Child and Adolescent Mental Health Services

Pat Glass Excerpts

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?

--- Later in debate ---

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

I thank my hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) for securing the debate, which has been excellent. I do not disagree with anything that I have heard, nor do I intend to repeat any of it. I shall concentrate on the areas that I have the most concerns about.

We have come a long way in recent years and there have been improvements, particularly in education, but we must not be complacent and there is still a long way to go. The two areas that I have the greatest concern about are transition, which I shall come on to, and diagnosis. This refers back to the issues of child and adolescent mental health services. In my experience, far too many children still receive a diagnosis that is less related to their symptoms and difficulties than to who they are and where they live. I still see too many cases in which clinicians go down the route of attention deficit hyperactivity disorder or EBD—emotional and behavioural difficulties—first, because of the family and where they live. That means that those children and their families do not gain access to the diagnosis, services and provision that they need. That is one concern, and it relates to what I said in an intervention about the quality and consistency of CAMHS across the country. If people look at the issue geographically—on a map, as I have done—they will see hot spots of certain diagnoses, and sometimes around certain clinicians. Those issues need to be addressed.

Everything that I have heard today about transition, particularly transition in the early years, is absolutely correct. If we get that right and provide access to the right services—good, well co-ordinated provision—the mental health of those children and their families will be much improved, outcomes will be much improved and we will save money in the long run. Transition in the early years is crucial and will save us money in a time of austerity.

The transition at the other end is also an issue. A lot of emphasis has been placed on that in recent years, but in my experience that has been about the process—the right forms filled in by the right people, and the right people being at the right meetings at the right time. For the families, the process can be fabulous, but if there is nothing to transition on to, it is a disaster for them.

When I was in my former role in education, we recognised that there was almost a time bomb here. Children are going through the education services and coming up to the adult services, but those services are not there for them. Will the Minister consider the issues of diagnosis and quality of provision across the country to ensure that a child’s diagnosis is right and not based on the family’s circumstances or socio-economic grouping? Will she also consider transition in relation to the quality of provision, not just the processes, forms and meetings?