Agenda item - Young People's Mental Health Services

Report of the Executive Lead, Strategy, Governance & Law (copy attached).

23.1    This item was presented by Rachel Walker, SPFT Operational Director - CAMHS, Specialist, Learning Disability/Neurodevelopmental Services; Alison Wallis, SPFT Clinical Director, Children and Young Peoples Services; and Paula Gorvett, Director of Mental Health Commissioning, Sussex Clinical Commissioning Groups. Deb Austin, BHCC Executive Director, Children, Families & Schools; John Child, SPFT Chief Delivery Officer; and Lizzie Izzard, Selma Stafford and Jayne Lodge (CCG) were also in attendance.

23.2    Ms Gorvett outlined a number of system priorities for young people’s mental health services. These include:

·         A focus on prevention and on maintaining good emotional health

·         Effective integration of services

·         A focus on effectively managing the transition from children’s to adult services

·         Implementation of the recommendations of the Foundations For Our Future review

·         Sussex wide service transformation planning

·         Moving away from the traditional tiered approach to a new model – ‘Thrive’

·         Working actively with young people to improve services

·         Addressing health inequalities

·         Ensuring that addition investment into young people’s mental health services is used effectively.

23.3    Ms Walker outlies some of the major service impacts and issues caused by Covid. These include:

·         Young people have suffered multiple impacts from Covid, losing educational and social opportunities, and in some instances being trapped in difficult household circumstances.

·         Social isolation and loneliness are particular issues

·         Not all young people are happy for services to be provided digitally; only a small percentage are comfortable with 100% digital services, with most people preferring a blended approach

·         Some young people struggle to use digital services because of a lack of privacy at home

·         People who do present for treatment are doing so at a later stage than before Covid and with higher levels of acuity

·         There is increased demand for wellbeing services and there are long waiting lists for some services

·         There has been an 11% increase in referrals to Child & Adolescent mental Health Services (CAMHS).

·         Schools have an important role to play in identifying young people potentially in need of CAMHS interventions, so referrals dropped when schools were closed. This is one of the causes of late presentation/high acuity

·         Waiting times for CAMHS assessment have increased, particularly for autism where face to face assessment is a necessity

·         Current CAMHS waits are up to 63 days from assessment and 100 days for treatment commencing. These are not acceptable waiting times

·         There has been a reduction in the discharge of cases, with practitioners finding it more difficult to be sure that clients and their families are ready to move on from services when all contact is virtual

·         Face to face contact fell sharply during Covid peaks, but most services are now offering a blended approach with face to face where required

·         There has been a spike in demand for eating disorder services and investment is being made here

·         There has been an increase in demand for specialist ‘Tier 4’ mental health services.

23.4    Ms Wallis told members that:

·         There have been recent workforce impacts, with services struggling to recruit to specialist roles, and an increase in staff absences due to Covid and its impacts

·         Covid has both suppressed activity (e.g. fewer referrals in lockdown) and increased it (e.g. additional demand from young people dealing with bereavement or the effects of social isolation)

·         The evidence-base for some treatments (e.g. Cognitive Behavioural Therapies: CBT) is better for face to face delivery than for virtual

·         Some assessments (e.g. for an autism diagnosis) are simply impossible to undertake virtually

·         Services have at times had to divert resources to acute care

·         Investment is being made and is being targeted to increase capacity, to focus on people who have been on waiting lists the longest, to reduce waiting times, to improve access for eating disorder services, and to improve crisis support

·         New clinical care pathways are being rolled-out, including a  stepped care model with CBT offered as a first line of intervention

·         Workforce development measures include virtual recruitment, the appointments of an SPFT Talent Acquisition Manager, more use of social media, and more investment in professional leadership

·         An eating disorder day service is being introduced

·         A new clinical model for crisis care will be introduced

·         There will be more focus on conducting physical health assessments

·         Communications are being improved, with the introduction of a Sussex mental health phoneline, digital wellbeing services, an online guide to services, and an improved website.

23.5    Ms Gorvett told the committee that in terms of performance:

·         There are real challenges dealing with the increased demand for eating disorders. The current national target is for 95% of referrals to be seen within four weeks, but local performance is around 60%

·         Access to CAMHS is improving

·         Services are trying to institute long term improvement plans, including a single point of access, better early help, eating disorder, specialist CAMHS, crisis, transition and suicide & self-harm services.

23.6    The Chair asked whether it was realistic to suppose that mental health services for young people could ever deliver effectively given the long history of underfunding and the stigma that still surrounds mental illness. Ms Gorvett responded that there is an increased openness about mental health in society which is a real positive. Services do need to be strategic and have a real focus on prevention. Historically this has been difficult as the funding to do this may not have been there, but investment in mental health services is increasing. John Child added that mental health services still need more attention and oversight: things will improve when mental health is seen as being as important as acute physical services. Ms Walker noted that recent transformation funding was really welcome, but needs to be supported by an effective workforce strategy.

23.7    Frances McCabe thanks NHS colleagues for an excellent presentation. She noted that there were real concerns about youth services; the role of parenting; and waiting times for young people with complex needs, particularly in terms of the impact on schools. Ms Wallis agreed that parenting is key: parents need to be supported to understand what normal development looks like and to ask for help. Health Visitors do an excellent job, but not everyone uses them. Deb Austin added that the city council supports the Thrive model and is currently reviewing early help services.

23.8    In response to a question from Cllr McNair on the comparative merits of face to face and virtual services, Ms Walker told members that most treatments currently use a combination of face to face and virtual delivery. The mix is determined in large part by service users and their families. Ms Wallis added that face to face interactions have continued through lockdown where there was a clinical need. Also, services do recognise that digital exclusion may mean that digital services are not suitable for everyone. However, a blended approach can be very effective, and there are some instances where digital really works: e.g. for medication monitoring where regular virtual check-ins can be quicker and less disruptive than repeated face to face appointments. Similarly, virtual has a role to play in CBT: e.g. for quick check-ins in between face to face sessions.

23.9    In answer to a query on waiting times from Cllr Brennan, Ms Walker told the committee that neurodevelopmental waiting times are currently lengthy. This is being addressed, in part through additional capacity offered by an independent provider. Mr Child added that there had been a full response in January to the mASCot complain about CAMHS services for young people with autism. There will be a follow-up meeting with mASCot in February 2022.

23.10  Cllr Wilkinson asked a question about delays in discharging non-acute patients. Ms Wallis replied that there has definitely been an impact on discharge during the Covid emergency. This is a complex issue, but it seems likely that practitioners are showing caution in ending treatment where the relationship with young people and their families has been entirely virtual. Where a relationship had been established in face to face meetings before services moved to virtual, practitioners may feel more confident that they know service users well enough to make a discharge decision.

23.11  In response to a query from Cllr Wilkinson about performance benchmarking, Ms Walker told the committee that CAMHS services are benchmarked annually, and that she would check whether this information could be shared with the HOSC.

23.12  In answer to a question from Cllr Wilkinson about mental health support in schools, Ms Austin explained that all local schools use the Brighton & Hove Schools Inclusion service. There are mental health workers attached to all secondary schools and to primary school clusters. Brighton & Hove is currently piloting an NHS scheme to provide additional mental health support to schools.

23.13  In response to a query on funding from Cllr Wilkinson, Ms Gorvett told members that there has been additional national investment in young people mental health services. Locally, there has been an extra £800K invested in services.

23.14  RESOLVED – that the report be noted.