Child and Adolescent Mental Health Service Review

The review of the Child and Adolescent Mental Health Service (CAMHS) was progressed as part of the broader Tasmanian Mental Health Reform Program (TMHRP). The objective of the CAMHS review is to ‘enable an integrated pathway for children and adolescents and their families and carers to navigate the mental health system.’ The review was undertaken by an independent consultant, Professor Brett McDermott who has extensive experience in child and adolescent psychiatry and in the design and implementation of contemporary CAMHS service models in other jurisdictions.

New CAMHS Case Studies

1. Youth Service

Printable PDF version (Case Study 1)

Georgie is 14 years of age and has a background of severe trauma and suffers from anxiety. Georgie also has physical health problems and has been bullied at school, which has led to her refusing to attend, and she is becoming increasingly socially isolated from friends and family. One night, Georgie self-harms and attempts to overdose, and is discovered by her mother. She discloses to her mother that she has been thinking about suicide for several weeks.

Under the current system:

Georgie is admitted to the paediatric ward where she is assessed as having Post Traumatic Stress Disorder (PTSD).

Georgie was discharged home after two days with an appointment made with a new private psychologist. Given Georgie will need regular and consistent support, her discharge plan outlined that she should be followed up by Child and Adolescent Mental Health Services (CAMHS) if she was not able to have regular appointments with her new psychologist.

In the new CAMHS Youth Service:

Georgie is considered to be a young person with severe and complex problems needing a team approach to her care. She is allocated a CAMHS worker who begins assertive care with her at home instead of in hospital. Georgie has a safety plan developed and she is also referred to the After-Care Suicide Response Service.

The CAMHS Youth team work with Georgie and her school to develop a transition plan for her return, and her GP to develop a plan to address her physical health issues, including diet and lifestyle choices.

Georgie’s mum is supported by the CAMHS outreach team to build her capacity to manage Georgie’s mood swings, suicidality and anxiety.

2. Out of Home Care Team

Printable PDF Version (Case Study 2)

Kristy is 17 and has lived in multiple out of home care placements. She has an intellectual disability, autism spectrum disorder (ASD), a history of low mood and distress, self-harm and suicidality. Kristy also needs frequent prompting to complete activities due to her intellectual impairment. When Kristy becomes unwell, she is known to run away and attempt self-harm and her placement is at risk of breaking down.

Kristy is admitted to hospital after a serious suicide attempt. While she is in hospital, a decision is made that Kristy will not return to her current placement when she is discharged.

Under the current system:

Kristy is very overwhelmed about being in hospital and on occasion staff have no choice but to restrain her for her own safety and others.

Kristy is discharged to her new home following a week in hospital. A referral is made to CAMHS for outpatient follow-up and she is started on an anti-depressant.

In the new CAMHS Out of Home Care Team:

A long-term treatment plan is developed by a multi-disciplinary team who are experienced in working with young people experiencing trauma.  The team work to stabilise Kristy’s behaviours at home with a combination of specialist psychological therapies, and medication and behaviour support strategies and training, avoiding the need for her to go to hospital or her placement breaking down.

Kristy is also referred to the CAMHS day program to attend group work around self-management of her behaviour and anxiety with peers around her age.

Kristy’s workers are trained in the Connecting with People approach for mitigation of suicidal distress, and after a 6-month period, the staff are becoming more comfortable in how to manage Kristy’s behaviours and suicidal ideation when she becomes unwell.

Kristy’s Child Protection Worker makes an access request to the NDIS with an aim to build her capacity to live more independently and to transition support for when she eventually leaves out of home care.

3. Early Intervention Service & Youth Forensic Mental Health Service

Printable PDF Version (Case Study 3)

Simon is 15 and lives with his grandmother and biological father. Simon has a history of poor impulse control and difficulty managing his emotions. Simon has a Conduct Disorder and Attention Deficit Hyperactivity Disorder (ADHD) and has recently experienced psychotic symptoms. From a young age, he had difficulties at school including poor concentration, poor attendance, difficulty complying with rules and difficulties interacting with his peers. Simon would often run away from school and refuse to go back.  He was expelled from school at 13 and began a life of crime, violence and substance use.

Under the current system:

Simon is referred to Youth Justice and is allocated a youth worker. He is also referred by his paediatrician to Child and Adolescent Mental Health Services (CAMHS), but due to his high support needs, they are not able to provide the level of support that he needs.

Issues with school, patterns of criminal activity and substance abuse continued, and Simon is eventually detained in Ashley Youth Detention Centre. There is minimal follow up when he was released, so he continued to reoffend, and this became his trajectory for the next few years.

In the new Youth Early Intervention Service and Youth Forensic Mental Health Service:

Simon is referred to the CAMHS Youth Early Intervention Service. The team provide assertive outreach to Simon in his home, his school and his family providing a range of specialist therapies to manage his emotional regulation and poor impulse control.  The Youth Intervention Service works in partnership with Simon’s paediatrician and alcohol and drug services to connect him to counselling and support and provide education and support to his family.

The Youth Forensic Mental Health Service work with Simon and his family to address his offending behaviour and develop a risk management plan for him. The Youth Justice Court accepts these two interventions as an alternative to going into Ashley Youth Detention Centre on the condition they remain intensively involved over the next two years and Simon and his family continue to engage with the service.