Mental Health of Children and Young People Conference Review
Thursday 23 October 2014 ORTUS learning and events centre Camberwell, SE5
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FOREWORD by GENEVIEVE GLOVER Thank you all for your attendance at Maudsley Learning’s inaugural Mental Health of Children and Young People Conference on 23rd October 2014. Your support and contribution added to a thought provoking and dynamic day. Maudsley Learning CIC has been established nearly 18 months and we are focused on our social vision of raising knowledge and awareness of mental health and wellbeing. We aim to do this by providing world class and accessible learning. We use a variety of media, both face to face at our multi-award winning learning and events centre in Camberwell as well as online, through our digital platform Maudsley Learning Online. One of Maudsley Learning’s three workstreams, Children and Young People, has evolved over the last few months with Dr Jane Padmore (South London and Maudsley NHS Foundation Trust) delivering a workshop on Mental Health & Street Gangs in February and July, a webinar led by Dr Maryanne Freer (Charlie Waller Memorial Trust) and Dr Virginia Davies (South London and Maudsley NHS Foundation Trust) looking at Prevention and Early Intervention in September and our inaugural Conference in October. The Conference provided a platform to a broad range of excellent speakers all experienced in service provision to children and young people. The discussion surrounding early intervention, funding and collaboration with the challenges faced, best practise to be shared, possible solutions and Government response and vision. All chaired expertly by Emma and Sam from University of Oxford, Mind Your Head and the It Gets Brighter Campaign. In addition to the learning events noted above, Maudsley Learning are currently delivering our Schools Programme across primary and secondary schools in a London Borough. Maudsley Learning’s Schools Programme takes a whole school approach by focusing on the real world of teaching and the role of education providers in promoting mental health, understanding mental health issues and knowing what to do to make a difference. Maudsley Learning intends to build on the knowledge and feedback received to date as well as new collaborating partners to develop the Children and Young People work stream further into 2015 and beyond. If you would like to be involved and/ or have a query about future events and our schools programme, do get in touch.
Introduction by Conference Chairs Emma Lawrance DPhil Student (Clinical Neuroscience-University of Oxford) It Gets Brighter Campaign Samuel Galler DPhil Student (University of Oxford) Mind Your Head Oxford & It Gets Brighter Campaign
HIGHLIGHTS OF THE SESSION • Emma shared her story of being diagnosed with OCD at the age of 14. She explained how everyday activities became major challenges as a result, and felt she had to hide her diagnosis from friends as she feared she’d never be treated as “normal” again. She was told she would live with the condition for life, and felt alone and hopeless. She felt that she was treated as “just another number” by psychiatric services. What she needed was hope. When she got to university she started to share her experiences with others and gave those around her immense relief and hope to know that they are not alone. • Sam talked about how things immediately changed when he started talking to others about his depression. Initially he was afraid to talk about it or admit it to himself, but taking ownership of it helped him to manage it better. • The “It Gets Brighter” campaign was a result of inspiration from Dan Savage’s “It Gets Better” video, which turned into a viral campaign in support of those who are bullied because of their sexual orientation. ‘It Gets Brighter’ is about showing that there are high-functioning people struggling, so that people see that mental health issues affect everyone, and give hope through stories of recovery. Sharing stories through social media is a low-cost, high-impact way to get this message out. The campaign website is due to launch in January 2015. Through this initiative, the team aim to provide hope, to encourage people to seek help, to encourage people to take an active role in their recovery process, and to direct them to resources of their partner and specialist organisations from across the world. • They hope that the website will become a hub for different organisations working in mental health, to increase communication across organisations, improve coordination, expand their reach and learn from one another. • Quoting the following statistics that – ‘10% of children and young people have a diagnosed condition and 1 in 6 will experience an anxiety disorder in their lifetime. 75% of adults with mental health problems have their onset before the age of 18, and 50% before the age of 15’ • Emma and Sam set out the objective of the conference - “We’re here to share our visions for a better future for young people, and practical ways of achieving that future”
