Mental Health of Children &
Adolescents:
The work of the Child and Family
Consultation Service
Dr. Joshua Westbury
Consultant Child and Adolescent Psychiatrist
Southend CFCS, South Essex Partnership NHS Trust
July 2012
Introduction
• All of you are here because you already have
some interest in, and some knowledge or
experience of mental health issues
• Please ask questions
• Please tell me what you think
Mental health issues faced by
young people
Are young people just little adults?
YES
• Same species
• Live in same place
• Same body
• Same language*
• Accident and illness
• Adults were once children
*LOL
NO
• Developmental process
• Biological differences
• Attachment
• Growth spurts
• Puberty
• Dependence on adults
• Education
• Responsibilities
Can a four year old be depressed?
Can a four year old be depressed?
• Controversial cases in media
• Depression is more than just unhappiness
• Low mood that is persistent over time and
doesn’t lift when circumstances change
• Severe enough to affect thinking and biology –
appetite, sleep, energy, concentration etc.
• Emotional development in early life poorly
understood but four is probably lower limit
When is it “just bad behaviour?”
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Depression: can present with angry spells
Anxiety: can cause fight or flight behaviours
ADHD: not ‘bad’ behaviour but ‘impulsive’
Obsessive-Compulsive Disorder, autism, tic
disorders: repetitive behaviours
• Alcohol and drugs
• Situational response and mimicry
• “Just bad behaviour”
“Isn’t it just bad parenting?”
• Anorexia nervosa
– Any family
• Schizophrenia
– Any family
– Genetic factors
– Environment factors
• Autism
– Any family
– Genetic factors
• ADHD
– Any family
– Genetic factors
The child
SCHOOL
FAMILY
THE CHILD
COMMUNITY
Examples of causes
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Genes
Bereavements
Change of school
Bullying
Trauma
Loss
Social and family stress
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Isolation
Alcohol and drugs
School exams
Physical illness
Being a child carer
Environment
No known cause
Impact of mental health issues
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Pain and distress
Disability
Can be stressful for whole families
Impact on education
Impact on social development
“Missing out”
Accidental or non-accidental harm
Long term consequences
What helps?
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Exercise and diet
Consistency, boundaries, encouragement
School and social circle
Listening!
Support for parents
Teams, clubs and societies
Therapies for individuals, groups and families
Medical interventions
Questions?
Child and Family Consultation
Service
What is CFCS?
• CFCS
Child and
Family
Consultation
Service
• CAMHS
Child and
Adolescent
Mental
Health
Service
Tiered care services
• Tier 1
• Tier 2
• Tier 3
• Tier 4
General Practice
Mental health workers in
community settings
PMHT
Charity sector
Integrated generic mental health
services e.g. CAMHS, CMHT
Inpatient services
Highly specialized clinics e.g. eating
disorders, Tourettes, OCD, autism
About CFCS
• The purpose of tier 3 is to provide an integrated service to
patients and families with complex difficulties
• We are an outpatient clinic
• We offer direct face to face work with the patient and their
carers, provided by one or more clinicians
• We provide carer support
• We provide liaison and consultation to other services
• We are multidisciplinary and can work using different
approaches with the same family at the same time
• We are not focussed on a single diagnosis or other type of
problem, or a single philosophical approach
South Essex CFCS teams
Who works at CFCS
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Child Psychiatrists
Clinical Psychologists
Social Workers
Mental Health Nurses
Family Therapists
Art Therapists
CAMHS Practitioners
Administrators
Referrals
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GPs
Schools
Social Services
CAF
Single Gateway
Examples of presentations
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Changes in behaviour
Changes in mood
Changes in eating
Developmental delay
Not attending school
Self harm
What do we offer?
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General and specific assessments
Family support
Individual therapies
Medication
Family therapy
Groups
Working in the real world
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We are a small team
One doctor
Five to six (FTE) therapy team
Covering a large area with a lot of needs
Part of a NHS Trust that spans South Essex,
Bedfordshire and Luton
• Commissioned to provide specific services
Working with other services
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Links with Tier 2 and Tier 4 services
Therapist seconded to Paediatrics
Therapist seconded to Youth Offending team
Medical support to Early Intervention team
Medical support to Drug and Alcohol Service
Medical support to Learning Disability team
Joint work with Crisis /Home Treatment team
Social worker seconded to CFCS
Promoting recovery
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Where are you now?
Where do you want to be?
How can we help you get there?
Shared expertise
Shared responsibility
Role in child protection
• Same responsibilities as any agency working
with children and families
• Act on concerns or to prevent danger
• Share information to prevent danger
• Work with families to resolve issues
• Maintain confidentiality
• Ensure our staff are checked and trained
Risk management
• We work with children who may present a risk
to themselves or others
• Sometimes a mental health issue can be a life
threatening illness
Risk management
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Suicidal behaviour
Impulsive behaviour
Self harm
Self neglect
Malnutrition, starvation
Social exclusion
Exclusion from school
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Aggressive behaviour
Alcohol and drug use
Excessive cleaning
Absconsion
Disinhibition
Vulnerability to abuse
Risk management
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This is a whole day’s topic in itself...
Assessing and making plans
Involving young person and their family
Working together with other agencies
Knowing who can and who can’t help
Taking “therapeutic risks”
Risk is never zero: but it is our job to help
manage risk as far as it is possible to do so
Questions?