Children & Young People’s Mental Health and Wellbeing

“Our Vision is to transform provisions of support for children and young people’s mental health services into asystem without tiers”

South Tees Transformation Plan

2015- 2020

(2017 Refresh)

Version 3

Children & Young People’s Mental Health and Wellbeing

South Tees Transformation Plan

Contents

1Introduction

2Executive Summary of Children and Young People’s Mental Health and Wellbeing Transformation Plan?

3National Policy Context

4 Local Policy Context

5Children and Young People’s Mental Health; National Profile of Need

6Children and Young People’s Mental Health; Local Profile of Need

7What Children and Young People have told us

8Commissioned Services

9Baseline access, waiting time, workforce and in-patient data

10 Children and Young Peoples Improving Access to Psychological Therapies (IAPT)

11 Analysis of Need, Gaps and Issues

12Our Vision

13Shared Values and Principles

14How are we going to achieve our vision?

15Engagement and Partnership

16National Evidence of Effective Interventions

17 Strategic Clinical Network

18 Towards a Model of Transformation

19 Achieving Parity of Esteem between Mental Health and Physical Health

20 Our Initial Priorities

21Collaborative Commissioning

22 Investment

23 Governance

24Performance

25Equity and Health and Inequalities

26High level Risk

27Executive Action Plan

Appendix 1 Stakeholder Consultation

Appendix 2 Outline Communication and Engagement Strategy

Appendix 3Executive Action Plan 2015/16-2016/17- 2017-2018

Footnotes

Children & Young People’s Mental Health and Wellbeing

South Tees Transformation Plan

1Introduction

1.1This document sets out the Five-year Children and Young Peoples Mental Health and Wellbeing Plan for South Tees, in line with the national ambition and principles set out in Future in Mind – Promoting, protecting and improving our children and young people’s mental health and wellbeing[1].

1.2A requirement of Future in Mind is for areas to develop and update theirlocal plan focused on improving access to help and support when needed and improve how children and young people’s mental health services are organised, commissioned and provided.

1.3In response, theSouth Tees Children and Young People’s Mental Health and Wellbeing Transformation Plan 2015-20 has been developed;updated in 2016 and further updated in 2017building on the foundations of theprevious Tees-wide Children and Adolescent Mental Health Services (CAMHS) transformation work.

1.4As this document incorporates Child and Adolescent Mental Health Services (CAMHS); it should be seen as the local ‘CAMHS strategy’.

1.5Future in Mind is further strengthened in its delivery and prioritisation within The Five year forward View for mental Health[2] which articulates that by 2020/21 at least 70,000 more children should have access to high quality health case when they need it

1.6The Sustainable Transformation plan October 2016 developed across region also highlights that the CCG’s will implement in full the Mental health 5 year forward view for all ages

2Executive Summary of Children and Young People’s Mental Health and Wellbeing Transformation Plan?

2.1The transformation plan provides a framework to improve the emotional wellbeing and mental health of all children and young people across South Tees. The aim of the plan is to make it easier for children, young people, parents and carers to access help and support when needed and to improve mental health services for children and young people.

2.2 The plan sets out a shared vision, high level objectives, and an action plan which takes into consideration specific areas of focus for local authority areas.

2.3 Successful implementation of the plan will result in the following outcomes:

  • An improvement in the emotional wellbeing and mental health of all children and young people;
  • Multi-agency approaches to working in partnership, promoting the mental health of all children and young people, providing early intervention and also meeting the needs of children and young people with established or complex problems;
  • All children, young people and their families will have access to mental health care based upon the best available evidence and provided by staff with an appropriate range of skills and competencies.

2.4This updated plan has built upon previous plans completed in 2015 and 2016 developed by a multi-agency group and builds on the Teesside CAMHS work.Stakeholders consulted in the development of the plan are listed in Appendix 1.

2.5The plan was informed by health needs assessment within each local authority area and has delivered some of the following from the increased Future in Mind Investment :-

  • Increased referrals into CAMHs services from 1594 in April September 2016 to 1732 in April 17- September 2017
  • Reduced waiting times from referral to initial appointment within four weeks achieved 100% compliance
  • Achieved Second appointment of set target of 90% within 9 weeks
  • Increase in staffing and skill mix within TEWV Camhs service
  • Commissioned 24/7 crisis service
  • Commissioned Peri- Natal service
  • Commissioned NICE compliant early Intervention in Psychosis service
  • Commissioned enhanced community eating disorder which is based on NHE England Commissioning Guidance. The provider is registered with the National Quality Improvement programme, and baseline data was completed within NHS Digital Mental Health Data Set
  • Ongoing commitment to roll out of CYP IAPT across wider workforce
  • Investment in local authority schemes to develop the wider workforce to enable early identification and intervention
  • Being innovative with schemes to ensure sustainability such as attunement an attachment training to help build capacity with front line staff.
  • Implementing early words together programme for children and parents
  • Implementing peer support and champions
  • Framework of providers who can deliver NICE compliant therapies within school settings
  • Headstarters working into every secondary school in Middlesbrough
  • Pilot working into college supporting young people emotional health and wellbeingduring exam periods to promote coping strategies and self help
  • Workforce development plan produced

