From ‘othered’ to ‘embodied’: neuroqueer art therapy with autistic, gender-expansive young people

Treatment Intensity in Child and Adolescent Mental Health Services and Health Care Reform in Norway, 1998–2006

This paper offers a review of how the role of Art Therapy is represented in four important areas: In Specialist (Tier 3) Child and Adolescent Mental Health Services (CAMHS) in England, in government and related documentation and polices, within broader literature pertaining to Child and Adolescent Mental Health Services, as well as in Art Therapy publications. The author found that there are shortcomings in the understanding of the profession including the unique role that art therapy offers, as well as an evident lack of inclusion across the range of literature. The author contends that central factors exerting influence include powerful socio-politico-economic agenda and influence, unprecedented change in the field of psychological therapies, unconscious processes, and limited self-promotion. The paper argues that lack of clarity and effective promotion of the unique role of art therapy may lead to there being a lack of consideration of art therapy or for art therapy to be decommissioned in CAMHS. The review has worldwide relevance to those concerned with practice, promotion and commissioning of art therapy in services that work children and young people with mental health and psychological needs. Keywords: socio-politico agenda, promotion, representation, NHS publications, child and adolescent mental health services

Background: Group programmes are a common component of treatment in inpatient child and adolescent mental health service (CAMHS) units. There is evidence for specific group interventions, however, comparison across a multidisciplinary group programme is under-explored. Aims: This research examines young people's experiences of, and satisfaction with, a multidisciplinary group programme on an acute inpatient CAMHS unit. Methods: Weekly surveys were distributed to young people, and 37 responses were gathered across four months in 2018. Rates of attendance, enjoyment and perceived helpfulness of groups were calculated. Content analysis was used to explore key themes in qualitative responses. Results: Young people rated a creative activities and games group (54.05%) and the art therapy group (48.95%) as the two most enjoyable groups. Art therapy was reported to be the most helpful group overall (45.65%). Young people also expressed their dislike for verbal psychotherapy groups (43.24%), finding these confronting relative to other modalities in the programme. Conclusions: Art therapy and arts-based groups received the highest positive feedback relative to predominantly verbal psychotherapy groups. A multidisciplinary group programme which integrates art therapy and other creative modalities has the potential to enhance engagement in acute inpatient settings which may result in improved mental health outcomes for young people. Implications for future research and practice: Future research should aim to foreground young people's perspectives and experiences of therapeutic programmes, and provide opportunities for clinicians to redevelop programmes responsively to service user feedback. Survey findings support advocacy for consistent art therapy roles and services within inpatient CAMHS units.

BackgroundIn the UK young people attending child and adolescent mental health services (CAMHS) are required to move on, either through discharge or referral to an adult service, at age 17/18, a period of increased risk for onset of mental health problems and other complex psychosocial and physical changes. CAMHS transitions are often poorly managed with negative outcomes for young people. Better preparation may improve outcomes and experience. This study aimed to co-produce, with young people who had transitioned or were facing transition from CAMHS, a CAMHS Transition Preparation Programme (TPP), deliverable in routine NHS settings.MethodsEighteen young people, aged 17–22, from three UK National Health Service (NHS) mental health foundation trusts participated in creative, participatory research workshops. Seven parents completed short questionnaires. Thirty clinical staff from two trusts took part in workshops to ensure deliverability of young people’s ideas. Young people were offered co-research opportunities.ResultsMost young people felt anxious, fearful and uncertain on leaving CAMHS and perceived mental health services as uncaring. Participants outlined transition procedures and drafted a range of preparation activities, centred around dedicated Transition Peer Support and a transition booklet, which should be offered to all CAMHS leavers, irrespective of discharge or transfer to an adult service. Preparation should aim to build confidence to help young people take responsibility for themselves and flourish in the adult world: coping or getting through it was not enough. Some clinicians also felt anxious at transition and recognised the potential impact on young people of poor communication and lack of understanding between services. Parents would appreciate help to support their offspring during the transition period. Clinicians cited lack of funding and inflexible NHS procedures and policies as potential barriers to the implementation of young people’s ideas. Nine young people took up co-research opportunities.ConclusionsMental health services underestimate the anxiety of CAMHS leavers. Young people have clear ideas about the preparation they require to leave CAMHS with the confidence to take responsibility for their own health care. Close collaboration of NHS staff and researchers facilitates the implementation of research findings.

