Child and Adolescent Mental Health Services

Mark Williams Excerpts

Wednesday 7th July 2010 Westminster Hall

[Annette Brooke (Mid Dorset and North Poole) (LD)]

I congratulate the hon. Member for Stalybridge and Hyde (Jonathan Reynolds) on securing this debate, and providing comprehensive coverage of the vital issues. I also congratulate the National Autistic Society on its “You Need to Know” campaign, because we must make services work better for people with autism. An important aspect of that is to make CAMHS services throughout the country work effectively for children with autism.

I have been contacted by constituents asking me to support the campaign, and I want to begin my brief contribution by describing some of their experiences, because they illustrate all the general points that the National Autistic Society makes. One constituent wrote:

“I first realised there was something wrong with Jon’s development at the age of 2 but was told by my Health Visitor that I was comparing him to his older exceptionally bright brother and that he was fine. I continued over the next 2 years to say that ‘something wasn’t right’ until she eventually agreed to get his hearing checked—he wasn’t interacting with me, seemed in his own little world and wouldn’t even respond to his name. His hearing was fine so she referred him to a speech therapist as he didn’t talk much but after a few weeks of attending, he was discharged saying he was ok. It was only once he’d started school that he was referred”—

to the local hospital—

“But the consultant…decided that Jon must have a form of epilepsy as he would ‘switch off’ in the playground and was oblivious to his surroundings. He did months of tests but they revealed nothing”.

Eventually, Asperger’s syndrome was diagnosed, and my constituent went through years of seeking help. She continued:

“I have no idea what or how to access services which may or may not be available to Jon especially CAMHS. He is 17, 14 stone and 6ft 3, and can have tantrums like a 2 year old—just as sudden and just as violent. I asked my GP if there was some kind of Anger Management course available to him or if he could see a psychologist that could help him. He said I would have to see Jon’s consultant”.

And so it went on. My constituent believes that training is needed across the board for GPs, nurses and psychologists, as well as with direct CAMHS services.

Another constituent who works with children and young people with autism said:

“I feel that many health professionals are unaware of the battles faced by those living with autism. I have often found those from outside agencies quite hostile towards our clients…not realising that they need to be treated differently from neurotypical people. Most of these students have diagnosis in other things such as Obsessive Compulsive Disorder, ADHD and Pathological Demand Avoidance and attachment disorders.”

They say that it is

“hard to find people with the right expertise to deal with these disorders as they usually have not dealt with people with autism before, leaving these other diagnoses untreated. Add this to the fact that the provision for all of these services usually drop away once a person with autism reaches 19 and are transferred into adult services and it seems we are failing those with a diagnosis”

of autism.

Another constituent said:

“My experience with CAMHS for Sam has been quite negative. We saw an ASD Nurse Specialist from CAMHS for about 6 months. He knew very little about autism, in fact he used to borrow books on autism from parents”.

Another constituent wrote:

“We are consistently told by professionals that they are severely overstretched which from personal experience and talking to other parents leads to very few families receiving adequate support…Maybe if money was invested on these children as they deserve…then they would be more likely to develop into functioning adults who are able to contribute to society in a positive way rather than developing into adults with mental health issues who are totally reliant on the state.”

Those four experiences sum up many of the issues that we are debating.

Autism is not a mental health problem, which makes it difficult for people to access appropriate services. As we have heard from the hon. Gentleman, a large proportion of children with autism have mental health problems, which may develop because of the symptoms that they express and subsequent interaction with other people. They may become more socially isolated at school because of their characteristics. The problem snowballs if the symptoms of autism are not identified early, and the child’s journey does not include trained people who understand its complexities and varieties.

[Mr Mark Williams (Ceredigion) (LD)]

The debate is rightly concentrating on the inadequacies of CAMHS, but my hon. Friend knows of my interest in teacher training and teachers’ awareness of identifying the characteristics of autism. There is understandable frustration among teachers at the lack of training facilities and opportunities available to them.

[Annette Brooke]

My hon. Friend and I, along with many others, have worked hard on education, and we are slowly making progress. Today’s debate takes us further afield because we have to get the whole package right for children with autism.

Being mindful of the time, Mr Benton, I would like to touch on two issues. First, I would like to emphasise the need for training for CAMHS professionals, which is vital for all the communication issues mentioned by the hon. Member for Stalybridge and Hyde. The issue is not straightforward, which means that there must be training; there must be flexibility, patience, skill and understanding. The local CAMHS commissioning process is designed to identify and address skills gaps in the local work force. What steps will the Government take to ensure that such gaps are identified and addressed with regard to autism?

I have been involved with the Every Disabled Child Matters campaign, and one area of concern that we have identified is the falling apart of services for disabled children during the transition period. There is a lack of forward planning for the transition, starting about age 14. That is particularly true for children and young people with autism, because they are likely to require ongoing mental health support and to need a smooth changeover between children’s services and those for adults. One issue that I have with children’s trusts is that in some local authorities, there is a great dichotomy between children’s and adult’s services. The best local authorities manage the transition well, but there is the potential for people to fall through the gap. How do the Government intend to ensure that CAMHS and relevant adult services work together to plan appropriate ongoing support for children with a mental health problem and an additional disability, such as autism, and for all young people who require ongoing mental health support?

--- Later in debate ---

[Mr Mark Williams (Ceredigion) (LD)]

I thank the hon. Member for North West Durham (Pat Glass) and my hon. Friend the Member for Brecon and Radnorshire (Roger Williams) for the speed with which they spoke. I intended to make a bigger contribution about some of the good precedents and good practice that we have experienced in Wales, in the hope that the Minister might have a look at that, but I shall just highlight the launch on 28 June by the Welsh Assembly Government of their new child and adolescent mental health strategy and the work commissioned by the Assembly Government from Professor Sue Leekam of the Wales Autism Research Centre. It is undertaking evaluation of the assessment and diagnosis of children with disorders on the autistic spectrum, which will analyse and strategically examine CAMHS provision and many of the inadequacies of that, particularly in professional training, which we have heard about from hon. Members.

I wish to highlight also the work being undertaken by the Betsi Cadwaladr university health board, which operates in north Wales, to develop a register for children and young people with autism. I applaud what the hon. Member for North West Durham said about the lottery of service provision, but the strong message is that we must identify the extent of the challenges that face the nation. The problem was not addressed by previous Governments; I hope that it will be addressed by this one.

I end with a brief anecdote. We have heard some powerful stories this afternoon. My earlier intervention about teacher training was deliberate. I spent 12 years in the classroom and I always realised that, even as a professional, I was sometimes failing the children in my care. The problem of the little girl who used to wander around the playground with no friends should have been addressed, but teachers are not often equipped to do so. The fact was that when we told her, “Don’t touch the hot boiler in the corner of the room,” we knew that she would probably end up touching it and burn herself. I should have been equipped to deal with the many problems that that girl presented.

However, there are huge opportunities, which is a point that was made strongly by the hon. Member for Stalybridge and Hyde (Jonathan Reynolds) and others. If we create the right environment—a nurturing, caring and enriching environment—in our classrooms and in our health service provision, people on the autistic spectrum will be able to make a huge and valuable contribution to society.

I am sorry for speaking so quickly, Mr Benton, but thank you for allowing me to contribute.