Templanza y justicia

The predominant concern of social workers was the current inadequacy of mental health services. A range of opinion was offered about these deficits. Some social workers felt there were insufficient mental health services available in New Zealand for children and young people. Others noted particular gaps in respect of certain diagnoses, lack of practical

assistance, and the low numbers of inpatient beds and residential care. In particular, the lack of mental health services outside the hours of 8.00 am to 5 .00 pm was discussed, illustrating the unavailability of crisis back up for caregivers. General ly mental health services were seen as unresponsive. Social workers experienced unacceptable delays in negotiating assessments for children and support services for their caregivers.

Limitations of interagency co-ordination with mental health services

Social workers expressed frustration at working with a number of agencies, in particular health and education services and indicated that similar difficulties existed for caregivers. A picture emerged from social workers of a failure of agencies to work together despite co­ ordination efforts. "My experience is that mental health services are reluctant to diagnose and or treat young people, this makes supporting caregivers difficult as CYF social workers are not experts ".

Allocation of case leadership appeared to be contentious. Respondents suggested mental health services were not assuming case leadership when mental health problems were the

presenting problem. What was needed, as one social worker commented, was: " the mental

health service to acknowledge and ACCEPT their responsibilities and be actively involved and supportive ". Openness and co-operation were highlighted as problematic particularly in

case discussion: "CYPS is happy to discuss and meet with all involved, health is too

protective of their own and need to learn to be more open and to be available to attend meetings, (they're too busy to attend, not good enough) H.

Interagency protocols and agreements exist but were reported as functioning poorly. In some cases, the procedures were described as onerous, and in other cases, further protocols were needed because existing ones were not working. One social worker described what was needed: "Clear protocols/working relationships with the Department and Child and Adolescent Mental Health Services or adult mental health. I believe this in turn will enable the social workers to support the caregivers better

H.

Some social workers indicated in this context, that while existing protocols may achieve co­ ordination, it is co-operation, which is needed. Respondents viewed co-operation as

meaning: "easy referrals, acceptance of each agencies obligations (no buck passing), simplified, easy access to funding". Another commented: "All involved agencies need to have and maintain open communication and a trusting relationship with each other and the caregiver ". Disparity in service philosophy accounted for some of the problems, for

example, the difficulties engaging adult mental health services, who do not have a child focus, with child protection services.

Informal exclusion of Child, Youth and Family clients from mental health services

Many social workers attributed their difficulties with mental health services to an informal exclusion of children and young people who are involved with Child, Youth and Family. These were amongst the strongest comments made by social workers. "It is my opinion that mental health offer little support especially when a young person is in the Chief Executive 's custody ". Social workers felt that if a child was with Child, Youth and Family, in effect this disenfranchised them, rather than promoting their access to support services. "Too often Child, Youth and Family are expected to have the primary role with these clients when the mental health professionals are more appropriate ".

Social workers commented on the implication of these access issues for caregivers:

"1 think often CYF caregivers are disadvantaged when seeking health or education support for their child or young person as these agencies often see that CYF are involved and try to put the responsibility for staff and resourcing on to CYF. Caregivers often end up in the

middle advocatingfor the child".

This appears to be the case for certain diagnoses:

"1 don 't believe that we work well with mental health services and I believe that this has a negative effect on placements and caregivers feeling supported e.g. young people who are experiencing suicidal thoughts and mental health services not accepting that their behaviour is suicidal but redefining it as a behavioural problem. This form of assessment means that totally unrealistic expectations and responsibilities are put on caregivers and CYF social workers ".

Needing health expertise

Mental health expertise was highly sought by social workers surveyed. They identified that, on their own, they could not support caregivers looking after children with mental health problems and that support must also come from the mental health services that hold this expertise. Haying a mental health worker assigned to support caregivers, because of their knowledge, was viewed as a priority for many social workers: "It is crucial that the mental illness is correctly diagnosed and treated and that the mental health system is appropriately caringfor the client and supporting the caregiver". One social worker suggested that caregivers needed to be recruited from within the mental health network: "Mental health disordered children or young people need to be cared for by health department caregivers -

CYFs caregivers are not trainedfor this ".