Child and Adolescent Mental Health Services (CAMHS) are specialist, publicly funded services that play a vital role in supporting young people with moderate to severe mental health needs. In Ireland, and internationally, CAMHS face enduring systemic pressures, including underinvestment, workforce shortages, and long waits for assessment and intervention. Caregivers are central to service engagement, acting as advocates and coordinators of care, yet their perspectives remain underrepresented in the literature. Understanding caregiver experiences is essential to improving quality, strengthening therapeutic relationships, and shaping meaningful reform.To explore the lived experiences of caregivers engaging with CAMHS in Ireland and to examine the relational, systemic, and structural factors shaping these experiences.Reflexive thematic analysis (RTA) was used to analyse semi-structured interviews and focus groups. A qualitative study design was employed, with participants purposively sampled following a national caregiver survey. Data collection and analysis were iterative and reflexive across all stages.Twenty-two caregivers participated, generating six interrelated themes: (1) When CAMHS Works: Feeling Seen, Heard, and Supported, (2) Barriers to Communication and Trust: Caregiver-Clinician Disconnects, (3) Fragmented and Standardised Care: Impacts on Continuity and Engagement, (4) Limited Access and Inadequate Crisis Response, (5) Workforce and Infrastructure Deficits, and (6) Neuroinclusion Gaps: Barriers for Autistic and Neurodivergent Young People. These findings illustrate how structural and relational challenges shape caregiver experiences and inform priorities for CAMHS reform.Caregivers described fragmented care, poor communication, and limited neuroinclusion, exacerbated by staff shortages, service fragmentation, and inconsistent support. Positive examples were rare but highlighted the value of relational, family-centred practice. The findings underscore the need for structural reform alongside a cultural shift toward more inclusive, family-centred and neurodiversity-informed CAMHS, in line with international calls for accessible, high-quality youth mental health services.

Leaving child and adolescent mental health services in the MILESTONE cohort: a longitudinal cohort study on young people's mental health indicators, care pathways, and outcomes in Europe

Background: Child and adolescent mental health challenges are increasing globally, thereby driving greater demand for inpatient child and adolescent mental health services (CAMHS), where restrictive practices persist despite WHO ambitions to eliminate them. Art therapy is a valuable clinical intervention associated with a significant reduction in these practices. However, there is a gap in knowledge as to why. Aims: This research aimed to hear directly from young people in inpatient CAMHS settings about their experiences of art therapy, and to identify how those findings might help explain the association between art therapy and a reduction in restrictive practices. Methods: Semi-structured, arts-informed interviews using the principles of sensitive enquiry were conducted with twelve young people within two Australian acute inpatient CAMHS units. Transcripts were analysed using reflexive thematic analysis. Results: The inpatient setting gave rise to several challenges, including difficulties communicating with staff, the constraining inpatient environment, and mental health escalations. Art therapy helped reduce acute distress through providing opportunities for freedom, choice and agency, externalising internal states, and generating positive physiological and emotional effects. Conclusions: Art therapy supports young people to navigate acute mental distress by providing an immersive, non-verbal avenue of creative expression within an inpatient CAMHS setting, where there are challenges engaging with verbal therapies. Lowering acute distress through art therapy also helps to circumvent mental health escalations, thereby reducing the likelihood of restrictive practices being used. Implications for practice/policy: The accessibility of art therapy programmes run by qualified art therapists should be a priority in all CAMHS settings.

IntroductionIncreased demand for Child and Adolescent Mental Health Services (CAMHS), alongside concerns that services should be better commissioned to meet the needs of the most vulnerable, has contributed to a...

