Επιτροπή Εποπτείας και Προστασίας Δικαιωμάτων Ψυχικά Ασθενών

In developed countries there are problems with mal distribution, a declining enrolment in child psychiatry training programmes and a recent reduction in those working in community settings. In the developing world there is an almost universal lack of enough trained individuals to staff even basic child and adolescent mental health treatment facilities and certainly not enough to implement a full continuing of care as conventionally defined. (WHO,2003)
We cannot afford to fail to take on the challenge when ‘’the lack of attention to the mental health of children and adolescents may lead to mental disorders with life long consequences, undermines compliance with health regimens and reduces the capacity of societies to be safe and productive. (WHO,2003)

The first major landscape issue that must be considered by all who develop policy for CAMHS concerns the workforce
- In many countries, supply of professionals in terms of quality and quantity is insufficient to meet the volume of demand
- The are enormous challenges to be overcome in recruiting, retaining, and ensuring the up-to-date training of all staff ( Williams & Kerfoot,2005)
The second item concerns the safety of children in society at large, and particularly those who are under the care of state
- Incidents of services failing to protect children, either by recognising risk and intervening in time or by their failing to provide sufficiently safe environments
- Children’s homes in Cyprus encounter a variety of problems due to the lack of staff and the lack of interventions that include the wider family

Client groups that challenge CAMH services

Suicide and deliberate self-harm
- The likelihood of repetition calls for increased efforts to develop interventions that are geared to the specific needs of young people and their families (Kerfoot et al;1995)
Depressive disorders

Young people with depressive conduct disorders are at risk of all the adverse outcomes of conduct disorder, including criminality and antisocial personality disorder (Harrington et al.1991)

Eating disorders
Homeless children and young people
- Homeless families experience multiple and complex needs, and move across service (Education, Social Services, Health ,Justice system) boundaries
Hyperactive children
Young people with troublesome behaviour
- Antisocial behaviour account for 30-40% of referrals to CAMH. Interventions need to address the full range of young person’s difficulties at home, school and in the wider community (Audit Commission, 1991)
Caring for ethnic minority and refugee children
- There is a growing recognition of the acute need to improve services by setting up community outreach work, interpreter, culturally sensitive therapy
Substance misuse
- Studies show that incidents of drug abuse have been increasing dramatically even in small countries such as Cyprus with long term effects

The above problems and groups indicate how complex, and dysfunctional cases are Child and Adolescent Mental Health problems especially those children who are under the care of State Authorities ‘’Looked After’’ so called
The collapse of the whole system demands a holistic and multidimensional approach through an interagency collaboration

The issue of what constitutes a child or adolescent mental health problem is difficult to determine!
- Medical Dimension: It has a tendency to isolate the individual from family and environment
- Social dimension offers a unique contribution to the multidisciplinary diagnostic process by considering roles and relationships as explanations for behaviour and particular the structures within which these develop and function.
Primary level of prevention
- Mental Health Social workers are found in primary care settings, such as health centres and community resource centres, where they work with groups who are at risk of mental health problems
Secondary Level of prevention
- Mental Health social workers working at the secondary level are located in crisis intervention services, day hospitals, psychiatric units in general hospitals, psychiatric hospitals and specialist settings such as child, adolescent and family psychiatric services
Tertiary level of intervention
- Mental health social workers in rehabilitation and community follow-up services work at this level to reduce the negative effects of institutionalisation and to promote social integration.

A distinguishing feature of mental health social work is the extent to which it takes place in multidisciplinary teams.
A social worker who should have a background in mental health or child care should work with issues such as
- Being part of prevention initiatives
  - Training workshops, Parenting groups
- Liaison of the CAMH service with the community resources
  - Avoid stigma, integrate
- Assessment of family situation
  - Looked after children, Prevent
- Liaison with other involved parties (Being the key worker )
  - Schools, Hospitals, Community Services (Panayiotopoulos & Kerfoot, 2005;)

Social Services come across a significant number of child and adolescent mental health problems through:
- Children’s homes
- Adolescents’ hostels
- Makario Hospital

Lack of trained staff
Lack of adequate staff
Multidisciplinary approach is not implemented on a regular basis
Long standing problems which are difficult to work with under the current circumstances
Lack of policy and design regarding CAMH

Interagency collaboration is necessary as these types of problems are multilevel and complex subsequently
A social worker as part of a team should get involved with the assessment of the environment and the implementation of an intervention and he/she should reassure that risk factors have been diminished in such a level that are controllable