I must confess I hadn’t heard of Community Forensic CAMHS services, so it was interesting to sit down (virtually) with Dr. Andrew Newman from Oxford Health NHS Foundation Trust to hear all about the work they do. The service is quite new, established nationally around 3 years ago, although already operating in some areas prior to that. Currently it covers all of England, divided into 13 regions. As a highly specialist service, the regions are large and Andy works within the South West (North) Community CAMHS service, covering Bristol, South Gloucestershire, Gloucestershire, North Somerset, Wiltshire, Swindon, Bath and North East Somerset.
Working at the interface between mental health and risk of harm to other people, the service has many functions primarily focused on supporting professionals who work with complex cases and to intervene (ideally at an early stage) to prevent custody or secure hospital. It works supporting children and young people up to the age of 18 (though the majority seen are older – around 14 and 15), and these are high harm situations, presenting a risk to others, where there is are concerns about the young person’s mental health – but this can include trauma and neuro-developmental conditions. Many of the young people the service provide input to may have never been seen by mainstream CAMHS because of rigid referral criteria, limited capacity and long waits, and recognised issues with engagement.
All the work involves risk of harm to others. Some children and young people are referred because of the risk specifically to a parent or carer, or similarly to a teacher. In addition to risk to adults there may be a risk to other children/adolescents. Although most referrals are concerned with violence, they also receive referrals for harmful sexual behaviour and / or fire setting. Andy reported that the majority of those he sees where there is a concern regarding child to parent abuse have a neuro-developmental conditions, generally autism, though this alters by region according to local service provision. While the family may be seen on occasions, this is predominantly a consultation service, offering advice to the professional network on how to support the family and manage the risk.
Referrals are accepted from any agencies (not from families), but statutory involvement is also required from a lead agency and this should continue throughout the contact. A team might typically include a psychologist, assistant psychologist, consultant psychiatrist, social worker and nurse, often working part time in FCAMHS and part time in another service. They would help develop safety plans and offer advice on (for instance) management, achieving sensory assessments, obtaining a diagnosis or understanding the history. Success in these situations can depend on in-depth support, and it is important to ensure that programmes such as Non-Violent Resistance (NVR) or Positive Behaviour Support (PBS) are properly understood and being applied in a consistent and meaningful manner.
Andy suggested thinking about the involvement of Community Forensic CAMHS as like clinical supervision… complete honesty is needed for the work to be effective, and this can sometimes feel challenging. Consent to – or at least awareness of – the team’s involvement by the family and young person is required, though this may on occasions be over-ridden if there is significant risk.
For those working to support families where there is significant high-harm child to parent violence and abuse, this is certainly a service to bear in mind!
Dr Andrew Newman is a Consultant Clinical Psychologist working in the South West (north) Community Forensic Child and Adolescent Mental Health Service. In this role he works with professional networks offering consultation & assessment where a young person (under 18) is considered a risk to others and presents with mental health difficulties, to include neurodiversity and learning disability. All of his practice as a psychologist has been in forensic settings and he regularly works with professional networks where there is concern within the family about child to parent abuse.
Dr Newman is also the clinical lead for the Bristol Probation Mentalisation Based Therapy (MBT) Service. He also regularly offers training to external agencies and presents at conferences. He offers expert witness assessment for the family court, crown court, magistrates and parole board and has published a number of papers within the field of psychology.
He is currently the child and adolescent committee member representative of the British Psychological Society (BPS), Division of Clinical Psychology ((DCP), Faculty of Clinical Forensic Psychology.