Mental Health Services for Children and Young People

Mental Health Services for Children and Young People Mark Burdon Commissioning Manager (Mental Health), NHS South Tees CCG

Introduction • • Pathways Resources Gaps in services How services are informed by the JSNA

Pathways & Access Routes • Open referral to CAMHS services for any concerned individual • Some areas e. g. Middlesbrough have colocated Primary Mental Health Workers with Early Help teams in Early Help Hubs • Tertiary onward referral to Eating Disorders • Multi-agency diagnostic pathway for ASD

Clinical Pathways Care Pathways • Anorexia Nervosa • ADHD • Anxiety • ASD • Bulimia Nervosa • Depression • Emerging Borderline Personality Disorder • Positive Behaviour Support for Behaviours that Challenge • Post Traumatic Stress Disorder • Social & Emotional Wellbeing Clinical Link Pathway (CLIP) • Adolescent Forensic Outpatient Pathway • Parenting • Self Harm

TEWV on a page

• ‘Core’ CAMHS: Tier 2 & 3 (‘targeted’ and ‘specialist’ • Colocated with Early Help Hubs • Alignment to schools • Direct referral • 9 -5 Mon-Fri with some flexibility

• 14 -65 year olds where this is the first episode of psychosis or person is in ‘at risk mental state’ • 9 -5 Mon-Fri with some flexibility • 3 -year intervention period • Family-based working

• 24/7 cover in hospital and the community for crisis and liaison • Established in June 2015 • Early indications are that it has cut admissions for MH conditions for under-18 s

• CAMHS, complex LD, Eating Disorder, Low Secure, Medium Secure, PICU beds • 43 admissions from STCCG last year • 3370 bed days from STCCG last year

• Usually 9 -5 Mon-Fri • Treatment for anorexia, Bulimia • Gatekeepers for specialist intensive day services and inpatient eating disorder beds

Resources Tier 4 (Inpatient) Tier 3 (Specialist) Tier 2 (Targeted) Tier 1 (Universal)

Tier 1 Universal Midwifery, Health Visiting, School Nursing Children’s Services Some Voluntary Services Tier 2 Targeted CAMHS (Tier 2 Targeted) Primary Mental Health Workers Ta. MHS / REACH partnership / Emotional Health and Wellbeing Framework Tier 3 Specialist CAMHS and Learning Disability – Community Services CAMHS – Crisis and Liaison, Community Forensics CAMHS – Community Eating Disorder Service CAMHS – Looked After Children Learning Disability Challenging Behaviour Intermediate Care / Respite Early Intervention in Psychosis (N. B. age range 14 -35) CAMHS - Secure Children’s Homes Liaison and Diversion (NHSE commissioned)

Tier 4 Assessment and Treatment – Mental Health inpatient Specialist services Assessment and Treatment – Learning Disability inpatient Eating disorders in-patient Psychiatric intensive care units Medium Secure (Mental health and Learning Disability) Low Secure (Mental health and Learning Disability) Complex Neuro-developmental Service National Deaf CAMHS

Key stats • Tees CAMHS (Hartlepool, Stockton-on-Tees, Middlesbrough and Redcar and Cleveland) holds an average caseload of 3674 at any given time (2015/16 average). • Each month around 365 external referrals are made: CAMHS Referral Source Outcome of Assessment Primary Health Care Education 36% 48% 1% CAMHS 13% Social Services Self-Referral 2% 5% 9% Other 85% Internally referred to other TEWV services Discharged

Gaps in services • Tees CAMHS is commissioned to diagnose and support with ASD diagnosis but there are significant waiting lists. • There is a high expected prevalence of conduct disorder on Tees based on surveys, but little data on actual diagnoses or information on how well supported this is.

How services are informed by the JSNA • JSNA modular so some pages e. g. Mental Health, Learning Disabilities now out of date • Main source of data is Public Health England inc: NHSOF, ASCOF, PHOF, performance data • Strategic direction from NHS England local context with input from partners