Children and Adolescent Mental Health Services Update
The report provides an overview of the current Child and Adolescent Mental Health Services (CAMHS) offer in Brent, the improvements and investments identified as in the CAMHS Local Transformation Plan as a response to ‘Future in Mind’.
It also provides an update on progress against the recommendations made by the Brent Council Community and Wellbeing Scrutiny Committee CAMHS Task and Finish Group as set out in their report of July 2017.
Duncan Ambrose (Assistant Director, Brent Clinical Commissioning Group (CCG)) introduced the report which provided an overview of the current Child and Adolescent Mental Health Services (CAMHS) offer in Brent and the improvements and investments identified in the CAMHS Local Transformation Plan. Mr Ambrose pointed out that two out of three children with mental health conditions did not receive the support they needed. In order to address this, the National Health Service (NHS) had set up a plan for investment in CAMHS which was refreshed on an annual basis.
Mr Ambrose directed Members’ attention to section three of the report which provided an update on progress against the CAMHS Scrutiny Task Group recommendations. In relation to increasing investment in mental health support in schools, it was noted that the Brent CCG had submitted a bit for School CAMHS service and was awaiting the outcome. Furthermore, Brent CCG had engaged with schools directly and through partnership fora to confirm the referral processes, leading to a positive impact in referrals. Work on developing a programme of peer and staff support in schools was ongoing as well as the engagement and recruitment of community champions.
Jackie Shaw (CAMHS and Eating Disorders Service Director, Central and North West London (CNWL) NHS Trust) added that Brent Council and Brent CCG had been successful in developing a children’s eating disorder service which had the ability to assess urgent cases on the day of referral. She added that commissioning arrangements had been under review as services had to become more responsive to the needs of children and the increasing demand. A potential option to achieve this would be the commissioning of joint providers to operate in a similar way to Autism diagnosis support services. Furthermore, an urgent crisis service had been introduced which enabled children who presented themselves at hospitals to access specialist support 24 hours a day, seven days a week, while new discharge arrangements had made referrals to local services quicker. Nevertheless, the CNWL NHS Trust would continue to work closely with local communities in order to prevent children from going to hospitals unless this was strictly necessary.
The Committee welcomed the report and enquired whether the CAMHS in Brent were at crisis point. Mr Ambrose said that there had been a reduction in the number of children on waiting lists – 90% of children were seen within the target of 18 weeks which had reduced waiting lists by approximately 50%. Although the total number of children accessing CAMHS continued to increase, the service was not at a crisis point, but there had been concerns related to falling mental health workforce numbers. A number of professionals were leaving because it had not been affordable for them to live in London which caused issues related to the development and expansion of staff. Brent CCG held weekly conference calls with the CAMHS team to monitor recruitment to vacant posts and in cases where recruitment rounds had not been successful, relocation support and training had been offered to prospective candidates. Ms Shaw added that there was a retention group looking at recruitment and retention and examining the specialist roles the service needed. The issues with workforce recruitment and retention had an effect on the ability of Brent CCG and the Trust to transform the service and there had been reports of high levels of stress among staff. This had been addressed through supervision, support and staff wellbeing events. Apprenticeships for nurses and therapists as well as training contracts, along with internal promotions, had been considered where practical and initiatives such as rotating nursing staff between children and adolescent wards had been introduced. Moreover, peer support for young people who did not have diagnosable conditions was expected to reduce the need for specialist interventions. Furthermore, the Trust had put in place a number of measures such as using temporary staff, offering extra hours, addressing staff expectations and altering the service model. The way people entered the system, received support and were discharged was managed in a stricter way to address the discrepancies in the number of appointments children were given. The CAMHS gateway had been revised to ensure that it provided a consistent access route for all commissioned CAMHS in Brent, enabling referrals to be assessed in a timely manner.
