Child and Adolescent Mental Health Services

Debate between John Pugh and Jonathan Reynolds

Wednesday 7th July 2010 Westminster Hall

[Jonathan Reynolds]

I am grateful to the hon. Lady for her intervention, and I acknowledge her work and expertise in this field. I approach this subject primarily as a parent, so I am happy to say that more needs to be done. I am not making this a party political issue between this Government and the previous one. I am trying to highlight the issue and, I hope, move forward together, across the House.

I wish to identify some good practice relating to the hon. Lady’s question. Dudley primary care trust operates an autism clinic that focuses on diagnosis and assessment, and has the specialist expertise to assess complex autism cases. The clinic takes a “broad apprenticeship” approach to training new staff, which gives them the opportunity to observe specialists and more experienced clinicians assessing children from behind a one-way mirror.

After new staff have watched several assessments, they progress to shadowing colleagues and then to taking the lead with children with autism, with support from a specialist. Finally, they are able to work alone and train new starters themselves. They learn through practical experience, rather than theory. The clinic also shares its expertise more widely and trains external agencies. For instance, it trained a group of specialist autism teachers and key workers to provide social skills training to children, meaning that social skills training could continue once a child had left CAMHS, making it far more effective than if it had been delivered once and then discontinued.

There is clear evidence that a good understanding of autism is vital to delivering an effective service to the high number of children with autism in the CAMHS system. All professionals working in CAMHS must have their training needs relating to autism recognised and addressed. In “Fulfilling and rewarding lives”, the Government’s recently published strategy for adults with autism, there is a commitment for

“all NHS practitioners”

to

“be able to identify potential signs of autism, so they can refer for clinical diagnosis if necessary… but more importantly so they can understand how to adapt their behaviour, and particularly their communication, when a patient either has been diagnosed with autism or displays these signs.”

The same strategy commits the Government to working with the General Medical Council and various professional bodies

“to improve the quality of autism awareness training in their curricula.”

What action do the Government intend to take to ensure that the NHS training objectives made in the autism strategy, “Fulfilling and rewarding lives”, are met, so that all CAMHS practitioners receive some basic training in autism?

[Dr John Pugh (Southport) (LD)]

The hon. Gentleman has made two distinct points so far: that mental health problems can be masked by autism so that a person who really has mental health problems may be seen only as having autism, and that autistic behaviour can be misdiagnosed as a mental health issue. Surely that is a very tricky situation for any diagnostician to be in.

[Jonathan Reynolds]

Yes, it is difficult. To be clear, my point is that the prevalence and frequency of co-occurring mental health problems with autism require CAMHS professionals to have specialist training. Without that support, there can be misdiagnosis, which can lead to the situation that the hon. Gentleman referred to.

Does the Minister agree that, given the high proportion of children with autism who access CAMHS, all CAMHS professionals should receive some autism training?

I have explained how a basic knowledge of autism among all CAMHS staff is essential to ensuring that appropriate interventions are delivered to children with autism, but that alone is not enough. Providing mental health support to a child with autism is a specialist skill. Research has found that when an autism specialist has been involved in the support of a child, the outcomes and service satisfaction both improve dramatically.

The NAS found that parents who reported that their child had received support from a professional specialising in autism were twice as likely as those whose children had not to agree that CAMHS had improved their child’s mental health. They were also four times as likely to say that a good understanding of autism by mental health professionals had positively influenced their child’s mental health. However, only two in five parents say that their child has had such support.