Child and adolescent mental health services (CAMHS) have long been struggling to meet demand (British Medical Association, 2023).
CAMHS are chronically underfunded, receiving only 0.7% of the NHS budget and 6.4% of the mental health budget in England (Health Europa, 2020). Without a direct training route for mental health nursing (MHN) students in working with children, recruitment of mental health nurses in CAMHS continues to be challenging.
Since 2021, I have co-chaired the national Mental Health Nurse Consultant Forum (Mitchell, 2021). In this capacity, I was afforded the chance to co-chair the children and young people’s (CYP) mental health sub-group of the workforce review of mental health nursing as part of Health Education England’s (HEE) work to secure 50,000 more nurses by 2025 (HEE, 2021). Working with service users and senior mental health nurses, the review examined the literature and data to inform recommendations for the future development of the profession. This was a great opportunity to develop a strategy that promotes the value, and secures the future, of MHN across CAMHS.
“Unless we establish evidence of the value of mental health nursing across CAMHS, it will not be sustainable in the future”
In the absence of a direct training route, we recognised that all branches of nursing can have a role in CAMHS, bringing valuable skills and knowledge to this practice area and contributing to a rich and diverse CAMHS nursing workforce. In terms of articulating the value and uniqueness of MHN in CAMHS, the role requires an in depth understanding of child development and differing presentations of childhood mental health difficulties as well as physical health knowledge; also the ability to understand and navigate systemic influences that can impact on children’s mental health difficulties. This knowledge is essential for MHN to provide patient centred care, while balancing the needs of the parents or care givers (Cox, 2019).
The CYP sub-group report came up with three recommendations.
The first focused on training, advocating that a CAMHS placement should be mandatory for all nurse training courses. This would improve nursing students’ knowledge of working in CAMHS, which could encourage more students to apply to CAMHS immediately after qualifying.
Second was a focus on recruitment and retention. It was proposed that, instead of using titles such as ‘mental health practitioner’ or ‘care coordinator’, every nurse working in mental health should have ‘nurse’ in their job title, placing value on this being a nursing role. Establishing a clear career development pathway to increase the number of advanced and consultant level nurses would also demand an update of the national strategy for CAMHS and CYP’s improving access to psychological therapies (IAPT) and give a training route for nurses to enhance their nursing skills without having to deviate into a psychological therapist role. Where nurses do train in a psychological therapy, the ‘nurse therapist’ title should be used, acknowledging these nurses as dual-trained professionals. Appointing an executive director of CYP nursing in every mental health trust, and a consultant nurse in every CAMHS service, would also ensure a clear and sustained focus on children’s MHN across the system.
Finally, unless we establish evidence of the value of MHN across CAMHS, it will not be sustainable in the future. Increasing the number of advanced and consultant-level nurses would provide dedicated research time to develop this area of research. Developing research pathways for MHN and collaborating with higher education institutions and integrated care boards is also key to maximising MHN research input and output.
Delivering these recommendations nationally would show the value of MHN in CAMHS and improve recruitment and retention by demonstrating the uniqueness of the role and helping MHN become a desired profession. Crucially, it would enable us to sustain MHN across CAMHS for the future.
We now have the tools to secure and develop mental health nursing across CAMHS. Together we must use them to create and sustain the change. #MHDeservesBetter.
Dr Ann Cox is nurse consultant and clinical academic in CAMHS, Midlands Partnership Foundation Trust
British Medical Association (2023) Mental health pressures in England. bma.org.uk, January (accessed 19 January 2023)
Cox AM (2019) Helping children and young people understand issues of consent to treatment. In: Baldwin L (Ed) Nursing Skills for Children and Young People’s Mental Health. Springer Nature.
Health Europa (2020) Children’s mental health funding not being used appropriately. Healtheuropa.com, 17 February (accessed 19 January 2023).
Health Education England (2022) Commitment and Growth: Advancing Mental Health Nursing Now and for the Future. Baroness Watkins of Tavistock Review of Mental Health Nursing in England. HEE.
Mitchell G (2021) Mental health nurse consultants regain national platform. nursingtimes.net, 6 October (accessed 24 January 2021).