1. Written Submission from Thornby Hall for Health Select
Committee for Inquiry re Children’s and Adolescent Mental Health
and CAMHS.
The author is clinical lead at Thornby Hall therapeutic community.
Thornby Hall is a part of a charity called Childhood First that offers long
term specialist residential therapeutic care, education, and treatment to
children suffering severe emotional and behavioural disturbance as the
result of early life trauma.
Thornby works with a group of around twenty high acuity adolescents.
Over the last five years more than 60% of admissions have had direct
experience of CAMHS and more than 50% come direct from either NHS or
private tier 4 adolescent psychiatric provision. These are young people
who have become “marooned” in psychiatric settings. This often reflects
complex and intractable circumstances within their families that have
generated the chronic problematic behaviours leading to CAMHS
involvement.
Crucially the setting provides a context in which these young people are
children looked after under the Children Act rather than patients under
the Mental Health Act. This provides the opportunity to receive care and
treatment that creates conditions supporting access to an educational
pathway leading to a position from which they can become net
contributors to society rather than consumers of services. This structure
also enables them to be supported in, and rewarded for, further
educational achievement as independent young adults under the Children
Leaving Care Act. This is in striking contrast to other routes available for
young adults to access support which require them to evidence
vulnerability or an inability to cope, and then to consume services from
health or social care.
This submission is based on engagement with twenty five different
authorities over the last five years to provide individual placements for
highly complex young people. Circumstances have also evolved in which
young people with equivalent complex presentation referred by other
authorities have not been placed because their CAMHS services have
judged they do not have mental health needs.
The young people from Thornby Hall are aware of this inquiry. We have
discussed it in our community meeting. A group of residents have
prepared their own submission which they have sent alongside this one.
What has impressed me through this process is their preparedness to
reflect on their own experience with CAMHS and their wish to represent it

2. in a way that might mean other young people could benefit from their
experience in the future. I am aware that they have asked for the chance
to talk directly with you about these things. They are articulate and would
be able to take the opportunity to describe their experiences and views in
greater detail if that would help the progress of the inquiry.
I have laid out my own responses to the terms of reference below:
The current state of CAMHS, including service provision across all
four tiers; access and availability; funding and commissioning;
and quality
1. There is enormous variation of resource and skill between
authorities.
2. There seem to be clear occasions when CAMHS agencies describe
young people as not meeting criteria for diagnosis either to avoid
responsibility for risk management or through limited resource. –
This observation is based in anecdotal experience in which young
people with equivalent difficulties have access to widely varying
services depending on the area in which they live.
3. Our predominant experience is of tier 4 provision and based in the
records provided and the accounts professionals and young people
give us of their experience as service users. This suggests a huge
variation in quality based in part on available skills and resources,
but also on the constitution of the group of young people being
treated at any moment.
4. It is extremely rare for tier 4 provision to provide a coherent well
prepared analysis of the composition and function of a young
person’s family. In our view this often means key elements in the
aetiology of their presentation are not addressed. It would also be
important to notice that this often reflects enduring and intractable
complexities in family function that would be best addressed
through effective inter-agency working.
5. There are some authorities in which there appears to be a growing
gulf between psychiatrists and commissioners which can impede
decision-making and action.
Trends in children’s and adolescent mental health, including the
impact of bullying and of digital culture
1. A proportion of young people who, in our judgement, would
previously have presented as complex cases within the social care
sector are now presenting through tier 4 psychiatric services. This

3. reflects a reduction in the availability and coherence of social care in
some authorities.
2. 100% of the young people we have admitted over the last five
years are reported to have had difficulties in the area of bullying
predominantly as victim but also as perpetrator
3. 66% of the young people we have admitted over the last five years
are reported to have had difficulties that have arisen through the
internet and mobile phones.
Data and information on children’s and adolescent mental health
and CAMHS
1. Childhood First are participant members of the Camhs Outcomes
Research Consortium. The data gathering and processing this
facilitates is helpful both in the assessment of individual progress
and to benchmark quality across the sector.
2. It would be helpful to find a way in which young people’s histories
and family function could be recorded in greater detail to support
targeted clinical work.
Preventative action and public mental health, including multi-
agency working
1. Our consistent experience is that a pathway plan leading from
“patient” to “student” makes sense to young people, professionals,
and families and motivates progress.
2. Multiagency working is pivotal in constructing a robust framework
that enables admission, treatment, and discharge processes that
can properly assess, intervene, consolidate, and sustain
improvement for young people.
3. The best conditions for an effective intervention are achieved when
it proves possible to attain a united view between health, care, and
education professionals, and their respective commissioners. This is
a complex task that requires expertise, focus, and energy. Often
this seems only achievable when the young person has generated a
crisis that “concentrates the mind” of the network. The first task in
a referral and admission process is to proactively engage with the
professional network to achieve these conditions.
4. The promotion and maintenance of an effective multiagency
network to support placement requires regular network meetings,
for the most part we achieve this by synchronising education and
health review processes to run in parallel with the LAC review
framework.
5. Education Health and Care plans as proposed in the Children and
Families Bill (2013) could potentially provide a structure to further

4. develop these processes. Thus far only one referring authority has
referenced their implementation.
Concerns relating to specific areas of CAMHS provision, including
perinatal and infant mental health; urgent and out-of-hours care;
the use of S136 detention for under 18s; suicide prevention
strategies; and the transition to adult mental health services
1. We regularly look after young people past their eighteenth birthday.
We have been impressed with the number of CAMHS services who
have found creative ways to ensure that psychiatrists who have had
consistent relationships with clients over years can continue to
maintain these into early adulthood.
Mark Waddington
Deputy Director