A Member of the Committee enquired about the awareness of neurodevelopment disorders among General Practitioners (GPs), teachers and parents, as the majority of the referrals to CAMHS were made by GPs, parents and schools. Dr Ketana Halai (Clinical Director – Willesden, Brent CCG) explained that GPs relied heavily on reports received by schools as the 10-minute appointments they offered did not provide sufficient time to assess children in detail. Mr Ambrose added that often children referred to CAMHS had communication problems. Therefore, although speech and language support was provided promptly, diagnosis could be delayed. In addition to the specialist Youth Offending CAMHS worker, Brent CCG was working with schools to put in place specialist CAMHS workers alongside the education psychology team.
Mr Ambrose said that there were various teams working on the prevention of anxiety, depression and negative impacts of social media. Local communities had been engaged in tackling stigma and encouraging an early diagnosis (prior to a formal referral being made), but this had been challenging due to the fact that people moved frequently. There was a wide range of activities focused in schools, with greater amount of psychotherapy being available at schools for pupils with Special Education Needs and Disabilities (SEND). Zoe Kattah (Representative, Healthwatch Brent) said that the Thrive Plan for 2018/19 was linked to CAMHS in schools and included proposals to establish community champion roles to promote good mental health and wellbeing among children and young people. Nine champions had been recruited to develop a social media engagement platform that could be used by young people to help them find out more about their mental health and there were plans to create a video to be shown in schools.
A specific question raised by the Brent Youth Parliament Observers on the Committee concerned the measures Brent CCG and the Council had put in place to ensure that young people throughout the Borough could access the same quality of support irrespective of where they lived and studied. Mr Ambrose explained that under the current arrangements some schools procured CAMHS themselves. Brent CCG had been actively trying to link schools up so they could achieve better value for money through joint commissioning which would also facilitate transitions between services. It was noted that while some schools had been very good at maximising the benefits of the offer in the Borough, others had not engaged as well and the Committee enquired about the measures that had been taken to encourage collaboration. Mr Ambrose responded that if the bid for School CAMHS service was successful, it would benefit all schools and colleges in the Borough as it would supplement the existing provision and would ensure that mental health support would be available to children even if some schools did not procure services.
Responding to a question about the link between childhood obesity and mental health, Mr Ambrose pointed out that this correlation had already been discussed at previous meetings of the Committee. He said that risks related to eating disorders were more acute than those linked to obesity, i.e. it was more immediately dangerous for a child to be anorexic than obese. Furthermore, obesity was not generally seen as a mental illness despite the fact that there was a link between mood and food and food was part of the cultural identity of many Brent residents.
Members of the Committee enquired about the support available to parents and Mr Ambrose said that an event for parents and relevant stakeholders had taken place in October 2017, with another one planned to take place in February 2019. Work with parents started at very early stages when children had displayed early signs of having a mental health condition and a number of indicators were examined if they struggled. A series of events targeted at young people had allowed commissioners to hear their views and had led to the development of an online counselling service which offered initial learning support and direct online counselling. In addition, as part of their work, Healthwatch Brent attended school assemblies and parental evenings to raise awareness about the importance of maintaining good mental health.
Mr Ambrose acknowledged that there were gaps in the existing provision and that certain communities found it difficult to access the offer. The support that was offered in the Borough relied on a multiagency approach to tackle stigmas associated with some communities living in Brent. For example, the Brent CCG was aware of the number of people who found it difficult to ask for help in their communities and it had linked up with Public Health England in relation to Thrive LDN - city-wide movement aspiring to promote mental wellbeing, prevent illness and eliminate suicide in London. Its approach relied on having a conversation in the community about mental health and it could be adapted for the needs of CAMHS as representatives of local communities could be trained to offer low level support.
(i) The contents of the Child and Adolescent Mental Health Services Update report, be noted;
(ii) The multiagency CAMHS steering group be encouraged to liaise with organisations such as the National Autistic Society to capture the symptoms of neurodevelopment disorders early;
(iii) The issue of staff retention be examined in a report on the workforce involved in delivering the CAMHS provision in Brent; and
(iv) A report on gaps in services and fragmentation of delivery, along with the associated risks, be provided.
Gail Tolley left the meeting at 6:26 pm in order to attend a meeting of the Teachers’ Joint Consultative Committee.
The outcome of the application was expected by 15 October 2018, but it had not been made available yet.