Children and Young People’s Services in Crisis: What Should Ideal Services look like? Lucie Russell Director of Campaigns and Policy Young Minds WIth Cammeron Mead and Stella Branthonne Forster YoungMinds Vs Activists
HIGHLIGHTS OF THE SESSION Lucie Russell, Director of Campaigns and Policy, Young Minds • Through facts and statistics, Lucie pointed out why children and young people’s services are considered to be in crisis. From 2010 to 2013 two thirds of local authorities cut CAMHS services by up to 30% (mostly to tiers 1 and 2, which gives people a perverse incentive to get more ill in order to get help). There are 1.3 million children and young people with a diagnosed (or “diagnosable”) mental illness –but, only 25% of these get treatment. Despite the arguments for early intervention, only 6% of the NHS mental health budget is spent on children and young people. She emphasised the urgency saying- “Now is not a good time to be growing up as a young person” • Indicating the unprecedented pressures young people face with internet use and mass media exposure which impacts their wellbeing, Lucie showed how building resilience is key. • She cited the Centre Forum Mental Health Commission (published in July 2014) which argues that the current health system is set up to treat the needs of “body parts not people”, she argued that we need a shift in attitudes; that there is no divide between the “well” and the “ill” but that we all have mental health that needs to be taken care. And, called for the innovative use of technology to achieve this, and for new collaborations – through an interdisciplinary approach. •
She concluded saying- “There are lots of recommendations – but, we need action!”
Cammeron Mead, YoungMinds Vs Activists • Cammeron shared his personal experience and journey through the services for the mental health of children and young people, highlight the challenges he had to face. • He suffered from anorexia nervosa from the age of 7 and spent 2 years on a child psychiatric ward. At the age of 15, he developed severe depression and was suicidal. As a result he was seen by two psychiatrists, who prescribed medications, as well as several therapists and counsellors.
• After nine months (by which he had reached his GCSE year) he began to get auditory and visual hallucinations and was voluntarily admitted to in-patient services, where he spent 12 days without speaking to anyone. Consultations with a community psychiatrist, cognitive analytic therapy and medications that he was prescribed helped him. • It was the switch from child to adult services which was problematic. CAMHS kept his case open in order to provide ongoing/handover support, which meant that adult services weren’t able to take him on while his CAMHS file was still open – this left him with no support for three months. In addition to this, Cammeron didn’t want to start any therapy whilst moving away to university. Once he got to university he was told that his symptoms were too severe for the university services and that he needed to access community support. • Community crisis team were called out in the middle of the night. His housemates at university had no idea of his problems and were shocked and frightened. He was then stuck in limbo between services because he wasn’t sure if he’d be able to stay at university or not, and services are organised by region depending on where you live – he was effectively told that no-one could help him. Stella Branthonne Forster, YoungMindsVs Activists • Stella gave an account of her journey which was positive and in contrast with Cammeron’s personal experience. • She came into contact with CAMHS for the first time at the age of 13 for low mood and self-harm. CBT didn’t help, but she found psychotherapy helpful. At 15 she went from cutting to overdoses, which spiralled out of control and she ended up in A&E on an inpatient ward. Stella’s experiences of CAMHS were positive – she felt she was lucky that SLaM (South London and Maudsley NHS Foundation Trust) was her local service, where she never had to wait for appointments and was fully supported. Cammeron and Stella together recommended what ‘Ideal services, according to young people look like’ • 6% of NHS mental health budget is not enough to be spent on children and young people • See whole person rather just diagnosis – family, likes, interests • One-stop-shops, with times that suit young people • Self-referral • Training for schools to spot signs of mental illness and know how to help • Fast track re-entry into services • Community outreach embedded to prevent hospital admissions • Better transitions from CAMHS to adult services • Make children’s and young people’s views central to service design • Appropriate inpatient provision (not hundreds of miles away or adult wards) • Learning from good practice (The Well Centre in Streatham is an example of a “one-stop shop” that is young person-friendly and meets many of these criteria)