Lower-income, less developed countries have few child and adolescent mental health professionals and a low availability of paediatric community mental health care. Child mental health professionals in low- and middle-income countries (LMICs) must therefore balance comprehensive tertiary care for the minority and provision of child and adolescent mental health services (CAMHS) within primary health care to serve the majority. This review aimed to identify the obstacles to, and opportunities for, providing CAMHS in LMICs. Articles from PsychInfo and PubMed, published up to November 2011, were retrieved using the search terms "child and adolescent", "mental health services", "child psychiatry", "low- and middle-income countries", "low-income countries" and "developing countries". Articles were then retrieved from PubMed alone, using these search terms plus the individual country names of 154 LMICs. Fifty-four articles were retrieved from PsychInfo and 632 from PubMed. Searching PubMed with 154 LMIC names retrieved seven related articles. Inclusion criteria were (i) articles relating to CAMHS or child psychiatric services; (ii) subjects included in the articles were inhabitants of LMICs or developing countries; (iii) articles reported in English. After removal of duplicates, 22 articles remained. The contents of these articles were categorized and analysed by use of the six domains of the World Health Organization assessment instrument for mental health systems (WHO-AIMS), a tool developed to collect information on available resources within mental health systems. The provision of CAMHS in LMICs clearly needs a specific strategy to maximize the potential of limited resources. Mental health-policy and awareness campaigns are powerful measures to drive CAMHS. Training in CAMH for primary health-care professionals, and integration of CAMHS into existing primary health-care services, is essential in resource-constrained settings. A wide gap in research into CAMHS still needs to be filled. To overcome these challenges, the child mental health professional's role in LMICs must encompass both clinical and public-health-related activities.

AimsBackgroundChild and young person (CYP) mental health is a public health priority with 75% of life long mental health problems starting before the age of 25.1 Prevalence of all mental...

Approximately one in five children and adolescents (CA) suffer from mental disorders. This paper reports on the findings of a situational analysis of CA mental health policy and services in Ghana, Uganda, South Africa and Zambia. The findings are part of a 5 year study, the Mental Health and Poverty Project, which aims to provide new knowledge regarding multi-sectoral approaches to breaking the cycle of poverty and mental ill-health in Africa. The World Health Organization's Assessment Instrument for Mental Health Systems (WHO-AIMS) Version 2.2 was used to collect quantitative information on mental health resources. Mental health policies and legislation were analysed using the WHO Policy and Plan, and Legislation Checklists. Qualitative data were collected through focus groups and interviews. Child and adolescent mental health (CAMH) - related legislation, policies, services, programmes and human resources are scarce. Stigma and low priority given to mental health contribute to low investment in CAMH. Lack of attention to the impoverishing impact of mental disorders on CA and their families contribute to the burden. Scaling up child and adolescent mental health services (CAMHS) needs to include anti-stigma initiatives, and a greater investment in CAMH. Clear policy directions, priorities and targets should be set in country-level CAMH policies and plans. CAMHS should be intersectoral and include consideration of the poverty- mental health link. The roles of available mental health specialists should be expanded to include training and support of practitioners in all sectors. Interventions at community level are needed to engage youth, parents and local organizations to promote CAMH.

There are many similarities between the psychiatric intensive care of adults and the management of children and young people who present with serious mental health problems. However, there are equally a number of differences stemming from the biological, developmental and social aspects pertinent to childhood and adolescence.

Purpose Young people can often “fall through the gaps” between Child and Adolescent Mental Health services (CAMHS) and Adult Mental Health services (AMHS). This discursive viewpoint study aims to reflect a conversation among the authors on how CAMHS and AMHS psychiatry came together to develop and embed a UK community “Youth Mental Health Service”. Design/methodology/approach This reflective viewpoint study explores the perspectives of three of the lead CAMHS and AMHS psychiatrists from the implementation phase of a community youth mental health service. It explores, in a discursive way, these individuals’ views on some of the key facilitators and barriers in the development of the service that aimed to “bridge the gap” for young people. Findings These clinicians’ reflections recognise the importance of strong clinical leadership in enabling a youth/young adult model of mental health to be implemented. They also recognise how culture internal and external to a service has a key role to play in the success and sustainment of implementing an innovative model. This study describes a merging of CAMHS and AMHS psychiatry to meet the needs of young people in the most developmentally appropriate way. Originality/value This reflective study highlights the need for services and systems to think creatively about how they can allow flexibility for CAMHS and AMHS psychiatrists to learn and plan together, as well as gain experiences across the age ranges, to facilitate collaborative working that is developmentally appropriate and meets the needs of young people in a way that is accessible to them.

