Closing The Gap: Shared Decision Making in CAMHS

VIK guest post
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19 Mar 2012

In my time at CAMHS, a lot of decisions had to be made, from when to go into hospital to the details of my food plan. Some of the decisions were made by me, and others were made by my clinicians, but very rarely did we agree.

By London VIK member Amy Feltham. 

To find out more about what YoungMinds is doing with Closing The Gap get in touch with London VIK Support Worker Erin Wright erin.wright@youngminds.org.uk.

The power to make the decision swung between me and my clinicians like a pendulum, and whoever ended up ‘winning’, neither of us felt good about it. It was a big problem for the relationships I made in CAMHS, which is why I was so excited to be involved in Closing The Gap – Shared Decision Making in CAMHS.

Closing The Gap is a project being run by the Health Foundation to look for ways to bring patients, the community and the healthcare system closer together in all kinds of different ways. Seven ideas are being tried out as part of this, ranging from helping people with kidney problems to care for themselves in hospital to making GP records really quick and easy to access. The particular idea I am involved in developing is called Shared Decision Making in CAMHS, and it’s really exciting.

The aim is to improve the relationship between the CAMHS clinician and the child or young person by helping them to make decisions together. If this works, it could help take the sting out of those constant disagreements, and make more time and a better relationship for therapy to take place.

To help guide the project, there is a steering group made up of people from four different organisations who have come together to help guide what happens in the project. It’s made up of:

  • Jasmine from the Anna Freud Centre who helps to organise the project on a day-to-day basis,
  • Neus and Miranda from the Anna Freud Centre who help the clinicians work out how to do shared decision making,
  • Andrew from Berkshire Consultancy who helps the team to work well together and achieve all the things we want,
  • Duncan from CAMHS Outcome Research Consortium (CORC) who helps to steer the project from a clinician’s point of view,
  • Kate from YoungMinds who looks at how the project can link in with the wider work of YoungMinds,
  • Erin from YoungMinds who helps to steer the project and supports Lisa and me,
  • Lisa and me from YoungMinds who help to steer the project from a young person’s point of view.

To begin with, we needed to know what shared decision making really is. While it sounds obvious, when we came to sit around the table together we found that we all had slightly different ideas about it. After a few meetings thrashing it out between us, we had more of an idea of what we were trying to do.

That meant that Shared Decision Making worked brilliantly in our heads, but the real test was still to come – does it work so brilliantly in the real world? In order to find this out, we needed some clinicians and young people to try it out on, and that meant finding some CAMHS units. We needed four sites who were willing to work with us, so when 23 applied we had a lot of choice! It was hard to narrow them down, but after reading application forms, interviewing sites and some very long discussions, we had found our sites; a mixture of inpatient, outpatient and outreach services spread far and wide across the country.

Work in progress
At the moment, these teams are starting to try out shared decision making for themselves. Jasmine, Miranda and Neus are helping them out by talking through things with them and creating any materials they need to make it work. Shared decision making already looks slightly different in all our sites, depending on how they work and who they work with, and we’re looking forward to seeing it develop even more.

So what is happening next? The thing is, we don’t really know. We don’t have it all mapped out, we’re just waiting to see what happens next, and responding to it the best we can. I hope that in the future we will see shared decision making really working, so that other young people leave CAMHS with good memories of decision making, not bad ones.

Personally, seeing so many people work so hard to work to make things better for Children and Young People in CAMHS has restored a lot of my faith in the system. It’s great to see that, for all its faults, CAMHS still has good things going on!"

  • To find out more about what YoungMinds is doing with Closing The Gap get in touch with London VIK Support Worker Erin Wright erin.wright@youngminds.org.uk

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