood age for improving mental
health, then it may arise continuously as per their age (Porter and et. al., 2017). For this purpose,
step taken by UK Government and NHS to support youngsters for mental health well-being,
includes CAHMS service. But with increasing demand of patients, medical professionals team
fail to provide timely and quality services to them (Berry, Broadbent and Otley, 2019). To attend
patients as much as possible, practitioners do not provide sufficient time to individuals or
sometime rejected or redirected also. Therefore, to improve effectiveness of CAHMS service,
management of NHS has used the concept of Kurt’s Lewin Change and Fayol Management
Theories, that helps in reducing medication errors also (Abrines-Jaume and et. al., 2016).
Kurt’s Lewin Change Management Theory
This theory includes three planned approach for making changes or improvement in a
policy as Unfreeze, Change (Transition) and Freeze (Refreeze). As per present scenario, to
improve medical or health care practices, Lewin theory is one of the cornerstone models that
provides a simple framework to understand the process of change, so that approach that suit best
can be implemented (Mummah and et. al., 2016). Since implementing changes in any health care
practice is difficult to implement, where a number of aspects need to be considered like changes
in role and responsibilities of multidisciplinary team-members, take perception or feedback of
each associated person in creation of changes etc. Therefore, Lewin change theory provides a
simple framework to make changes (Stafford and et. al., 2016).
Unfreeze: It is first stage of Lewin’s Analysis model that involves identifying the areas where
change is necessary, like updated the technologies and service delivery system at a large
psychiatric facility (McGovern and et. al., 2016). Hereby, key components of this step incudes
proper communication with all stakeholders such as psychiatrists, frontline nurses,
administration and other medical team professionals to discuss about where changes are needed
to created first (Stafford and et. al., 2016). This will help in developing a sense of security as
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well as trust among team-members with the proposed change. As it has been evaluated that due
to raise in demand of mental services, providing the same by NHS members seems to be
difficult. Therefore, with proper communication with team-members, roles and responsibilities
need to be equally distributed first, so that every professional provide equal contribution in
attending the people with mental health disorders (Berry, Broadbent and Otley, 2019). The
inclusion in this regard, of front line staff within key decision, will help in promoting the feeling
of empowerment that leads to overcome from resistance to adopt change, as well as enable them
to understand the importance of CAHMS objectives.
During this unfreezing stage, discussions within multidisciplinary team with purpose of
how to tease out the driving and restraining forces, lead to identify the factors that may create
barriers (Allen, 2016). In this regard, some restraining forces will include staff resistance for
attending more patients in a day, giving them sufficient time, the possibility of workarounds and
more. While driving forces may include factors that will help in making the changes successfully
like proper amount of financial investment, through the support of local organisations, support
adequately from upper level of management, proper management of time and more. The
important point here is that implementation of new technology for recovery of mental health
issue, which can only be exercise if proper funds will be raised (Hayes, 2018). For this purpose,
NHS and other social organisations need to provide more funds with proper budget plan to spend
same, on recovery of people, will work towards accentuating the positive driving forces, also
lead to diminishes the restraining forces.
Change (Transition): This is the second stage of Lewin model, where changes are
actually begun to start i.e. implementation of planned activities. For example – Implementing the
new technology, recruiting more members in multidisciplinary team to reduce waiting time in
providing services to child and youngsters having mental health issues etc. Here, sustained effort
from all members of professional team is required for executing the changes in CAHMS services
successfully (Jacobs and et. al., 2016). As changes requires much funds and proper attention of
association that may affect other departments also in different ways, therefore, proper planning is
also needed for overcome of such barriers. For this purpose, it has been recommended that if
members of multidisciplinary and interdisciplinary team members will actively contribute their
efforts then such process will execute effectively (McDougall and Ryan, 2016). Some areas that
need to be considered at such changes in roles and responsibilities of team-members or
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implementation of new technologies are included - reliability of equipment, proper training
needs, organizational culture, effects on workflow, proper management and leadership.
Freeze: It is the final stage of Lewin’s theory, which states process of freeze or
refreeze the changed health care practices. Therefore, with ongoing support of
medical professionals on the frontline, with technology support, help in continuing the
changes until, it is deemed complete (Porter and et. al., 2017). Afterwards, once it is
completed as well as fully operational, management of NHS need to evaluate and
encounter the problems, so that effectiveness of CAHMS service can be increased, by
enhancing quality of same.
Fayol Management Theory
To create high functioning multidisciplinary or interdisciplinary team, for delivering
value based care, it is essential for NHS administrators to adopt effective management
techniques (Allen, 2016). It includes Fayol Management Theory, that provides an insight for
developing strategies to promote changes and initiate the patient-centred care delivery system, so
that proper support can be provided to children and youngsters, who are experiencing mental
health related problems.