To investigate parental help-seeking patterns prior to referral to outpatient child and adolescent mental health services (CAMHS), and whether type of symptoms or duration of mental health problems prior to referral influence help-seeking. Child mental health services in Denmark involve several sectors collaborating based on stepped-care principles. Access to CAMHS is free of charge but requires a formal referral. In this cross-sectional observational study, parents of 250 children were interviewed about pathways to outpatient CAMHS using the Children's Services Interview. The median parent-reported duration of mental health problems prior to referral to CAMHS was 6.0 (IQR 3.4-8.5) years for children referred for neurodevelopmental disorders compared to 2.8 (IQR 1.0-6.5) years for children referred for emotional disorders. Educational services were the first help-seeking contact for the majority (57.5%) but referrals to CAMHS were most frequently from healthcare services (56.4%), predominantly general practitioners. Educational services played a greater part in help-seeking pathways for children referred for neurodevelopmental disorders. The majority of children referred to CAMHS have mental health problems for years before referral. The delay in time-to-referral was most pronounced for children referred for neurodevelopmental disorders. Help-seeking pathways differ by symptom duration and type of symptoms.

uring the last 10 years or so, there has been a remarkable rise of interest in children’s mental health. This is good news – and we shouldn’t be too shy to celebrate, nor too afraid to dwell on a worry or two lest, in ignoring them, we find the rise begin to fall. Broadly speaking, up until the early 1990s child mental health was pretty much hidden within the preserve of the specialist professional groups. This is not to say that little was going on. A great deal about children was being learned and practised. From Freud onwards, major advances in psychoanalysis, developmental psychology, behavioural and cognitive therapy and family and group therapy were bringing to life our understanding of the minds of children. Of course, much more needed to be known (and still does) but there was undoubtedly an exhilarating sense of inquiry into the nature of children’s mental health problems and family dynamics and into how interventions could be improved to bring about change in people’s troubled lives. What was lacking, however, was any real concerted desire to make these developments known to the wider public. Children’s mental health was simply not a political issue. The fact that it lay at the heart of so many of the prevailing social problems such as crime, drug misuse, teenage pregnancy and homelessness simply didn’t seem to ring a bell. At the time poverty, child welfare and child protection were the key political preoccupations but the concept of child mental health didn’t hit the headlines. If anything, the term carried with it something pejorative – as if it was stigmatising to associate the words ‘child’ and ‘mental health’. What was clearly needed was an effort to make more of a hue and cry about what was known and what was being done – a promotional campaign that would help to make the public more aware. YoungMinds, which I and others formed in the late 1980s, played a major role in taking forward this campaign. Most of us came from within the child guidance movement which in the mid-twentieth century was very involved in D developing multi-disciplinary working. In addition to YoungMinds various similar movements were afoot in the USA and some European countries, and in the UK certain key people proved critical in taking forward the agenda. Virginia Bottomley, for example, secretary of state for health from 1992 to 1995, was a former psychiatric social worker in child guidance clinics in London. Other leading figures at this time were Dr Richard Williams, a consultant child psychiatrist and director of the NHS Health Advisory Service, Dr Bob Jezzard, also a child psychiatrist, employed as a senior adviser in the Department of Health, and Dr Zarrina Kurtz, a public health consultant who had a particular interest in child development and children’s mental health problems. I myself was a child psychotherapist working in child guidance and residential treatment. Together, with one or two others, we joined up almost as if by accident. In effect, we shined as a kind of virtual multi-disciplinary team! We all set about in our own ways to build up and tell the story of the states that children’s minds could get into, of the prevalence of their mental health problems and of the predicament of those who tried to serve them. Most importantly, we brought to much greater light the invaluable findings of Professor Michael Rutter’s and Professor Philip Graham’s epidemiological research in the 1970s. It was, of course, not by chance that the first seminal review of child and adolescent mental health services produced by the Health Advisory Service (1995) was entitled Together We Stand. Let us take just a brief review of what is currently going on. First and foremost, the government now openly acknowledges the existence of child and adolescent mental health services (CAMHS) and is committed to investing considerable sums of money in them and also to introducing an infrastructure designed to support a more systematic and forwardmoving programme. All of this is quite unprecedented and I think it is true to say that the national child and adolescent mental health service is not the Cinderella service it once was some 12 or so years ago. It may not yet be in the prince’s arms, and the ugly sisters are still around, but at least it’s in the court!