The ThamesValley Forensic Child and Adolescent Forensic Mental Health Team (FCAMHS Team): Developing a Mental Health Service for Young People Across the ThamesValley.
Information for Locality Specialist CAMHS Teams and Allied Mental Health Professionals (updated September 2009)
Comments and Feedback to Dr Nick Hindley, 0845 2191465
1) Introduction
Young people under 18 in contact with the criminal justice system, or those elsewhere presenting serious risk of harm to others, have high rates of mental health problems and have traditionally not accessed core child and adolescent mental health services (CAMHS). This group of young people with complex needs is highlighted in the National Service Framework for Children as requiring special consideration. In March 2004, achild and adolescent forensic mental health service was established in Oxfordshire after detailed multidisciplinary consultation, to work with this group of young people across a variety of custodial and other settings.The service has since developed to fulfil a wider regional role (see below).
The serviceis now funded by a combination of:
- central NHS prison in-reach monies mediated by Oxfordshire PCT (for prison in-reach provision to HMYOI Huntercombe)
- regional specialist commissioning funding for the regional community component of the service
Service level agreements operate for both components of service provision.
The team offers a range of services and interventions to a specific geographical area (Oxfordshire, Buckinghamshire, Berkshire and Milton Keynes). The team provides specialist child and adolescent mental health expertise at a variety of levels and to a variety of institutions and networks working with young people under 18 years old in the criminal justice system. The scope of the team’s remit is broad and is highlighted in figure 1.
2) General Functions
The multidisciplinary team functions on several levels in all environments:
- As a resource for information
- As a means of formal consultation
- As a service providing specialist assessments and interventions
- As a training resource for front-line workers
- As a means of informing and developing strategic links between mental health services and the criminal justice system.
3) Specific Functions
a) Mental Health In-reach to HMYOI Huntercombe (380 15-18 year old sentenced male inmates)
The team provides multi-disciplinary child and adolescent mental health input to the prison as well as providing supervision for primary mental health workers. There is a strong liaison function within the prison and with boys’ home services across the south of England.
b) Regional Tier 4 Child Tertiary Referral Service for Oxfordshire, Berkshire, Buckinghamshire and Milton Keynes
The service is principally a tertiary referral service for CAMHS teams (including CAMHS/YOT linkworkers) although contact from other agencies is not excluded.The team wishes to be accessible to all agencies (eg. social services, YOTs, prisons, courts, solicitors, education etc) which may have contact with risky young people or young people in the criminal justice system who have mental health difficulties. For this reason initial contacts about possible referrals are welcomed from all agencies; however, referrals for assessments are usually only accepted with the knowledge and active support from local CAMHS tier 3 services.
Other Functions within regional role include:
i) Child and Adolescent Forensic Mental Health Input to Other Custodial Settings
The existence of a specialist service covering a specified geographical area allows for the possibility of input from the service to custodial institutions not previously linked in a coherent way.
ii) Liaison with Locality CAMHS and YOT’s
The teamhas worked to establish good working and training relationships with local services. It seeks to promote good local arrangements for mental health working between locality specialist CAMH teams and YOTs. The ultimate aim of this area of strategic development will be to develop coherent practice models based on local initiatives (eg CAMHS/YOS mental health linkworkers) supported by the specialist FCAMHS team.
The team maintains strong liaison links with individual CAMHS and YOS teams and provides specialist support for CAMHS/YOS linkworkers.
iii) Liaison and Advice to Courts and the Legal System
The team seeks to act on various levels in its contact with courts and the wider legal system i.e. as both a resource for general advice and more formal consultation as well as a provider of specialist assessments and management advice. The emphasis in this area would be to support local services to develop appropriate skills to carry out this function themselves with recognition that in particularly complex cases the team’s direct input will be required. (This latter role will require direct funding on a case by case basis).
iv) Wider Strategic Functions
- Linkage with national in-patient services
- Linkage with services elsewhere involved in mental health provision to young people in secure or community settings
- Informing policy and forming strong links with national organisations responsible for strategic development
- Providing professional training for individuals wishing to obtain the necessary experience to work in this area of expertise
4) Referral Process (see Figure 2)
Referral criteria are as follows:
- The young person is under 18 years old
- The young person has already had a mental health assessment where mental health needs have been identified and remains in contact with local CAMH services
- The young person is in contact with the criminal justice system (serious offences) or is presenting with risk of serious harm to others
Referral process:
- The referrer will provide clear reasons for referral and adequate background information including baseline risk assessment
- The referrer will undertake an initial verbal consultation with a designated member of the FCAMHS team
- Referrers will retain overall clinical responsibility for the young people they refer. They should also identify a CPA case coordinator who will remain in contact with the case throughout the period of FCAMHS team involvement.
Referral outcomes: there will be three possible outcomes for referrals which will be fed back to referrers:
- Referral accepted for consultation to referrer/local network re general management (no direct clinical involvement).
- Referral accepted for specialist assessment and advice re future management. This outcome requires the home team and network to remaininvolved with the case (e.g. by providing a care coordinator) and to participate in ongoing risk-management. Following the assessment the FCAMHS team will remain involved, as appropriate, to support the local network to manage the case.
- Referral not accepted
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Figure 2: FCAMHS Team: Regional Community Forensic Service: Referral Pathway for Young People under 18
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