Q&A HIGHLIGHTS 1. Health visitors are increasingly approached by child carers for adults in the family. What support is available for children who have parents with mental health problems? YoungMinds doesn’t offer this service. But, Lucie referenced the LSE report on the cost of perinatal mental health and that there is also a discussion around teenage parents, who are often treated as adults. The mental health taskforce is looking at different models of service delivery (i.e. beyond 0-18 and 18+, such as 16-25 services, or 0-25 as they have in Norwich). Lucie’s opinion was that this shouldn’t be necessary if existing services can learn to work better with one another. She also mentioned that levels of teenage pregnancy in the UK are dropping, and that there is a 10 year Big Lottery-funded project in Lambeth focussed on improving outcomes for the children of teenage parents. 2. What’s happening in schools to promote peer recognition and allow young people to talk about mental health? Lucie responded saying: The main political parties are now discussing mental health education, with talk of a “curriculum for life”. Labour and the Liberal Democrats are pushing for PSHE to be compulsory (the problem being that the people doing PSHE are untrained in the issues they’re teaching and that there is no budget for this). Prime Minister, David Cameron is arguing for a “whole school” approach. MP, Nicky Morgan has spoken about “building character and grit”, which implies resilience, and has pledged £5 million to develop this in schools. OFSTED is considering introducing a new indicator for measuring schools’ performance on wellbeing/behaviour/character.
IGNITE SESSION: Youth Violence John Poyton, CEO, RedThread
HIGHLIGHTS OF THE SESSION • John began by clarifying that their perspective is of youth work rather than mental health alone. In line with this their key principle is engaging youth where they are – i.e. designing services to fit their lives and removing hurdles to accessing help. • Quoting the costs and cause, John described the enormity of the issue. The costs of violence are estimated to be £2.5 million per year, with interpersonal violence being the third leading cause of death in the 15-29 age range, and the 9th cause of death in the under-14s. Triborough Public Health Report of the Westminster Joint Health and Wellbeing Board (Aug ’13) found that most of those involved in interpersonal violence have mental health problems. It also highlights the importance of the relationship young people have with the person helping them • John suggests that offering help in less formal settings is found more helpful by young people. This gives the opportunity for a “teachable moment”. Being in A&E is a window of opportunity when young people’s bravado drops and they may be willing to reflect and look at the possibility of change • RedThread’s initiative to bring a team of youth workers into A&E is the first of its kind in the country. It was started at Kings College Hospital and is now being rolled out to other hospitals in London. • John argues that if youth workers refer on young people with mental health problems to CAMHS this breaks the relationship and reinforces their sense of rejection (which many of these young people already feel as a result of attachment problems earlier in life) so it’s more productive to have youth workers continue to support those with mental health problems as key workers once they’ve gained their trust • He quoted Charlie Alcock of MAC-UK who suggests that instead of demanding that vulnerable young people fit in to our schedules and rejecting them if they don’t turn up, we’re better off being flexible – e.g. “I’ll be in Macdonald’s from 2pm to 6pm, it’s up to you if you drop by”, which young people with complex lives respond better to • He finished with a thought for the audience to ponder on- Often in our professional capacities we forget how young people relate – we need to “support them where they’re at”
IGNITE SESSION: Service Description of the Well Centre Dr Stephanie Lamb, Co-founder The Well Centre and GP partner at Herne Hill Group Practice
HIGHLIGHTS OF THE SESSION • Dr Lamb described the Well Centre as a partnership between the statutory and voluntary sectors, and as co-produced with young people with priorities set by young people. It is not a medical setting, with no reception staff, so young people are greeted by a youth worker. • They’ve found that they’re seeing a lot of unregistered patients, which indicates a high level of unmet needs. Drop-in sessions with GP, CAMHS nurse, youth workers, and visitors always see the same people so they get continuity and young people get to know the staff. They work with a team approach and information sharing. They also run outreach activities in schools. • Simple, non-threatening questions are used to prompt conversation, on sleep, safety and how they are on a 0-10 scale. This has led young people to disclose all sorts of information for the first time, including suicide attempts, as it relaxes people. • The Well Centre is seeing young people travel across London to access their services. The issues that bring them ranges from sexual health, acne and sports injuries providing them an opportunity to talk about mental health. • They collaborate with other organisations such as Girls in Gangs, drug and alcohol support, Lambeth Youth Offending Service, Knights Youth Club. Alongside, their GPs run pop-up services in colleges, and youth workers run PSHE in local schools.
