Agenda item

The Chair invited Jane Rowland, Associate Director of Mental Health Transformation (BSW ICS) to address the Panel.

Jane Rowland gave a presentation to the Panel entitled ‘B&NES Child and Adolescent Mental Health Update’, a copy of which will be attached as an online appendix to these minutes and a summary is set out below.

She said that colleagues from Oxford Health would like to attend a future meeting of the Panel to provide a further update.

Aligning priorities – MH and BSW Model of Care

·  Working together to empower people to lead their best life

o  Starting well

o  Living well

o  Ageing well

·  Personalised care – We want health and care to be right for every individual – not ‘one size fits all’

·  Healthier communities – We want people to live in communities that help

them to live healthier lives

·  Joined-up local teams – People from the NHS, local authority, third sector and other partners will form teams together and we will have the right teams in your area

·  Local specialist services – We will provide more access to routine

appointments, tests and treatments closer to where you live

·  Specialist centres – Our specialist centres like hospitals will focus less on routine care and more on specialist health and care

Context – Population

NHS England benchmark data for us every year in relation to Child and Adolescent Mental Health Services.

B&NES has a lower percentage of the population aged 0 – 18 that receive these services. Swindon has the highest across the BSW footprint.

Context – Needs

B&NES is higher than the national median and mean for the percentage of school pupils with social, emotional and mental health needs.

Important to consider this when we structure the services required within our local communities.

National context

Covid has had an effect on the mental health of children and young people – this cannot be underestimated.

Referrals to CAMHS increased significantly during the pandemic.

Regional context

The number of referrals accepted by Oxford Health (BSW) is high in comparison to other South West areas and that should be seen as a positive. This shows that the right number of children and young people are being referred to receive the services they need.

Waiting times

Oxford Health (BSW) performs really well in terms of waiting times and is low in comparison to neighbouring areas.

There is a need to try to provide access to local services whilst waiting for actual CAMHS treatment to lessen the impact of waiting times.

Key findings (BSW)

Overall our children and young people are less affected by income deprivation and their mental health needs are slightly lower than the national average.

The number of children and young people in need due to abuse / neglect is also lower than the national average.

We are however higher than the national average for the number of school pupils that have with social, emotional and mental health needs and the number of 16 – 24 year olds who are not in education, employment or training.

Meeting the challenge of CYP MH and Wellbeing in 2022

Local and National Plan:

·  Improve access rates to our services for children and young people

·  Creating the right service models with a particular focus on the needs of 16 – 25 year olds 

·  Think carefully about how to provide Eating Disorder services as this can often be a co-presenting condition alongside their mental health status.

Response:

·  Work closely with colleagues in Education and Social Care and the community to provide a more joined up wrap around response for our children, young people and their families.

Recovery:

·  Workforce has been particularly impacted by Covid and we need to learn how we can move forward and continue to implement the plans we have.

Vision of a CYP offer

·  Place children, young people and families at the heart.

·  Locally tailored version of the nationally recognized ‘i-Thrive Model’

·  Evidence based support and treatment available close to home in community settings.

·  Accessible integrated and flexible targeted and specialist community mental health service.

·  No wrong door – Access to good advice and support through one place, a single, simple point of access for our children and young people.

Future model of provision

i-Thrive Model

·  Getting Advice – Those who need advice and signposting

·  Getting Help – Those who need focused goals-based input

·  Getting More Help – Those who need more extensive and specialised goals-based help

·  Getting Risk Support – Those who have not benefitted or are unable to use help, but are of such a risk that they are still in contact with services.

There are principles that underpin all these elements:

Common language reflecting the framework – moving away from use of ‘Tiers’.

Needs-Led – making sure that care and treatment is personalised to the individual and their family and is not based on disease or severity.

Shared decision-making – in partnership with children, families and carers.

Proactive prevention and promotion – with a focus on whole community response and strengths based approaches.

Outcome informed – continuous review, goal based.

Reducing stigma – mental health and wellbeing is everyone’s business.

Accessibility – timely intervention for the child and family, where they are in their community.

Where are we now ……

Community based support and one off contacts: Local support offers in place (eg Off the Record), alongside Kooth – digital activity has dropped post Covid.

Mental Health Support Teams (MHSTs) in place across BSW. B&NES: 2 Teams, referral rates at c. 60% for one team, 5.9% for other.

Community CAMHS: Demand and complexity increasing, with associated impact on access rates.

CAMHS Crisis: Local CAMHS Liaison team in place at RUH, operating well but demand rising.

CAMHS Inpatient: National shortage of inpatient CAMHS provision, new approaches being taken to keep more children at home in the community.

Ambitions for the coming year

·  Embedding i-Thrive across our whole system – mapping community assets, linking with education and social care, supporting children and young people in their communities.

·  Investment and improvement in access times for children and young people – meeting the NHS England Long Term Plan target.

·  Addressing the needs of children and young people with Eating Disorders – implementing:

o  FREED – First Episode Rapid Intervention for Eating Disorders

o  ARFID – Avoidant Restrictive Food Intake Disorder

o  ALPINE – Assessment and Liaison for Paediatric Inpatients with Eating Disorders

If you can positively intervene within the first three years of presentation this is more likely to recover that child and prevent the disorder continuing into later life.

