Martin Daly urges single-door referrals and school psychologists
Martin Daly, a practising GP, criticised current referral practices to CAMS and called for a single point of access, a dedicated triage team and better integration across services. He argued that references to neurodivergence, autism, ADHD or anxiety on referral letters often trigger refusals and leave families to navigate fragmented services.
Referral barriers to CAMS
Martin Daly said one of the biggest reasons for refusal of a referral to CAMS is that a GP may have identified neurodivergence - maybe autism or ADHD - or described anxiety-triggering situations, and that assessment notes on referral letters can lead to the door being closed. He reiterated that families with lived experience must be listened to and warned that the current system places undue pressure back on families, general practitioners and community services like Jigsaw.
Single point of access and triage
He endorsed a single point of access with a dedicated triage team where all relevant people talk in the same space, arguing this would allow decisions about which service is most appropriate and timely. Daly said such an approach would particularly help young people with complex presentations and those with co-occurring needs by enabling multiple services to work in partnership rather than passing referrals back and forth.
Integration with associated services
Daly emphasised that CAMS is not a catch-all and called for improved communication with related services, including neurology and paediatrics, where assessments are often required. He noted that the closure of institutions shifted infrastructure into the community without sufficient resources, citing the Summit example and warning that adults as well as children are falling through the gaps.
Psychologists in schools and early intervention
As a route to reform, Daly proposed placing clinical psychologists in schools, either in every school or shared between schools depending on numbers, to provide early intervention and wellbeing support. He highlighted issues like exam pressure and social media as reasons to make psychological services accessible on site so problems can be addressed before they escalate.
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I just want to follow up to what definitely said about, again, as a practicing GP, one of the biggest reasons for refusal of a referral to CAMS service is because you might have identified the idea that there's neurodivergence, maybe autism, ADHD, or that another member of the family has it, or you describe symptoms of anxiety and anxiety-triggering situations in which an assessment is made on your referral letter and the door is closed. And so I just want to reinforce that point, what Deputy McGuinness' experience was and what the family's experience was, because they're the people we need to be listening to because they actually have that lived experience. So just to reinforce that point, that one door, and hopefully that one door referral system, whereby the pressure is taken off families, taken off general verdicts, perhaps taken off jigsaw as well, where when a referral is made into the system, that a decision is made, where best placed that assessment should be done, which service is the most appropriate and timely for that person. And I do take the point that CAMS isn't a catch-all for everything, but you made the point very correctly, that we closed down all these institutions, but we just moved the infrastructure into the community. And in fairness, Summit was good, but the resources didn't follow, because we have a lot of people falling through the gaps, not just in child and adolescence, but also in adult mental health service, which I've pointed out of this committee before. I think the point you made about the ecosystem, that's the one that I think is a really, really good idea. And I think you've all pointed out that you get into the system, hopefully this one door will do that. And within that system, people with more severe illness will be looked after by CAMS at particular times in their life. But there's access, not simply a door closing and a mirror held back to the GP, they should be somewhere else. Or give me a list of groups you should refer to, and then you do another referral, back to you, back to you, back to you, back to you. All of these services not available to a lot of people. So just expanding on that ecosystem, because it will take integration, it will take communication, not just within the mental health services, but as I pointed out earlier, to associated services like neurology services, where there are assessments required, and paediatric services. Because that's where I feel is just the communication is simply not good enough. Yeah, you'll be able to speak to this, but I'll say very quickly just that I think it is the kind of route to reform. One of the things as well, you know, with this idea of the single point of access and a dedicated triage team where all the relevant people are in the same space and are having these conversations, you know, one of the things that can come from this as well can really serve young people who have more complex presentations, who might need support from multiple services at the same time. So it's not like, oh, I'm just getting support from CAMS, so I'm not getting anything else. It means if you have these kind of, I suppose, co-occurring needs, that they can be met together in partnership between multiple organisations. And I think that will really help to, because from our consultation work, that's what we saw, is that people who had more complex presentations were really being let down. Could I just make a point, because my time has gone and I apologise and give you, but the idea of having a psychologist in schools, it might be in every school, it could be a shared psychologist between a number of schools, depending on numbers, not just for mental illness, but for mental and health well-being, so that there's early intervention and when things are beginning to build, that students have a resource to go to and it's in their school. And how to cope with exam pressure, with pressures of life, social media and that, that is an accessible psychological service to schools, clinical psychology. Thanks for your coming here today. Thank you. Thank you.
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