PIONEERING SERVICE

As controversial changes have been made to Nelson Marlborough Health’s Child and Adolescent Mental Health Service (CAMHS), Samantha Gee looks back at how it began.

Clinical psychologist Robyn Byers didn’t hesitate when she got an invitation from 18-year-old youth mental health campaigner Zoe Palmer.

She got the message a day before the public meeting organised by Palmer as part of her campaign to halt changes to Nelson’s Child and Adolescent Mental Health Service (CAMHS).

Byers, who was part of the pioneering CAMHS service, did not know Palmer, but she found the Nelson teenager’s drive to be impressive.

‘‘Values and integrity are very important to me, and to see a young woman stand up for what she believes in. I have always felt we should support our young.’’

Byers has always believed it’s crucial to have the voice of youth involved in shaping health services. So she got on a plane from Wellington, and just made it to Palmer’s meeting, where she spoke about the history of the service.

Byers joined the Nelson Marlborough District Health Board as a clinical psychologist in 1977, working as a clinician for 19 years before moving into management. She was the general manager of mental health services before her departure nearly 40 years later in 2016. She continues to work as a consultant, auditing mental health services around the country.

She said that in the late 1990s, the top of the south had a high suicide rate among youth. A conscious effort was made to include the views of young people when it came to making decisions about the region’s youth mental health service.

‘‘It is really good to get youth involved in telling you what they need in their services, because they will tell you better than anybody. Families and clients know more about their needs than we clinicians will ever know.’’

Byers said she was unable to comment on the recent restructure and the decision to remove youth specialists from the after-hours service, as she had no knowledge of how it had come about.

But she recalled how the service, now known as CAMHS, had developed over time.

She said the region pioneered the development of a dedicated child and youth mental health service. For some time, Nelson Marlborough was the only region to have a 24-hour mental health crisis team for youth.

Byers said this could be traced back to the work of psychiatrist Dr Kay Bradford at Nelson’s Braemar Hospital in the 1960s.

‘‘She was very advanced in her thinking of psychopaedic and child psychiatry as it was way back then.’’

Bradford was appointed as the medical superintendent at Braemar in 1965. She said she was given a large budget and told to ‘‘revitalise’’ the hospital, with the aim of moving those who lived there out into the community.

Many of the residents were children with intellectual and behavioural issues.

‘‘The child and adolescent social welfare used to put people there every week . . . kids had just been dumped there, and I had to get them out of the place, get them fostered – and I did that,’’ Bradford said.

Unable to specialise in child psychiatry in New Zealand, Bradford had gone to Melbourne in 1961, where she did postgraduate study in child and adolescent psychiatry. She returned to New Zealand as one of the few youth mental health specialists, settled in Nelson, and lived at Braemar with her family.

Bradford said she was particularly interested in working with young people. ‘‘If they are very young, you have got a bigger chance of them coming all right.’’

At the request of the Nelson Hospital medical superintendent, she established a weekly outpatient clinic for children with behavioural and developmental problems. With funding for preventative care, Bradford helped to establish a community centre for those children in a hall in Tipahi St.

Along with others in 1980, Bradford helped to establish the Neighbourhood Centre. It was focused on providing after-school activities for children, and hailed by social welfare agencies and the police for its early detection of health or behavioural problems.

Byers said the child and adolescent service continued to develop, and a community clinic was introduced in the early 1990s.

‘‘It was an outpatient service with these offshoots, a neighbourhood centre for kids to go to after school, and in the outpatient service they ran groups around attachment, bonding and parenting.’’

The service saw between 500 to 600 families a year. Referrals came mostly through GPs for children who weren’t thriving or had issues settling into their environment.

‘‘They were young people who were depressed or had other social adjustment issues and maybe had anger management issues.’’

After a review in 1995, the service was split into ‘‘sub-specialties’’ for 0to 12-year-olds, and 13- to 18-yearolds. It offered respite care and day programmes for adolescents with mental health issues.

The day programme was set up so young people didn’t need to be admitted to the mental health unit, and a respite service meant they could stay a few nights away from home if needed.

‘‘For those adolescents who were really unwell at that time, there were really no other options other than the adult unit,’’ Byers said.

She said that for a teenager in distress, admission to an adult mental health unit could be quite traumatic.

In 2003, it was reported that teenagers as young as 14 were being admitted to the adult mental health unit in Nelson. It was a situation mental health commissioner Jan Dowland called ‘‘inappropriate and undesirable’’. In 2004, it was reported that 20 patients aged between 14 and 18 had been admitted to the unit in the previous year.

Byers said child psychiatrists worked to manage adolescents in the community, and that figure dropped to around two a year.

She said the creation of a mental health inpatient unit specifically for adolescents was considered on several occasions, but it wasn’t financially viable.

‘‘The biggest difference with working with young folk and children is you are not working with just them, you are working with their families, and you are working with their schools and other agencies.’’

The 24-hour on-call youth mental health service was piloted in 1997, to respond to those who needed help after hours. Byers said the pilot led to the introduction of after-hours teams based in Nelson and Blenheim the following year.

‘‘Adolescence is a time when young people are going through the most developmental change that they will actually go through in any part of their life,’’ she said. ‘‘In terms of comprehensive changes, their physiology, their psychological development, social development, interpersonal stuff and family relations, all of those things.

Changes to CAMHS are currently being implemented by the health board. Instead of using child and adolescent specialists after hours, it will provide an all-ages service overnight. But Palmer and others who oppose the changes say the after-hours specialist youth service has saved lives and needs to stay.

The health minister has requested a review of the changes.

‘‘It is really good to get youth involved in telling you what they need in their services.’’ Robyn Byers, clinical psychologist