2.6The following areas have been identified for this year and to take us to 2020

  • Key to this is to monitor and review areas where non-recurring monies awarded to look at sustainability moving forward
  • Review and update local area workforce plan to cover wider 0-25 children and young people’s service linked to SEND and Learning Disabilities Transforming Care. Appendix 4
  • Review and analysis of previous staffing, skill mix and current numbers against activity to inform future workforce needs. Linked to future In mind Thrive model, moving away from currently commissioned Tiered services
  • Working with provider and specialist commissioned as part of new models of care to ensure pathway are reviewed and refined for admissions and discharges from Mental Health inpatient settings.
  • Speech and Language Pilot linked to Youth Offending services to upskill staff to assess and support the communication needs of children and young people to improve emotional health and wellbeing, to improve compliance and reduce reoffending rates
  • Review Autism pathway and redesign due to waiting times for diagnosis remain high, there is no consistent post diagnostic support and no commissioned occupational therapy service to assess sensory needs and deliver interventions
  • Funding to Support the VCE to enable then to complete the Mental Health Service minimum Data set
  • Develop robust mechanism of performance monitoring of all schemes linked to contract variation with provider or within S256 agreement to the local authorities
  • Identify programmes of work for future funding up until 2020 and sustainability beyond

3National Policy Context

3.1National policy over recent years has focussed on improving outcomes for children and young people by encouraging services to work together to protect them from harm, ensure they are healthy and to help them achieve what they want in life.

3.2In regard to improving outcomes for children and families, No Health without Mental Health[3] published in 2011, emphasises the crucial importance of early intervention in emerging emotional and mental health problems for children and young people. Effective commissioning will need to take a wholepathway approach, including prevention, health promotion and early intervention.

3.3Future in Mind – Promoting, protecting and improving our children and young people’s mental health and wellbeing), responds to the national concerns around provision and supply of system wide services and support for children and young people. It largely draws together direction of travel from preceding reports, engages directly with children young people and families to inform direction and the evidence base about what works.

3.4The report introduction includes a statement from Simon Stevens CEO of NHS England he stated ‘Need is rising and investment and services haven’t kept up. The treatment gap and the funding gap are of course linked’. The report emphasises the need for a whole system approach to ensure that the offer to children, young people and families is comprehensive, clear and utilises all available resources.

3.5The joint report of the Department of Health and NHS England sets out the national ambitions that the Government wish to see realised by 2020. These are:

  1. People thinking and feeling differently about mental health issues for children and young people, with less fear and discrimination.
  1. Services built around the needs of children, young people and their families so they get the right support from the right service at the right time. This would include better experience of moving from children’s services to adult services.
  1. More use of therapies based on evidence of what works.
  1. Different ways of offering services to children and young people. With more funding, this would include ‘one-stop-shops’ and other services where lots of what young people need is there under one roof.
  1. Improved care for children and young people in crisis so they are treated in the right place at the right time and as close to home as possible. For example no young person under the age of 18 being detained in a police cell as a ‘place of safety’.
  1. Improving support for parents to make the bonding between parent and child as strong as possible to avoid problems with mental health and behaviour later on.
  1. A better kind of service for the most needy children and young people, including looked after children, care leavers, those who have been sexually abused and/or exploited making sure they get specialist mental health support if they need it.
  1. More openness and responsibility, making public numbers on waiting times, results and value for money.
  1. A national survey for children and young people’s mental health and wellbeing that is repeated every five years.
  1. Professionals who work with children and young people are trained in child development and mental health, and understand what can be done to provide help and support for those who need it.

3.6 Future in Mindidentifies key themes fundamental to creating a system that properly supports the emotional wellbeing and mental health of children and young people. The themes are:

  • Promoting resilience, prevention and early intervention
  • Improving access to effective support – a system without tiers
  • Care for the most vulnerable
  • Accountability and transparency
  • Developing the workforce

3.7 The reportfurther sets out of 49 recommendations that, if implemented, would facilitate greater access and standards for Children and Adolescent Mental Health Services(CAMHS), promote positive mental health and wellbeing for children and young people, greater system co-ordination and a significant improvement in meeting the mental health needs of children and young people from vulnerable backgrounds.

3.8One of the recommendations is specific to implementing theCrisis Care Concordat[4] – an agreement between police, mental health trusts and paramedics to drive up standards of care for people, including children and young people experiencing crisis such as suicidal thoughts or significant anxiety.

3.9 Future in Mind also makes reference to the Children and Young People’s Improving Access to Psychological Therapies programme (CYP IAPT). This is a service transformation programme delivered by NHS England that aims to improve existing Child and Adolescent Mental Health Services (CAMHS) working in the community[5]. The programme works to transform services provided by the NHS and partners from Local Authority and Third Sector that together form local area CAMHS Partnerships. It is different to Adult IAPT as it does not create standalone services. The programme began in 2011 and has a target to work with CAMH services that cover 60% of the 0-19 population by March 2015.

