Your web browser is outdated and may be insecure

The RCN recommends using an updated browser such as Microsoft Edge or Google Chrome

Improving outcomes for children and young people with severe mental health conditions

Lee Cowie, Nurse Consultant, NHS Fife CAMHS Intensive Therapy Service

Lee's case study was completed in June 2013 and reflects 2013 prices

When NHS Fife closed its child and adolescent mental health inpatient unit in 2002, the Health Board set up a new nurse-led Intensive Therapy Service (ITS) to provide personalised community care for 8-18 year olds.

Under the leadership of Nurse Consultant Lee Cowie, Child & Adolescent Mental Health Service (CAMHS) brought together nurses, psychiatrists, psychologists and therapists to offer high-intensity home support, which is tailored to meet the needs of young people and their family and carers.

From April 2011 to May 2012, 38 11-17 year olds were referred to the CAMHS ITS. In total, 44 young people were discharged by the service. Previously all of these patients would have required some level of inpatient care, but because of CAMHS ITS, only two of those discharged from the ITS required a period of time in hospital.

Despite strong clinical evidence that community care was better for children and young people, Lee wanted to augment his case with economic evidence.

Lee demonstrated in the three years prior to his economic assessment there had been a £74,556 reduction in inpatient costs associated with his service. Lee also developed two hypothetical scenarios to further illustrate the value of his service. In the first he compared the costs of his service with what the old in-patient service would have cost 'in today's money', demonstrating that the community based CAMHS ITS was over £400,000 more efficient. In the second scenario, Lee also demonstrated that in the absence of his service (and the in-patient facility his service replaced), alternative inpatient care for the clients serviced by the ITS would cost his Health Board £1,227,072.

Lee subsequently used his evidence to promote community-based intensive therapy services for children and young people across Scotland and further afield.

You can email Lee at

Case study
One page summary
RCN Scotland policy briefing