A bottleneck is where there is a demand and capacity imbalance. It only appears when the demand exceeds the capacity. This may be an imbalance now or one in the recent past. For example a CAMHS team might have no waiting list and be seeing all the referred patients. However a maternity leave may add roughly 50 patients to the waiting list because of the large effect of staff loss on small teams and after the staff member and the team returns to demand / capacity balance the unseen 50 cases are still sitting on the waiting list.

The evidence for a bottleneck is a QUEUE. The classic and most obvious sign of a bottleneck in CAMHS is the waiting list. Other common examples in CAMHS of waits or queues can be letters waiting in the typing basket, waiting lists for psychotherapy, psychometric assessments, ADHD clinic etc.

In situations of low demand a potential bottleneck may be concealed. For example CAMHS may have long waits for ADHD assessment. Fixing this by increasing the number of clinicians in the team who do assessments may just expose the wait for starting stimulant medication due to a lack of medical capacity.

Some CAMHS have moved to an early assessment or triage model. It is quite possible that this removes the queue for assessment but pushes it deeper into the system by creating a treatment waiting list.

Unless you do something different! Implement CAPA!

We also have a bottlenecks quiz...