3.10The Mental Health Five Year Forward View and STP identify that the CCG 9 must do’s which include improving access to mental health support from local services; talking therapies and greater involvement from voluntary sector and social enterprise

3.11STP must Implement plans regarding Early Intervention into Psychosis (EIP), psychological therapies (IAPT) and improvements to CAMHS , Develop community based services to support repatriation of ‘out of area’ placements.

4Local Policy Context

4.1 This transformation plan contributes to the delivery of local priorities detailed within Joint Health and Wellbeing Strategies.

4.2 The Middlesbrough Joint Health and Wellbeing Strategy aims to ensure children and young people have the best health and wellbeing. Specific priorities include: early help with focus on the family; supporting emotional health and wellbeing of young people and their family; and improving maternal health and early years health and wellbeing outcomes.

4.3 A key priority in the Redcar and Cleveland Joint Health and Wellbeing Strategy is to ensure children and young people to have the best start in life. This includes children, young people and families being supported through integrated prevention and early intervention programmes, and improving maternal and early years’ health and wellbeing.

4.4 The transformation plan also aligned with the NHS South Tees Clinical Commissioning GroupsClear and Credible Plan 2012-17, which acknowledges the need to focus on children and young people, particularly those in vulnerable groups (children in care, careleavers, children with special needs) and developing commissioning intentions.And captured within STP transforming mental health services

4.5 Delivery of this plan will also support the Clinical Commissioning Groups Mental Health Strategy 2015-20, and aligns with the draft Joint Strategy for Autism Spectrum Disorders.

5Children and Young People’s Mental Health; National Profile of Need

5.1Mental health problems cause distress to individuals and all those who care for them. Mental health problems in children are associated with underachievement in education, bullying, family disruption, disability, offending and anti-social behaviour, placing demands on the family, social and health services, schools and the youth justice system. Untreated mental health problems create distress not only in the children and young people, but also for their families and carers, and the wider community, continuing into adult life and affecting the next generation.

5.2Information in key policy documents suggests:

  • 1 in 10 children and young people aged 5 - 16 suffer from a diagnosable mental health disorder;
  • Between 1in every12and 1 in 15 children and young people deliberately self-harm;
  • More than half of all adults with mental health problems were diagnosed in childhood - less than half were treated appropriately at the time;
  • Number of young people aged 15-16 with depression nearly doubled between 1980s and 2000s;
  • Proportion of young people aged 15-16 with a conduct disorder more than doubled between 1974 and 1999;
  • 72%of children in care have behavioural or emotional problems;
  • About 60% looked after children in England have emotional and mental health problems and a high proportion experience poor health, educational and social outcomes after leaving care;
  • 95% of imprisoned young offenders have a mental health disorder.
  • Suicide is the leading cause of death in young people.
  • Accounts for 14% of deaths in 10-19 year olds
  • Over half of young peoples who die by suicide have a history of self-harm

5.3 Just like adults, any child can experience mental health problems, but some children are more vulnerable to this than others[6]. These include those children who have one or a number of risk factors:

  • who are part of the Looked after system and care leavers
  • from low income households and where parents have low educational attainment
  • with disabilities including learning disabilities
  • from Black, Minority,Ethnic (BME)Groups including Gypsy Roma Travellers (GRT)
  • who identify as Lesbian, Gay, Bisexual or Transgender (LGBT)
  • who experience homelessness
  • who are engaged within the Criminal Justice System
  • whose parent (s)may have a mental health problem
  • who are young carers
  • who misuse substances
  • who are refugees and asylum seekers
  • who have been abused, physical and/or emotionally
  • who have had family bereavement
  • who have experienced suicide bereavement

6Children and Young People’s Mental Health; Local Profile of Need

6.1 The following data is taken from Public Health England Fingertips[7] (Crown Copyright 2016 updated august 2017)Children’s Mental health and wellbeing profile. The reports bring together key data and information to support understanding key local demand and risk factors to inform planning.

6.2 Tabled below is the 0 to 19 years population for both Middlesbrough and Redcar and Cleveland.

Male population aged 0-4 years (2016) / Male population aged 5-9 years (2016) / Male population aged 10-14 years (2016) / Male population aged 15-19 years (2016)
Middlesbrough / 5,078 / 4,675 / 4,156 / 4,572
Redcar and Cleveland / 4,079 / 3,953 / 3,626 / 4,139
Female population aged 0-4 years (2016) / Female population aged 5-9 years (2016) / Female population aged 10-14 years (2016) / Female population aged 15-19 years (2016)
Middlesbrough / 4,743 / 4,639 / 3,981 / 4,391
Redcar and Cleveland / 3,838 / 3,607 / 3,419 / 3,829

Source: Local authority mid-year resident population estimates for 2016 from Office for National Statistics. CCG population estimates aggregated from GP registered populations (Oct 2014).