Child and Adolescent Mental Health Services

Debate between Jonathan Reynolds and Pat Glass

Wednesday 7th July 2010 Westminster Hall

[Jonathan Reynolds]

Speaking as a parent, we must recognise that this is a spectrum disorder. Therefore, children with autism are in different situations and have different symptoms, and each requires a response particular to them. Generalisations of the kind that the hon. Gentleman asks about cannot be made. Each parent and professional would, in respect of the support that they had, have to make the decision based on what was best for that particular child.

The professionals who spoke to the NAS stressed the importance of specialist autism expertise when dealing with a child with autism and mental health problems. They explained how in many cases a specific skill-set is required to treat these children and that without that specialist knowledge it can be very difficult to effect any real improvement. They felt that specialist expertise was often required to get a real understanding of how the child’s mental health problems related to their autism, and how they would need to adapt the interventions they provided to take account of the child’s autism.

Although basic autism knowledge will help a professional to communicate better with the child and understand better why the child displays certain behaviours or symptoms, greater expertise is often needed to make a positive difference to the child’s mental health. That is because many therapies and interventions rely on thought processes and communication techniques that do not make sense to children with autism, and only skilful adaptation from a specialist can make them relevant and useful. Children with autism often will not gain any benefit from treatment that is applied in the standard way. Indeed, such treatment can make things worse.

Again, we should recognise good practice where it exists. West Berkshire has a social communication team that provides home and community-based assessment and intervention for young people with complex diagnostic issues or needs that cannot be met by local services. That team works with children with autism and a co-occurring mental health disorder. It takes a multidisciplinary approach, incorporating speech and language therapists, two clinical psychologists and a psychiatrist. The team is also part of a wider multidisciplinary group that provides services for children with autism in west Berkshire. The team recognises the need to adapt therapies to account for autism. Psychologists divide their time between diagnosis and follow-up appointments, and provide behavioural and mental health interventions.

[Pat Glass (North West Durham) (Lab)]

I have worked in this area for many years, with many children and CAMHS services. I have found across the country that there is massive inconsistency in the quality of CAMHS services, but there is absolute consistency in the lack of those services for children. Quality is variable throughout the country. Although the services that my hon. Friend is talking about are at the upper end of the scale, for many children they simply do not exist.

[Jonathan Reynolds]

I am tremendously grateful to my hon. Friend for her intervention. She has great expertise in this and other matters, and in another capacity was responsible for the education system that I went through. I hope that I am not letting her down.

Following on from that, as so many children who access CAMHS have autism, what action will the Government take to ensure that specialist autism support is available to all children with autism and mental health problems? To take up what my hon. Friend has said, I think we would all agree that one matter that always arises when we talk to parents and campaigners is the inconsistency in service delivery across the country. For every example of innovative or positive practice, there are often many examples of children with autism and mental health problems facing inadequate or non-existent provision.

Local commissioners are supposed to plan services based on the needs of the local population, but it seems that in many instances commissioners are unaware of either the number of children with autism and mental health problems in their area, or that those children need specific support from people who understand autism, or both. When commissioners fail to recognise and address the needs of children with autism and mental health problems, those extremely vulnerable children and their families do not receive the support that they need. Commissioning is a local exercise, but there is no doubt that direction from the Government at national level can make a huge difference to what is commissioned.

Previous Government directives—for example, the national indicators, Care Quality Commission inspections and the national service framework for children—have instructed commissioners to prioritise specific areas of CAMHS, such as age-appropriate in-patient wards for teenagers, early intervention services, and services for children with a learning disability. Those directives drive commissioning in those areas, and lead to greater availability of services and greater consistency across the country.

The National Autistic Society has provided strong evidence that CAMHS are failing children with autism, and that results for such children can be greatly improved by improving autism understanding and specialisms within CAMHS. We know that only 10% of CAMHS provide targeted support to children with autism. Surely, there is a strong argument for the Government to prioritise the commissioning of services for children with autism.

Ten thousand children with autism access CAMHS each year. Given that the mental health of two thirds of children with autism is not improved by the support that they receive, that is a huge waste of NHS resources when we can ill afford such a waste. Furthermore, when children with autism receive services that do not work for them, or receive no support because none is available, their problems escalate and become more complex. Not only does that mean that it is much harder for families to cope; it means that, ultimately, those children are much more expensive for the NHS to treat. A relatively short period of appropriate therapy from an autism specialist at an early stage could prevent a child from needing a long stretch in an expensive in-patient unit.

If commissioners were given more guidance and direction to help them to commission the right services for children with autism in the first instance, we could stop wasting money and stop wasting lives. What action will the Government take at national level to ensure that the right services for children with autism are commissioned locally across the country?