Case Study: Southern England CAMHS

Claimont supports a Southern England CAMHS to allow a highly complex individual to remain at home to avoid a protracted hospital admission

An 11-year-old child lives alone with their Mum, as their Dad lives overseas. Mum reported having some friends that can be of support at times, but no one that she can rely on significantly.

First CAMHS involvement – first episode of psychosis

In November 2021, there was a sudden change in the child’s behaviour – they stopped communicating completely, this was the case both at home and at school. Mum took them to A&E on the 23rd of November, a blood test was completed and there were no significant issues. On discharge home, an assessment with CAMHS commenced.

On the 16th of December things got progressively worse, the child started pacing up and down and kept bursting into laughter, fidgeting and chewing on their sleeves. They said they could see someone outside holding a gun, were talking to themselves, appeared angry and became aggressive. They also began hallucinating and were exhibiting delusional ideas about war and racism.

Despite this, Mum reported that things at home were okay and there were no major problems at school. The child had started to thrive but they may have become a bit unsettled in year 7 as they had a new teacher, there had been a few friendship issues and an incident of bullying, however this appeared to be resolved.

In the first week of March 2022, the child was unsettled every day, with violent and aggressive outbursts. They ran out into the main road and the police were called. Mum made calls to the crisis team and then went to A&E.

Following this, CAMHS screened for both ASD and ADHD, and the child met the threshold for a full assessment. CAMHS were supported by the crisis team who confirmed the first episode of psychosis.

Report outcome

• Risk to self and others due to aggressive behaviour and absconding
• Needs 1:1 RMN support on a hospital ward

Mum expressed a wish for her child to return home as soon as possible with an appropriate package of care. It was decided that the ward was not the best environment for them as it was noisy and busy; however it was agreed by all that they should remain in hospital as they were currently not safe to discharge.

Mum was not confident to manage the child at home. The hospital was considering completing a tier 4 referral but Mum was not keen on a tier 4 admission therefore an urgent LAEP was called.

Claimont: an alternative to inpatient admission

As an alternative to an inpatient admission, Claimont were commission by The CCG (now ICB) to develop a full care plan involving a short-term 24-hour care package at home. Claimont would provide RMN cover, who would closely observe, monitor and review the child’s mental state. This would be combined with an MDT approach with intensive support from CAMHS and support from social services.

Discharged from hospital with Claimont support

Claimont arranged for one RMN to offer 12 hours of day support between 08:00 – 20:00, and one support worker to offer12 hours of night support, between 20:00 – 08:00, seven days a week, starting at the end of April.

Claimont’s support was reduced on the 23rd of May when the RMN support went to five days a week, 08:00-20:00, Monday to Friday, where the night support remained the same. One week later, this was further reduced to only one day a week RMN support, night support remained the same.

After seeing improvement, the support worker cover was reduced to three nights a week, 20:00 – 08:00, and RMN cover remained at one day a week on the 18th of July.

From the 8th of August, support worker cover was reduced further to two nights a week, 20:00 – 08:00, whilst the RMN cover remained at one day a week. The following week, until discharge, the support worker cover was reduced to one night a week, with RMN support cover remaining at one day a week.

Outcome

In this case, with Claimont’s support, this highly complex young person was able to remain at home with Mum and avoided a protracted hospital admission.

How Claimont can help you

Claimont understands the challenges that NHS and Local Authorities are facing, from a commissioning, operational and service delivery perspective. The service works in partnership with mental health commissioners and providers to support the continued delivery of high-quality mental health services across the UK. Contact us today to find out how Claimont can support your NHS mental health services.