As per this theory of management, it has been argued that managers of multidisciplinary
team first needed specific roles for managing work and other members. For this purpose, a
systematic framework approach needs to be adopted that opposed the orthodox doctrines (Berry,
Broadbent and Otley, 2019). With proper inter-personal relationship and effective
communication with team-members, workflow can be managed successfully. Through division
of work between health practitioners based on individual skills and level of specialization,
management of NHS can distinguish the knowledge areas, as well as supports team for personal
and professional development. This will promote efficiency, accuracy and diversification of care
delivery in CAHMS service at both technical and managerial level (Mummah and et. al., 2016).
Furthermore, for establishment of hierarchy and smooth workflow, managers need to develop
discipline, authority as well as responsibility with traceability also. Through adoption of seven
principles as given by Fayol and Mintzberg theory, NHS can improve the efficiency of its
CAHMS and other health care related policies. It includes Division of Work; Discipline;
Authority; Unity of Direction, Unity of Command; Remuneration; and Subordinate of individual
interests towards general interests. All these principles will help in improving and increasing
quality of CAHMS services.
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CONCLUSION
It has been concluded from the entire discussion that in providing mental care and other
health related policies, NHS and UK Government has contributed a major role. With increasing
demand of people to get support for recovery of mental issues, NHS has established a number of
policies, where CAHMS refers to best among them. This service organises within a four tiers
framework as per severity of mental health disorders, such as risk of self-harm or attempt to
suicide, eating disorders, lack of abilities in making emotional connections with others, severe
disorders, depression and more. But as shortage of funding always remain as a major issue, that
arise barriers in achievement of objectives regarding with establishment of CAHMS service.
Therefore, to overcome from the same, a number of health care approaches, like change
management theories lead to overcome from the same as well. To improve mental health
services, NHS need to recognise some complementary issues, that are waiting time for accessing
the specialist services, which are unacceptable for people having severe mental disorders.
Similarly, gap in services at community for supporting children and youngsters for overcome
from mental disorders also need to be reduced. In addition to this, poor provisions of crisis
support also required to be improved.
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REFERENCES
Books and Journals
Abrines-Jaume, N. and et. al., 2016. A qualitative analysis of implementing shared decision
making in child and adolescent mental health services in the United Kingdom: stages
and facilitators. Clinical child psychology and psychiatry, 21(1), pp.19-31.
Allen, B., 2016. Effective design, implementation and management of change in
healthcare. Nursing Standard, 31(3).
Berry, A. J., Broadbent, J. and Otley, D.T. eds., 2019. Management control theory. Routledge.
Hayes, J., 2018. The theory and practice of change management. Palgrave.
Jacobs, M. and et. al., 2016. Mental health services for children and adolescents with learning
disabilities: a review of research on experiences of service users and providers. British
Journal of Learning Disabilities, 44(3), pp.225-232.
McDougall, T. and Ryan, N., 2016. Nurse prescribing in CAMHS: An evolving role. British
Journal of Mental Health Nursing, 5(2), pp.62-67.
McGovern, M. and et. al., 2016. The Vasarhelyi method of child art psychotherapy in child and
adolescent mental health services: A stakeholder survey of clinical supervisors. Irish
Journal of Psychological Medicine, pp.1-8.
Mummah, S. A., and et. al., 2016. IDEAS (Integrate, Design, Assess, and Share): a framework
and toolkit of strategies for the development of more effective digital interventions to
change health behavior. Journal of medical Internet research, 18(12), p.e317.
Porter, S. and et. al., 2017. Music therapy for children and adolescents with behavioural and
emotional problems: a randomised controlled trial. Journal of Child Psychology and
Psychiatry, 58(5), pp.586-594.
Stafford, V. and et. al., 2016. “Why are you here?” Seeking children’s accounts of their
presentation to Child and Adolescent Mental Health Service (CAMHS). Clinical child
psychology and psychiatry, 21(1), pp.3-18.
Online
Child and Adolescent Mental Health Services (CAMHS) in Scotland: Waiting Times and
Inpatient Activity and CAMHS Workforce in Scotland. 2019. [Online] Available
Through:<https://www.isdscotland.org/Health-Topics/Mental-Health/Child-and-
Adolescent-Mental-Health/>.
The UK doesn’t spend enough on the mental health of young people – we found out why. 2019.
[Online] Available Through:< http://theconversation.com/the-uk-doesnt-spend-enough-
on-the-mental-health-of-young-people-we-found-out-why-124315>.
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