Dr Madalina Toma

Project Title: Central policies, national improvement approaches and sustained local change; An exploratory study of access to mental health treatment for children and young people in Scotland

This study focused on unpicking on the process of translating government strategies into local services, by exploring the interactions between policy makers (macro) and national organisations (meso) supporting policy implementation within local CAMHS delivery context (micro).

Data collection consisted of 16 semi structured individual and four focus group interviews with a purposeful sample of policy makers, national health and social care stakeholders and local outpatient and inpatient CAMHS teams representing three NHS boards. Most participants expressed concerns about the somewhat ambiguous macro-level objectives with overlapping recommendations, the under-reliance on scientific evidence and lack of transparent consultation which creates a tunnel vision that runs counter to the policy’s original intentions.

Participants believed that the broad spectrum of meso-level organisations needed to assure a whole system approach made local implementation fragmented, creating gaps in provision or waste as remits overlapped. The language used within policies led to conceptual uncertainties around CAMHS service specifications and it was still unclear which services are best placed to deliver interventions to support the mental illness, mental distress and mental well-being needs of children.

At micro-level, there was a transformation fatigue through the constant expectation of delivering improved services and increased tensions between the need for local autonomy to innovate and the limitations created vertically by national directives and horizontally by the proliferation of national organisations which must work together to implement abstract recommendations in a resource-constrained environment.

These findings shift the focus of the debate away from how many children and young people access the right service, in the right place, at the right time, to an understanding of the governmental, national and local drivers that need to be co-ordinated in a whole-system approach to ensure services deliver high quality services to meet actual need.