IGNITE SESSION: Mental Health across Child Health Max Davie Community Paediatrician Convenor Paediatric Mental Health Association
HIGHLIGHTS OF THE SESSION • Max started by clarifying a common assumption that mental health work can and should only be done by mental health workers, which fits with how NHS services work. He quoted that the WHO definition of mental health is effectively a person’s function as a person, rather than as simply an organism – given this definition of living well, he said “It seems crazy to hive our humanity off as a specialist service”. • Max’s opinion is that non-CAMHS professionals don’t regard mental health as their business nearly enough. These are missed opportunities for reassurance and education, and leads young people to feel lost and rejected, which makes their mental health worse • He posed a question to the audiences saying from among those with recurrent abdominal pain, 80% have anxiety, (which unfortunately is ignored in the article “Finding the Organic Cause”), therefore created an artificial division between the mental and the physical • Given that the NHS will have a £30 billion funding gap in 5 years, Max urged that the link between physical and mental health needs be made at first contact. Indicating that there is parity of mental and physical health in law but not in training, funding or professional cultures
IGNITE SESSION: What can the Independent Sector do for CAMHS? Dr Sasha Hvidsten Clinical Lead (Acting) Huntercombe Hospital
HIGHLIGHTS OF THE SESSION • Dr Hvidsten confirmed the unmet need and severity of problems which is worse than it was 5 years ago, whether that’s because cuts are exacerbating social problems or because people are being seen later, once problems have deteriorated further. She pointed out strongly to politics and egos as getting in the way of teams working together and using resources efficiently • She urged the audiences to aim for pathways that fit around patients, rather than doing things the way we’ve always done them • Independent sector takes 6% of NHS caseload and all Huntercombe patients are NHS patients. The independent sector can innovate, e.g. trying new ways of delivering care like telemedicine, which is good for mental health where there is stigma attached to visiting a psychiatrist. • Dr Hvidsten concluded by saying that a partnership between various sectors (NHS and independent) will deliver the best care for patients as all are working towards the same goals.
The Children and Young People’s Mental Health and Wellbeing Taskforce Flora Goldhill Director for Children, Families & Health Inequalities Department of Health UK
HIGHLIGHTS OF THE SESSION • Flora says that mental health is one of the top priorities of her department. The Health Select Committee Enquiry into children’s and adolescent mental health and CAMHS, published this year, made a number of recommendations. This led to a pledge, “Better health outcomes for children and young people” (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/207391/better_health_outcomes_children_young_people_pledge.pdf ), signed by various organisations working in public health. Her vision is to take this pledge across the health system, and she points out that only by working together will we achieve its goals • Flora mentioned the forward progress made in mental health in recent years, with £54 million invested in CYP IAPT (the Children and Young People’s Improving Access to Psychological Therapies programme) and the establishment of the MindEd portal (https://www.minded.org.uk/) which provides information on mental health for anyone working with children and young people • In response to commissioners’ feedback saying that they don’t know enough about the need when it comes to mental health, her department will be conducting a survey on children and young people’s mental health to go to tender by the end of the year, which is being designed with the help of children and young people and we should have the results by 2016. • Flora recognises that at the moment there are perverse incentives for people to get more ill, that there is disinvestment in mental health services and that there are varying and sometimes inappropriate thresholds for referrals • The Children and Young People’s Mental Health and Wellbeing Taskforce has cross-sector membership and had their first meeting on the 24th September 2014. They will deliver their final report in May 2015. There is a consensus that radical change is needed, and that we need a change to involve service users and allow them to control their own care • The taskforce recognises that people are currently having to plan their lives around services whereas it should be the opposite way around
• Four sub-groups have been formed in the taskforce, focussing on data and standards, prevention and access, coordinated systems, and vulnerable groups and outcomes for these groups (including those in care, and those in the criminal justice system) • She welcomed hearing from anyone who wants to be involved or share their thoughts, at flora. goldhill@dh.gsi.gov.uk, @FloraGoldhill, or #CYPMHTaskforce Q&A HIGHLIGHTS 1)
How will these improvements work when services are being cut on the ground?
