Child and adolescent mental health

Recommendations

The Central Bedfordshire vision for the new CAMHS service is as follows:

  • Children and Young People in Central Bedfordshire benefit from accessible, integrated, flexible and timely CAMH Services, which ensure effective assessment, treatment and support, for them and their families. In realising the Central Bedfordshire vision to promote the following key features of CAMHS service and is in the process of re-procuring services which reflects the following:-
  • An integrated service: Central Bedfordshire’s CAMHS service will co-ordinate universal and targeted services relevant to mental health within an overall planning process so that they support each other, and are able to offer a transparent and accessible service to users, using integrated care pathways.
  • Care pathway: CAMHS will adapt to the Whole Systems Model. This approach is the preferred methodology to apply packages of care in a coordinated and integrated way and to create professional consensus and standardise elements of care to improve efficiency, effectiveness and value for money. Essentially, this model describes the nature and anticipated course of treatment for a particular client and a predetermined plan of treatment and for pathways within and between services
  • A single point of access: an important aspect of the integrated service will be a single point of access for CAMHS, which will ensure consistent approaches, regardless of method of referral or type of need. Decisions about referral will be taken in a timely and integrated way, and referrers will be confident that the child they have referred will receive an appropriate response from CAMHS.
  • A focus on early intervention: the service aim is to ensure better co-ordination of lower tier of CAMHS services so that they are increasingly able to provide help and support at an earlier stage, and also so that they can train and support universal services providers on mental health issues.
  • Improving input from children and young people:  it is essential to involve children and young people, parents and carers in the planning and evaluation of services to ensure that services are designed around the needs of children, young people, and their carers rather than the needs of the service or agency.
  • Community-based delivery: the aim is to ensure delivery of CAMHS through multi-agency approaches, in for example, health centres, schools, Surestart centres and youth centres, near to where the need is.
  • Moving from a medical to a social model:  to promote a social model of CAMHS delivery, where the medical aspects of a child or young person are assessed as part of their wider needs, including social or psychological needs. This approach will avoid the risk of stigmatising a child or young person with language which places pathology on them, but will focus on the strengths and needs of children and young people in their family and social context.
  • Key outcome measures: it is important that the service is able to clearly monitor and demonstrate the outcomes of delivering the Specialist CAMHS Service.   Measuring outcomes is important, not only to ensure good services continue to be commissioned, but also in ensuring the level of services provided matches need or severity of issues and we can continually assess the mental health of children and young people. For Commissioners of the CAMHS Service across Bedfordshire we expect a service that can demonstrate not how many children and young people the service has seen, but the difference that service has provided.  In order to ensure there is consistency of measuring these outcomes across the CAMHS pathway – the principle outcome measure to be used is the Strength and Difficulties Questionnaire (SDQ).

The Director of Public Health’s report recommends action in three key areas to improve children and young people’s mental health

  • Ensure excellent maternal mental health: Maternity and Health Visiting services
    • To identify women early who have poor mental health through antenatal and postnatal maternal mood assessments
    • To ensure that the ante and postnatal pathways for maternal mental health are followed and women have access to high quality and timely support for mental health illness.
  • Help children to become more resilient: Health and early years practitioners and providers
    • should develop and agree pathways and referral routes that define how practitioners will work together, as a multidisciplinary team, across different services (NICE guideline PH40)
    • Ensure practitioners have the knowledge, understanding and skills they need to develop young people’s social and emotional wellbeing (NICE guideline PH20)
    • Provide a curriculum that promotes positive behaviour and successful relationships and helps reduce disruptive behaviour and bullying (NICE guideline PH20 Mental health and behavior in schools: Department for Education. June 2014
  • Increase the early identification of children who are at risk of poor mental health earlier and ensure that they have access to appropriate services
    • Early intervention: Early intervention is key. Identification of those children at risk of developing mental illnesses, through the identification of maternal mental illness (e.g postnatal depression, see chapter 1) and predisposing factors in childhood. Family-based interventions and creating a positive home and educational environment for such children is a priority
    • Service Integration: Reduce the need for families to deal with multiple agencies that do not appear to be working jointly. Equally some services are fragmented and not necessarily focused on the most vulnerable groups. Commissioning work needs to be developed jointly with adult colleagues as a significant proportion of children with mental health problems also have parents with mental health issues and the two should not be treated in isolation.

The findings of the report on self harm (1) recommend that Public health should work with colleagues across the system to:

  • Further investigate the apparent rise in hospital admissions, triangulating data on self-harm from other parts of the system including School Nurses, the Balding Survey, the mental health providers and the Child Death Overview Panel.
  • Establish what support is available post-discharge to children and young people who have self-harmed, particularly where there is a history of repeated self-harm.
  • Consider multi-agency plans for children and young people who are repeatedly self-harming.
  • Work with the new Children and Adolescent Mental Health (CAMH) provider to ensure that the responsive acute service is maintained, and that prevention and early intervention are enhanced.

Further recommendations:

  • Transition from children to adult services: CAMHS to ensure adequate pathways exist for the transition of children to adult services.
  • Deprivation:  CAMH services for behavioural and emotional disorders, such as parenting and psychological services should be focused on the areas of highest social deprivation as indicated by the increasing prevalence of conditions in these areas.
  • Vulnerable groups: Recognition and needs assessments of vulnerable groups such as those children in areas of deprivation, those with family history of mental illnesses, and ethnic minorities. CCGs (2) need to reflect the high level of mental health needs amongst looked-after children in their strategic planning of child and adolescent mental health services (CAMHS).
  • Robust local pathways: Ensure local pathways for mental health conditions in children and adolescents are robust, have clear step up/down criteria and services available are in line with best practice.
  • Data collection: It is important to have an accurate representation of the local picture of mental health in children and adolescents. Local prevalence data can help target interventions and preventative measures to areas that have the highest need, and can allow time trends to be effectively established to evaluate the impact of such interventions. Local data should be collected by Public Health and CAMHS for mental health conditions as opposed to applying national prevalence alone.
  • Increase awareness: Children’s workforce  to increase the awareness of mental illness in children and adolescents in the public, along with ensuring that there is public awareness of the services that are available for support

Cross Cutting Themes

  • Protection and safety chapters including domestic abuse and looked after children.
  • Maternal Mental Health JSNA
  • Adult Mental Health JSNA
  • Deprivation JSNA

References

(1) Royal College of Psychiatrists, 2010 No health without public mental health The Case for Action London.

(2) Department of Health 2015 Promoting the health and well-being of looked-after children: Statutory guidance for local authorities, clinical commissioning groups and NHS England


Last updated Thursday, 11th May 2017