Mental Health Services for Children and Young People: The Past, Present and Future of Service Development and Policy
| Published date | 01 June 2004 |
| DOI | https://doi.org/10.1108/13619322200400014 |
| Date | 01 June 2004 |
| Pages | 6-14 |
| Author | Stella Charman |
| Subject Matter | Health & social care |
Mental Health Services for Children and
Young People: The Past, Present and
Future of Service Development and Policy
Stella Charman
Director, CAMHS Consultants
Framework Feature
Introduction
This article provides an overview of the development
of mental health services for children and young
people (CAMHS) in England and Wales. It describes
the early growth and gradual emergence of services to
the forefront of national policy in recent years. The
present position in relation to the national policy
agenda and CAMHS development is assessed, and
some conclusions are drawn about how services are
likely to change in the future in response to a variety
of influences. Comments and observations regarding
the impact of policy on services are based on the
author’s extensive experience of working as a
consultant with CAMHS and on a database of
information on over 40 specialist teams.
The past
Child guidance
Although the development of child psychoanalysis
and the child guidance model date back to the 1920s,
it was only in the second half of the twentieth century
that the mental health of children became the subject
of study and research by the mainstream mental
health professions. Mental health services for children
then began a long struggle to attract the same degree
of attention and resources, as did adults, but they were
largely overlooked by policy-makers and managers
alike until the last decade. In a National Health
Service in which mental health was generally regarded
as a ‘Cinderella’ service, child and adolescent mental
health services were an immature offshoot. Most
commonly, services began to develop and were
configured within child guidance clinics, which in
theory combined professional skills from different
agencies but frequently failed to produce an
appropriate multidisciplinary therapeutic response to
the problems presented by children and their families.
Many of these clinics were uncomfortable places in
which to work, and appeared to be disconnected from
and unaccountable to the health authorities and the
education and social services departments which had
placed staff within them. By the 1990s many were
either being dismantled and the staff and resources
withdrawn to parent agencies, or were being re-born as
child and family consultation clinics which have since
grown into the specialist CAMHS teams of today.
Focus on children’s rights
The turning point for CAMHS came with an
emerging awareness of the needs and rights of
children, independent of those of adults, which was
given international recognition and status by the 1989
United Nations Convention on the Rights of the
Child. In the UK the Children Act 1989 was passed.
This new focus led to a number of major reports and
studies being undertaken in the early 1990s which
identified serious deficits in service provision,
proposed significant service changes, and laid the
foundation for the development of more effective
provision for children and young people.
Emergence of the four-tier model of CAMHS
In 1994 the first comprehensive audit of the resources
available to children and young people with mental
health problems uncovered wide variations in staffing
and practices across England, and highlighted the mis-
match between resources and need (Kurtz et al, 1994).
Its findings were incorporated into Together We Stand, a
Health Advisory Service (1995) review of specialist
child and adolescent mental health services which
6The Mental Health Review Volume 9 Issue 2 June 2004 ©Pavilion Publishing (Brighton) 2004
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