Vulnerable young people’s experiences of child and adolescent mental health services

Published date12 June 2017
Pages95-110
Date12 June 2017
DOIhttps://doi.org/10.1108/MHRJ-09-2016-0016
AuthorJo Davison,Victoria Zamperoni,Helen J. Stain
Subject MatterHealth & social care,Mental health
Vulnerable young peoples
experiences of child and adolescent
mental health services
Jo Davison, Victoria Zamperoni and Helen J. Stain
Abstract
Purpose The purpose of this paper is to explore the experiences of vulnerable young people in using a local
child and adolescent mental health service (CAMHS).
Design/methodology/approach A mixed methods design was employed in which participants
completed the self-report Experience of Service Questionnaire (CHI ESQ) (n¼34), and a subgroup
completed individual semi-structured interviews (n ¼17). CHI ESQ satisfaction data were also compared with
a national data sample provided bythe Child Outcomes Research Consortium (n ¼621).
Findings Many young people appeared to have a mixed or negative experience of the CAMHS service.
They strongly emphasised that feeling listened to, cared for, and supported, in addition to access and
continuity of care, are key methods to enhance their experience. They also reported a lack of knowledge
and stigma associated with mental health as key barriers to engagement with services more widely.
Research limitations/implications Purposive sampling was used to recruit a carefully defined group of
vulnerable young people from one school using a single CAMHS service.
Practical implications A number of recommendations were identified that could enhance the service
experience of young people.
Originality/value There is a significant paucity of knowledge regarding young peoplesviewsandexperiences
of CAMHS, especially those with high vulnerability for mental health difficulties. This exploratory study offers
methods forcapturing the opinions of underrepresented young people to inform future service design.
Keywords Service experience, Young people, Service involvement, CAMHS
Paper type Research paper
Introduction
The successful negotiation of key social, psychological and vocational milestones is fundamental
to a young persons successful transition to adulthood. As this critical developmental stage
between adolescence and early adulthood is also the time of greatest risk of mental health
difficulties (Kessler et al., 2007), it is imperative that young people access timely and effective
mental health support to ensure these challenges do not extend into adulthood. If left
untreated, mental health difficulties can impact significantly upon their health, well-being and
quality of life, including disruption to school, unstable employment and poor social functioning
(Burns and Birrell, 2014). Although young people have the greatest need for mental health
services, they remain the least likely of all age groups to seek help (McGorry, 2014). In response
to this vast prevalence-treatment gap, significant attention has been paid to redesigning
traditional child and adolescent mental health services (CAMHS) in the pursuit of developmentally
appropriate, youth-friendlymental health care (Plaistow et al., 2014).
Children and Young Peoples Improving Access to Psychological Therapies (CYP IAPT)
(Department of Health, 2015a) is the most recent UK national governmental initiative to transform
CAMHS, underpinned by young peoples active involvement in the planning, design and
evaluation of services to more effectively combine experiential and scientific knowledge.
Received 20 September 2016
Revised 16 February 2017
15 March 2017
Accepted 16 March 2017
Jo Davison is based at the
Early Intervention in Psychosis
Service, Northumberland Tyne
and Wear NHS Foundation
Trust, Newcastle upon Tyne,
UK and Department of Applied
Social Sciences, Durham
University, Durham, UK.
Victoria Zamperoni is based at
the Child Outcomes Research
Consortium, London, UK and
Anna Freud National Centre for
Children and Families,
London, UK.
Helen J. Stain is a Professor of
Psychology at the Department
of Applied Social Sciences,
Durham University,
Durham, UK.
DOI 10.1108/MHRJ-09-2016-0016 VOL. 22 NO. 2 2017, pp. 95-110, © Emerald Publishing Limited, ISSN 1361-9322
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The implementation of routine outcome measures, supported by the Child Outcome Research
Consortium (CORC) (www.corc.uk.net), forms a central priority within CYP IAPT to ensure clinical
effectiveness and treatment outcomes are assessed from multiple perspectives, including from
young people themselves. The Commission for Health Improvement Experience of Service
Questionnaire (CHI ESQ) (Attride-Stirling, 2003) is one such measure that enables the routine
assessment of young peoples experiences of using services. Psychometric testing has found the
CHI ESQ to be a valid subjective measure of CAMHS experience that can reliably distinguish
between services (Brown et al., 2014). As young people were also involved in its development
alongside mental health professionals, this measure derives from constructs that are also
important to them, not just those of clinicians or parents as seen in prior related research and
service evaluation efforts (Day et al., 2011; Rickwood et al., 2015).
The CHI ESQ measures a young persons satisfaction with the service environment and care
provided, which are often conceptualised as a core aspect of the wider service experience
(Ahmed et al., 2014). An increasing body of the literature demonstrates the value of young
peoples satisfaction with the care they receive (Biering, 2010; Day et al., 2011; Rickwood et al.,
2015; Watsford et al., 2013). Furthermore, Brown et al. (2014) suggest the interplay between
satisfaction and treatment outcomes highlights satisfaction as important as clinical effectiveness.
As studies have shown an association between dissatisfaction, poorer outcomes, early treatment
termination, and disagreements between young people, families and professionals around their
care (Day et al., 2011), promoting satisfaction could be beneficial in helping to minimise the high
dropout rates in CAMHS (De Haan et al., 2013), and to ensure that young people are not deterred
from future help-seeking.
Despite the importance of monitoring service-user experience and satisfaction, research
indicates a poor uptake of these measures in CAMHS, especially in regards to the CHI ESQ
reported at less than 5 per cent (Hall et al., 2013, 2014). Common barriers to the uptake of such
measures include time and resource constraints in services, and in the case of the CHI ESQ,
could be suggestive of young people having difficulties completing the measure, and clinicians
being deterred from employing this as a result of its novelty (Hall et al., 2014). Initiatives are
therefore needed to improve the uptake and repeated use of routine measures of service
experience, like the CHI ESQ, to ensure young people are empowered to voice their opinions
about their service experience.
Due in part to poor use of routine service experience measures, there is a gap in our current
understanding of how young people are experiencing mental health services in the UK. In a recent
systematic review of over 30 studies exploring young peoples views of UK mental health
services, less than 5 per cent of individuals reported actual experience of using these services
(Plaistow et al., 2014). While the review found young people hold strong and consistent opinions
about the valued and undesirable features of services, the small proportion of actual service users
included in the review led authors to conclude that further research is urgently needed to explore
the perceptions and experiences of young people using CAMHS. Particular emphasis was
placed upon those who are the most vulnerable to developing mental health difficulties given that
their views on the features they value, and their experiences, remain largely unknown within both
service evaluation efforts and the related literature to date.
Individuals may be identified as vulnerablebased on their background or circumstance,
including those fr om minority ethnic and dis ability groups, tho se experiencing socioe conomic
deprivation, and y oung people with sig nificant social a nd emotional needs t hat necessitate
specialist schooling provision (Department for Education, 2015). They often have complex and
heterogeneous needs, and experience a higher rate of inequalities in relation to access and
treatment outcome s, and are more likely t o disengage from serv ices or end treatment
prematurely (Department of Health, 2015b). Service structures can end up inadvertently
reproducing inequ alities for vulnerab le young people within p articipation effo rts, illustrated by
the fact that individuals who are engaged and motivated with good social skills are most likely to
be involved (Day, 2008; Head, 2011). Conversely, vulnerable young people are often denied
opportunities, an d their level of comple xity can lead clinic ians to position them w ithin a
protectionist fr amework and as less-than-id eal candidates for involvem ent (Dexter et al., 2011).
Actively seeking out the views of vulnerable young people through appropriate methods of
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