CAMHS

Statistical Publication Notice

29 January 2008

Child & Adolescent Health Services (CAMHS) in NHS Scotland:
Characteristics of the Workforce Supply in 2006

INTRODUCTION

The Scottish Needs Assessment Programme (SNAP) Report on Child and Adolescent Mental Health highlighted the importance of Child and Adolescent Mental Health Services (CAMHS) and the need for development of these services within Scotland. In October 2005, the Scottish Executive published The Mental Health of Children and Young People: A Framework for Promotion, Prevention and Care which set the policy direction and a commitment to developing these services.

Delivery of good quality CAMH services depends on adequate numbers of well trained staff being available for career posts in services across NHS Scotland. In the context of the SNAP report and the emerging shape of the Framework, the Scottish Executive (now Government) established a CAMH Workforce Group to identify ways in which to build capacity for the implementation of promotion, prevention, care and treatment within CAMHS. Their report, The Mental Health of Children and Young People in Scotland: Getting the Right Workforce, Getting the Workforce Right, A Strategic Review (2005) considered the workforce implications of the Framework and provided a range of proposals about how these might be met.

The Group identified the need for accurate and up to date data about the CAMHS workforce in NHS Scotland, and a web based data collection system was launched in 2005 to capture this information. Prior to this development, pre-existing NHS Workforce data did not allow for a detailed analysis of the CAMHS Workforce. The first dataset has been published, and work is underway to further develop the system. This is the second publication of CAMHS Workforce Statistics and presents data about the CAMHS Workforce in NHS Scotland as at 30th of September 2006.

KEY POINTS

741 staff members (653.73wte) were working in CAMHS in Scotland as at 30th September 2006.
Nationally, this represents a staffing level of 12.8 clinical workers per 100,000 of the population of Scotland.
Where information on tier of Operation was provided: Tier 4 CAMHS working (day units, inpatient unit and highly specialised outpatient units) accounted for 119.3wte of total CAMHS staff
Community CAMHS (Tiers 2 & 3), as at 30th September 2006, were staffed at 10.4 clinical workers per 100,000 of the population of Scotland, although rates vary between NHS Boards.

INTERPRETATION

CAMH Services vary across Scotland and the definition includes the following service types:

Multi-disciplinary CAMHS, including clinical psychology
Multi-disciplinary CAMHS, excluding clinical psychology
"Standalone" child clinical psychology services
Island services - provided by two or three professionals

Interpretation of the data presented should be made with caution for a number of reasons, as follows:

The response rate for CAMHS to this survey in 2005 was 72%. We are unable to estimate this figure for 2006 but believe that the response rate has improved.
A proportion of the information was collected retrospectively.
There are gaps in the dataset as information is updated via each service, and does not include vacancy information.
A number of CAMHS posts, particularly in community settings, are funded through time limited revenue streams, such as the Changing Children's Services Fund, it may be likely that some of the staff in post as at the 30th of September 2006 may no longer be in post now.
The dissolution of NHS Argyll & Clyde is another factor which must be taken it account, effective from 1st April 2006. Therefore, from 2006, staff from NHS Argyll & Clyde transferred to NHS Highland and NHS Greater Glasgow & Clyde.

For these reasons, it is not advised to use the 2005 data in conjunction with the most recent iteration, as it will not reveal accurate trends in the number of new staff appointed to NHS Scotland CAMHS.

DETAILED FINDINGS

The National Service Framework for Children, Young People and Maternity Services: Child and Adolescent Mental Health (2004) suggest:

"A generic specialist multidisciplinary CAMHS at Tier 3 with teaching responsibilities and providing evidence-based interventions for 0-17 year olds would need a minimum of 20 whole time equivalents (WTEs) per 100,000 total population, and a non-teaching service, a minimum of 15 WTEs." (paragraph 9.2, p.28)

By breaking down the number of whole time equivalent staff members in CAMHS in Scotland (653.73wte) by NHS Board level and removing Tier 4 services (primarily regional and national inpatient units) it is evident that staffing levels as at 30th September 2006 (10.4 clincial workers per 100,000 of the total population) do not meet the recommended number required to deliver adequate community CAMH Services.

Currently, a high proportion of the CAMHS Workforce includes trainees and assistants and a large number of temporary posts, removing these staff from the equation is likely to paint a more unfavourable picture of the core CAMHS Workforce in Scotland.

Furthermore, there is widespread recognition amongst clinicians and policymakers that CAMHS should provide services for young people up to their 18th birthday and in some cases, e.g. young people with complex or enduring mental health issues and/or learning disabiliies, beyond this stage. (The Mental Health of Children and Young People: A Framework for Promotion, Prevention and Care, 2005). Currently, CAMHS vary in the age of population served. In some areas services are provided up to age16 only; while others offer services up to 18 years.

The 15-18 year age range in particular is associated with an increase in the incidence of severe mental health problems, including conditions such as schizophrenia (SNAP, 2005). Therefore, the unique mental health needs of young people in this age range suggest an additional workforce capcity is necessary to deliver appropriate services for this age group.

CONCLUSIONS

This is the second publication of CAMHS Workforce Statistics and presents data about the CAMHS Workforce in NHS Scotland as at 30th of September 2006.

The continued collection of reliable intelligence about the CAMHS workforce is essential for service planning and development and to ensure equity and quality of Mental Health Services for children and young people throughout Scotland.

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MAIN CONTACTS:

Alyssa Gilinsky
Information Analyst
0131 275 6343
Alyssa.gilinsky@isd.csa.scot.nh.uk

Liz Jamieson
Principal Information Analyst
0131 275 6422
Elizabeth.jamieson@isd.csa.scot.nhs.uk

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GLOSSARY:

CAMHS = Child and Adolescent Mental Health Service

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PRE-RELEASE ACCESS TO THIS PUBLICATION WAS GIVEN TO:

This is a NON-NATIONAL STATISTICS publication.
Mental Health Division, Scottish Government Health Directorate (SGHD)
CAMH Services Lead Clinicians (NHS Boards)
Graham Bryce, Consultant Child and Adolescent Psychiatrist (Greater Glasgow & Clyde) & Former Chair of the Child & Adolescent Mental Health Workforce Group.
National Workforce Planning Unit, Scottish Government

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