Working Within Systems: Inter-Agency Practice and Safeguarding in CAMHS

Child and Adolescent Mental Health Services (CAMHS) across the UK are facing demand and resource challenges. This thesis aims to explore the embodied experiences of clinicians working in and alongside CAMHS, to provide insight into an under-researcher area.

The thesis is divided into two parts. The first chapter is an updated qualitative synthesis, which focuses on how clinicians working within and alongside CAMHS experience inter-agency working. Thirteen papers were identified by searching three databases. Participants felt that organisational factors impacted on their ability to work collaboratively between services, whilst acknowledging that relationships and communication were imperative for collaborative working. Diagnostic-led services were felt to be limited in capturing the diversity of children’s needs. In contrast, interventions that operated closely with the system were viewed as favourable.

The second chapter is a qualitative empirical study conducted with clinical psychologists around their experiences of navigating safeguarding dilemmas within CAMHS. Nine participants took part in semi-structured interviews. Thematic Analysis was used to analyse the data. Participants speculated that increased demand, and less funding, led to high thresholds within social care. Obtaining safeguarding support became more difficult, which was emotionally and cognitively demanding. Involving social care led to therapeutic relationships being damaged, especially when concerns were not progressed. Where patients were living in ‘unsafe environments’, participants worked with the system around the child, whilst recognising the impact of socio-economic circumstances on their mental health. Participants identified that assessment and formulation enabled a comprehensive and critical take on safeguarding presentations. Supervision allowed participants to reflect and connect with the emotional aspects of the work. A preference for responding to safeguarding concerns with a team approach was highlighted. Participants anticipated that more direct collaboration with social care would ease tensions. They recognised, however, that structural barriers made this difficult.