Child and Adolescent Mental Health Services (CAMHS)
Child and Adolescent Mental Health Services (CAMHS) are provided to children
and young people under the age of 18 who suffer from a functional mental
health problem, which range from common issues like anxiety and depression,
to severe illness such as schizophrenia and bi-polar affective disorder. In
contrast to adult mental health services children and young people’s services
operate on a wider spectrum with some support offered by non-specialist staff in
a range of settings e.g. schools and youth clubs.
Around a quarter of young people (28% of 11-16 year olds) and 22% of post-
16’s in the NFER survey reported feeling very sad or depressed at least one or
two times a week. It is important to stress that depression in this context is not
related to clinical diagnosis of any kind.
Kent mirrors the national picture in terms of children and young people with a
mental health need and the table below sets out estimates of numbers in Kent.
The mental health issues are estimated in relation to the existing CAMHS tiered
system in Kent.
Tier Description Estimated Estimated
Prevalence numbers in
One Mild emotional and behavioural 15% 51,441
Two Moderately severe problems requiring 7% 24,006
attention from professionals training in
Three Severe and complex mental health 1.85% 6,344
problems requiring a multi-disciplinary
Four The most severe, persistent and 0.08% 274
complex problems requiring specialist
The Joint Strategic Needs Assessment (JSNA) Health, well-being and healthy
public policy–January 2010, highlighted areas of inequality in Kent. The
evidence suggests there is a strong link between the prevalence of the most
common disorders in childhood and adolescence and social disadvantage.
Children who have experienced significant adversity in early life being at
particularly increased risk.
November 2011 1
Ten per cent of five to fifteen year olds have a diagnosable mental health
disorder. In Kent this equates to 17,608 children and young people.
Kent and Medway Children’s Joint Strategic Needs Assessment
National Service Framework for Children Young People and Maternity Services
The public health team have recently undertaken an updated CAMHS needs
assessment (June 2011) and this can be accessed at the public health
observatory via the link below.
The total value of commissioned community services at Tier 2 (targeted) and
Tier 3 (specialist) by health in Kent is in the region of £13 million.
The Tier 4 service which is largely inpatient based is £4.9 million across Kent &
Medway. In addition the PCTs also spot purchase on demand for young people
with very complex problems who require provision involving highly specialist
Specialist services at Tier 3
Kent and Medway Mental Health and Social Care Partnership Trust (KMPT)
provide CAMHS services in west Kent and Medway including the Dartford,
Gravesham and Swanley (DGS) locality. Commissioners meet with KMPT on a
monthly basis to review performance against the contract. A number of
performance indicators are monitored including waiting times for assessment
and treatment, numbers of urgent and routine referrals, number of contacts,
discharges and length of stay on caseload by different teams. Other areas such
as staff vacancies and capacity issues are also discussed.
Commissioners are working closely with providers to improve the data they
collect in particular for Looked After Children and are also developing a
dashboard of indicators to better focus on and monitor trends in key areas.
The table below shows comparative average waiting times for assessment in
weeks by CAMHS team across Kent over the last year.
November 2011 2
Average waiting time from referral to assessment for specialist CAMHS
Team Feb 2011 April 2011 June August Oct 2011 Jan 2012
Canterbury 24 16 8 4 4 6
Thanet 13 13 14 14 16 18
Shepway 44 26 12 6 8 12
Ashford 18 18 18 18 21 14
Dover 12 12 12 6 6 6
Dartford, Gravesham & 14 16 16 15 14 17
Maidstone and Malling 11 10 10 9 10 14
T. Wells, Tonbridge and 11 11 15 8 9 9
Swale 7 8 8 7 6 10
Average across Kent 17 14 12.5 11 10 12
Overall average waiting times for Kent have improved slightly over the last
couple of months with average assessment time now down to 10 weeks and
treatment times at 12 weeks.
In west Kent waiting times for assessment have remained unchanged though
waiting times for treatment have improved particularly in Dartford, Gravesham
and Swanley and Tunbridge Wells.
DGS has the highest number of deliberate self-harm referrals in west Kent,
which require an immediate response. They also have the largest caseloads
and the longest average length of stay on caseloads. Much of this is attributed
to the high number of ADHD cases the team holds, largely for medicine
management and review.
Targeted services at Tier 2
These services are provided by Kent Community Health Trust. The
commissioner meets with the provider on a quarterly basis and receives
monthly performance reports.
This service is small and historically underfunded. In addition the team has
been affected by staff being on long-term sickness and as a consequence a
considerable waiting list has built up. The trust has sub-contracted work to a
voluntary sector partner over the last few months and there have been
discussions with the locality CCG regarding short-term investment to bring the
Significant progress has been made to re-commission emotional wellbeing
services and mental health services in an integrated model, which will address
the main recommendation of the National Support Team visit in September
November 2011 3
2010, to completely redesign the system across Kent and deliver integrated
emotional wellbeing, primary and specialist mental health services.
Following consultation with providers and agreement by GP commissioning
boards, final approval was given by the Kent & Medway PCT cluster board on
20th July 2011 to procure a new community CAMHS service. Approval for the
re-commissioning of early intervention emotional wellbeing services was also
agreed by KCC cabinet on 18th July 2011. Both these processes have now
started and the plan is for EWB services to be commissioned for April 2012 and
a new community CAMHS service to start in September 2012.
The Kent & Medway PCTs have invested new monies to ensure CAMHS
services can be available for young people up to the age of their 18th birthday.
The service is now operational and its administrative base is at Gatland House
in Maidstone but the team accepts referrals from west Kent, Medway and Swale
for all newly presenting 17 year olds.
There is additional investment in west Kent, which will enhance the service for
16 and 17 year olds known to CAMHS and support them in transitioning to other
There are two further developments as part of this investment package that will
directly benefit DGS. Firstly a senior nurse practitioner for ADHD based in the
T3 CAMHS team. This person started on 7th November 2011. Secondly an out
of hours service from 5.00 p.m. to midnight to be available for A & E
departments, including Darent Valley, particularly for young people presenting
having self-harmed. This service started in September 2011.
In addition the team are now providing a daily in-hours service to the hospital.
National Support Team (NST) Action plan
Following the visit from the Department of Health NST in September 2010 a
number of recommendations were made and an action plan formulated to adopt
these recommendations and monitor implementation. A group including key
staff from the PCTs and KCC are responsible for overseeing progress on the
plan an updated copy of which is attached.
One key area of the plan is the development of CAMHS Access Points (CAPs)
to provide better co-ordination of CAMHS and emotional wellbeing services
across health, education and social care, ensure a quicker response to the most
appropriate agency and avoid duplication of service.
Considerable work has been undertaken between the child health
commissioning team and KCC, in particular to ensure that this process
interfaces with CAF and SPA. Implementation groups have been set up to
develop pathways and referral processes in west Kent including DGS.
November 2011 4
Expressions of interest have been received from prospective providers of the
community CAMHS service and they have undergone an initial evaluation.
Those prospective providers that have successfully completed this initial
evaluation have now been invited to tender for the service.
UPDATE APRIL 2012:
Tenders are now in the process of evaluation with recommendation to the PCT
board to be made by 30th May 2012.
Senior CAMHS Commissioning Manager
Child Health Commissioning
NHS Eastern and Coastal Kent & NHS West Kent
November 2011 5