Service cuts depend on local decisions and priorities, and are determined by a Joint Strategic Needs Assessment. Flora urged those in the audience who feel that children and young people’s mental health services need more investment to argue their case to their local Joint Strategic Needs Assessment, using evidence and making the economic case for investment. She suggested that joined-up working and some of the other strategies being discussed won’t necessarily cost more money. She also pointed out that there will be a spending review after the next election and claimed that her department will be arguing strongly for more funding for children’s mental health, as early inventions save money in the long run 2)
But local services are being affected across the board – overall budgets are reducing?
The taskforce recognises this. They believe that universal services respond early and are much more effective than support that is targeted at those in crisis. Mental health problems arise from broader social problems. The government needs to address the inequalities in society that give rise to these issues. The taskforce will be linking up with other projects in the department such as the “troubled families” project.
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Therapeutic Care for Vulnerable Children in Challenging Neighbourhoods Camila Batmanghelidjh Founder and Director Kids Company
HIGHLIGHTS OF THE SESSION • Camilla started off by stressing that she wasn’t here in a critical capacity, although she had some challenging things to say. She recognises that there are good people doing good work in the area of children’s mental health, but thinks that the system isn’t working well enough. She called for conversations driven by courage and truth! • She spoke about clinicians and practitioners who visit her privately, who can’t reconcile their ambitions for children with their poor delivery of support because of the constraints of our current system. She empathised about how they are unable to speak out because they are worried about the impact on their jobs and future promotions, and this leads to silence in which they feel that what’s happening isn’t right and yet feel powerless to change this for the better to honour children’s needs and clinicians’ aims and integrity • The Centre for Social Justice spent two years working intensively with Kids Company and produced a 416 page report on their caseload of children (who are self-referred from the streets or schools) entitled “Enough is enough”. These children and young people have severe difficulties with mental health and child protection, and Kids Company try to refer their cases to CAMHS and social services, often without success. This suggests that those who are seen in services represent only a fraction of the need – national statistics used to measure service need and access are likely to be highly inaccurate. She called this “living in parallel worlds”. • Camilla recounted her journey - When Kids Co started out, it was under railway arches in Camberwell. They initially planned to deliver services for under-11s during the school holidays, as lots of children were worried about the long summer holidays without the school’s protection. These children had been known by authorities since toddlerhood, but local authority thresholds for protection involved children being hit with an implement. In the case of the seven-year-old, it was only a chance encounter of the mother hitting the child in the street with a shoe that triggered any intervention
• Camilla interviewed 400 children at the beginning of the project, starting at 8am and finishing at 8pm in order to speak to everyone. She said that it was remarkable that the kids queued all day to share their stories. They learnt that power and personal safety comes from being the most violent person around. These children reported that it felt good to be violent. They felt nice when they were violent, they said. Kids describe a cycle of stress – escalation – evacuation – collapse, where the collapse is the closest thing they’ve experienced to rest, or being soothed. They consistently said that they “can’t calm down”, “We are soldiers,” and “This is our war”! • Camilla set out to find a scientific explanation and after personal research yielded nothing satisfactory she went to the British Medical Society to get an expert group to study Kids Co children. The researchers found that children’s perceptions of the human face in a neutral expression were no longer neutral, but seen as threatening. They perceive aggression in others, so attacked in response. When they looked at 16-25 year-olds, they found that 1 in 5 had been shot at or stabbed, 1 in 4 had had family members who had been shot at or stabbed, and 50% had witnessed stabbings or shootings. The neural pathways of these young people who have faced such adversity mimicked that seen in PTSD in war veterans. Sexual abuse was 13 times more common in this group than in controls. Neglect was 11 times more common than in the control group • Quoting some statistics they have identified Camilla said nothing much has changed - 85% of children and young people involved with Kids Company are homeless; 