The pioneering Enfield Child and Adolescent Mental Health Services (CAMHS) co-production project commenced in March 2022, and was completed in October 22. It was designed and led by Meera Kapadia; a CAMHS psychotherapist/ BEH Transformation and co-production Project lead, alongside community researchers Maggie Byrne and Miguel Arnez.
CAMHS services are under unprecedented demand and new innovative thinking and action is required to change the system. Co-production provides some answers as it involves providers of services moving from “doing to” to “working with “users of services, in an equal power sharing partnership, to improve the system. To this end, the Enfield CAMHS project involved gaining the perspectives and innovative ideas of young people, parents, and professionals, to improve mental health services locally.
Nine focus groups with a total of 76 participants took part in this research. This included 24 young people, 25 professionals and 27 parents. Equity and diversity have been major considerations when recruiting focus group members. 50 % of all young people were from Black, Asian and minority ethnic groups, and there were an equal number of boys and girls in the groups.
The focus groups were reviewed to identify common themes across the nine groups. These reviews were co-produced with two young community researchers who have lived experience of mental health issues and CAMHS, as well as a CAMHS parent.
Meera said:
“This ground breaking project is a deep dive into mental health and emotional wellbeing services in Enfield, and the insights are wide ranging. We learnt about the desire to have more codesigned signposting to help navigate the complex mental health system, and young people friendly mental health platforms, as well as families wanting all children’s services to be based together, in community mental health hubs, across organisational boundaries.
We learnt about the passion of young people parents and professionals in the field to become community change makers and help us improve our services. “
Maggie said:
“The analysis process for this project has allowed a plethora of voices to be heard, all of whom are stakeholders in the mental health of young people in Enfield. Concerns, issues, stories, perspectives and ideas differ between groups, yet there are startlingly clear and coherent themes and relationships which transcend the whole data set. The most striking takeaway from the results is arguably the tragic cycle which stems from the long wait for CAMHS intervention. People voiced the same sequence of events, in which young people had waited so long to be seen by mental health services, that their condition had dramatically deteriorated during this time. Existing in parallel to this phenomenon is the deficit of communication between different stakeholders surrounding YP with mental health issues; schools, GPs and CAMHS urgently need to collaborate and communicate better in relation to referral pathways, the general state of YPs wellbeing and containment whilst on the CAMHS waiting list. In a similar vein, parents and professionals alike have repeatedly voiced the lack of knowledge of and signposting to mental health services which frequently remain unknown to those who urgently need them, especially in the absence of timely CAMHS intervention. Encouragingly, there is keen recognition that more early intervention in the community may be a key part of the solution to the problems outline above; early intervention talking therapies, youth clubs, mechanisms to tackle stress and anxiety in young people before things get to the CAMHS threshold of severity.
The project has revealed valuable insights about the experiences of YP with neurodevelopmental disorders and YP from minority ethnic groups, revealing how their journey from recognition of mental issues, to referral, to access and to treatment is often more fraught with even more specific barriers.”
Miguel said:
“It’s been very interesting to see how consistent the messages are across different stakeholders. If you take all the different perspectives from each of them, you come up with a very coherent picture of what people need in the borough”.
The in-depth analysis of the data identified five final themes, from the nine focus groups were.
1.Comms and engagement
These were elaborated on to create 12 cross cutting themes. These included:
1. Parents and sibling support: parents solutions included self help groups run by parents for parents. It also included the need for therapy for parents and siblings, particularly siblings of young people with neurodevelopmental issues
2. Mental Health stigma: addressing these through young people and parents’ friendly mental health campaigns and psychoeducation for parents and professionals.
3. Equity: Mother tongue languages, culturally sensitive CAMHS, and hearing loops for people with disabilities as standard.
4. Socio political context: impact of austerity on cuts, Sure start, children’s centres, and length of CAMHS waiting lists leading to mental health decline on the waiting lists
5. Schools: This included the need for better comms between schools, CAMHS and parents.
6. Interagency collaboration: More relational informal networking to enhance collaboration
7. Lack of knowledge/ signposting: Families and professionals need better signposting and thought of codesign ideas for this
8. Early intervention services: Need for more early intervention services.
9. Internal CAMHS
10. External CAMHS
11. In patient services
12. Neurodevelopmental Service (NDS) / Special Educational Needs and Disabilities (SEND)
A final feedback event was held in the community on 19th December 2022, and was attended by 18 young people, 10 parents and over thirty professionals across the system, who were very passionate about implementing the co-design and co-production ideas. Barnet, Enfield and Harnigey senior leadership from the board with Enfield CAMHS staff all attended and committed to continuing the coproduction journey with the community.