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Why we need psychological representation on NHS England’s Clinical Reference Groups

12 March 2019 | by Guest

Today's guest blog comes from Tim Atkin, formerly Chair of our Faculty for Children, Young People, and their Families.

I’ve served on the Child and Adolescent Mental Health Services (CAMHS) Clinical Reference Group (CRG) since late 2016, alongside 10 psychiatrists and one nurse.

This imbalance demonstrates why we need more psychologists to apply for positions during this new round of invites for newly constituted CRGs – it’s a fantastic opportunity for psychologists to have real influence on the development of services for the future.

CRGs lead NHS England’s (NHSE) specialised commissioning function, so representation here can influence the specification, commissioning and, ultimately, the provision of services across England.

Commissioning bodies in the devolved nations also make reference to initiatives produced by NHS England, so influence achieved within a CRG can lead to impact across the whole of the UK.

During my time on the CAMHS CRG, it has ratified the publication by NHSE of six Tier 4 CAMH service specifications, as well as overseeing a consultation into children’s units, drafted a service specification for “out of hospital Tier 4 CAMHS”, and created guidance to address the various challenging issues which are faced by Tier 4 services.

The CRG has also drafted an operational handbook for the process of accessing Tier 4 services across the country, including a complete rewrite of the forms to be used.

One of my main contributions to the CRG was in highlighting the importance of a comprehensive psychological assessment leading to a psychological formulation, with reference to BPS and DCP guidance.

Tasked with creating visual pathways for the handbook, I have been able to ensure that psychological formulation is absolutely pivotal to the illustrations, creating the most accessible guide to how Tier 4 CAMHS are supposed to work, and of the journey that service users are likely to make through such services.

I feel like I have been able to influence and shape the provision of Tier 4 CAMHS in England through informing both the process of providing services, and the content of provision which is available within Tier 4 CAMHS.

Other CRG members acknowledged that the medical, diagnostic model wasn’t sufficient to address the complexity of presentations within Tier 4, presenting an opportunity for me to promote psychological alternatives.

I was able to contribute the psychological perspective in the areas of gender dysphoria in children and young people, the out of hospital specification which can provide outreach, crisis intervention and consultation to community services, and the development of Care Quality Indicators.

The alternative to having a psychologist on this CRG would have been that the only professional perspective available to NHSE to inform the commissioning of Tier 4 CAMHS would have come from psychiatrists and a nurse.

This would have been to the detriment of the group and its aims at a time when children and young people’s mental health is so high on the political agenda, on the NHS agenda and a stated priority for the BPS.

I have loved serving on a CRG and felt that it offered a rare but genuine opportunity to introduce psychological perspectives into a setting with clear terms of reference, intended goals, and outcomes where you can work towards a common purpose of excellent, innovative, strategically and ethically sound care commissioning and provision.

Tim Atkin is a Consultant Clinical Psychologist and Past Chair of our CYPF Faculty.

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