Developing our 16-25 pathways, ensuring that we provide the right support that meets the specific needs of young people entering early adulthood.

Links being built with our Universities in Bath to support young people that come here that may already have mental health needs.

Working with our Provider Collaborative (which oversees inpatient services across our geography) to implement a Hospital at Home service, keeping more children and young people at home but with the right support from CAMHS.

Working across providers to support children and young people who may have co-presenting neurodevelopmental and mental health needs.

Councillor Paul May commented that it was good to hear that a joined up approach to the transition between child and adult mental health services is being looked at.

Jane Rowland replied that Oxford Health and AWP jointly lead the work involving 16 – 25 year olds and are absolutely working together to think about the pathways for that cohort of young people and how their needs can best be met. She added that Family Therapy was a good example of how work can be extended to 17 / 18 years of age.

She stated that Primary Care and our Third Sector partners are also involved in this element of work as children, young people or their families often present to their GP in the first instance.

Councillor May said that he felt that i-Thrive was a brilliant model and asked if that was in use within Adult Mental Health Services as well.

Jane Rowland replied that Adult MH Services do not have the same standards that wrap around it, although it very much was looking to provide services on a needs led approach.

Councillor Liz Hardman asked what the threshold was for receiving a referral in respect of a child / young person with an eating disorder. She also wanted to know how much FREED was currently being used locally.

Jane Rowland replied that money had been invested in FREED this year to support its rollout across our communities and said that it does come with a challenge to have enough workforce in place. She acknowledged the need to get children and young people into the system sooner and support them.

She said that she would speak to colleagues to seek further information in relation to threshold figures. She added that Third Sector partners are also supporting this work in an effort to make it clear that there are places to go if they have concerns.

Councillor Hardman asked how much involvement with schools do the Mental Health teams have.

Jane Rowland replied that the Mental Health Support Teams are a nationally mandated model, of which there are two in B&NES. She added that they had recently had a successful meeting with Olwyn Donnelly, Head of Education Commissioning in B&NES about whether it would be possible to provide some specific low level support for Mental Health & Wellbeing for schools and in particular those pupils who are on the verge of being referred to the Home Education Referral Service.

Councillor Gerry Curran asked if a connection was required between the Disabled Schools Team and Social Workers with regard to those children with neurodevelopmental and mental health needs.

Jane Rowland replied that as this work is progressed it will more than likely seek to involve Social Workers at some stage. She added that it will also be important to link the work back to schools through the pupil’s EHCP.

Councillor Curran asked if any stats were available on the numbers of children and young people who receive therapy treatments and those in receipt of medication as a result of their diagnosis.

Jane Rowland replied that she would need to check on those figures and reply to the Panel in due course.

Councillor Andy Wait asked if B&NES was an area where mental health services are in greater demand than the rest of the country.

Jane Rowland replied that the need was still high across B&NES, but offered a note of caution as this statistic covered social, emotional and mental health needs. She added that further analysis might be required to understand whether local children and young people are more aware of services that can be provided or more informed about these types of needs.

She added that that the information was gathered by Public Health England as part of their Fingertips data.

Councillor Wait asked how the evidence for the ‘Evidence based support and treatment available close to home in community settings’ is collected and whether it was qualitative or quantative.

Jane Rowland replied that FREED, ARFID and ALPINE are all evidence based models and will have been developed nationally and will be both qualitative and quantative in terms of how those models are derived. She said that it was a blend of evidence that was gathered and some would be based on the National Institute for Clinical Excellence, a national standard that we have to meet.

She added that they are trying to learn from other organisations both nationally and locally about what works well for children and young people, then to ask those in receipt their view and to then replicate that or extend it.

Councillor Wait asked if the national data was usually quantative.

Jane Rowland replied that it was and gathered from a range of sources.

Councillor Paul May commented that it would be helpful for the Panel to see statistics for Bristol at some stage as we have some residents that live on the border and might be directed to services in that area. He asked if she and colleagues would be involved in discussions on the new Local Plan for B&NES in terms of housing and the provision of services that might be needed as a result of any developments.

Jane Rowland replied that they do by contributing to and supporting the work of the Joint Strategic Needs Assessment (JSNA) where there is a specific chapter that focuses on the needs of children and young people. She added that they are also involved with the Community Infrastructure Levy (CIL) and discussions in support of Council driven initiatives.

She added that they were just about to start to refresh the B&NES, Swindon & Wiltshire Mental Health Strategy and that the children and young people’s element will be a feature of the strategy. She stated that they will look to set out priorities for the area, put in place support for early access points and initiatives that involve communities as much as possible.

The Director for Children’s Services & Education commented that children and young people’s mental health has been a feature of the recent JSNA work and that the Children & Young People’s Health & Wellbeing Survey was ongoing and the results of this were likely to be available in September and will feed into the work of the BSW Mental Health Strategy refresh.

The Chair thanked Jane Rowland for her presentation and attendance on behalf of the Panel.