87% have significant emotional and psychiatric problems; 81% have problems with substance misuse; 82% are criminally involved. A very small fraction of these are accessing statutory services, so most aren’t seen officially • Epigenetic studies have found that the environment in which children grow up affects their gene expression. Camilla claims that this means that when kids receive adverse care this leads their genes to be expressed differently, which can then be passed down through the generations. She also points out that these environments have an impact on children’s physical as well as mental health, and this group has high levels of auto-immune disorders, thyroid problems and premature ageing. These are biological implications of social issues. • Camilla says that she has faith that the current review will produce useful information, but points out that there has been a wealth of enquiries and reviews over the years. A problem impeding improvements for these children is that each silo works in isolation, so our response is divided. This separation suits civil society’s administrative requirements, but she questions whether this is the best methodology for traumatised children. She points out that if your parent is the person who is abusing you, they’re not likely to bring you to services. Pointing out the need for psychologists in schools to get to know kids rather than kids going to them. • She expressed her concern about 1 in 3 drop-out rate in clinical appointments for the most vulnerable. One appointment every two weeks is not enough – these kids need stable provision and continuous access; arguably support on a daily basis, from morning until night, and they need to be given an additional “positive re-parenting opportunity”. Kids need “wraparound” care and resilience. Sometimes what they need is a psychiatrist or psychologist, some will want music, art or sports opportunities, some will need a pair of shoes more than anything. Mental health is not always their first or only priority
• She calls for a fusion of children’s mental health with social care – asking for the creation of a Department for Child and Family Resilience, covering youth offending, social services, children’s mental health, special educational needs services and possibly even education • Camilla wants this process to start by having clinicians define an ideal situation, then getting a team of economists to model this setup, then piloting it on a small scale before rolling out. She was critical about the current measuring tools and said that it distort’s service delivery. Many outcomes used as indicators focus on skills acquisition, but children with complex trauma have a phase to go through before skills acquisition. They’re working through the “biology of terror”. This means that services stop taking in the most disturbed kids because they won’t get the required results • She called for a more rigorous and courageous challenge to the management of these services. Asking that we speak together to stop authorities from tidily collaging service delivery. • Camilla compared current approaches to improving services with selecting a slice of a cake to work on. For example, the current administration is working on speeding up adoption time, which is an easier aim to deliver than broader system reform. They don’t acknowledge that this is not the whole cake and not a strategic vision, and it’s used to silence “big picture” talk • Making reference to the riots in 2011 she spoke about how authorities were impressed at the ease with which the youths executed it. But asked that we need to recognise that these were driven by the fury of young people, which is still out there and can’t simply be squashed by the administration • In summary, Camilla called for better use of clinical research into these issues, fusion between mental health and social care, robust leadership, a rearrangement of our administrative systems, redefinition of outcomes, rearranging how we deliver services and a new vision of what we want to achieve which is more long-term than a few hours here or there Q&A HIGHLIGHTS 1) Should we be redirecting the money we spend on e.g. Trident defences and channelling this into youth services? Yes, we need to start thinking about our priorities in this way. We need a safety net for young people. Remember that before we went to the moon we thought it was impossible. Before finding treatments for cancer and making them widely available it was thought that this was impossible. This too seems impossible but could happen with sufficient will. 2)
What has the government response been to your calls for action?
The government has “reluctant respect” for Kids Company. Figures in Downing St have apparently said to Camilla that they know children’s services aren’t fit for purpose but no-one wants to touch them. Only 40% of services are rated by Ofsted as either “good” or “satisfactory”, so 60% aren’t performing at an acceptable standard by their measures. We need a cross-party plan for the next 15 years, to hold whoever comes into power.
Early Interventions During Tough Economic Times Professor Dame Sue Bailey Chair Children and Young People’s Mental Health Coalition
HIGHLIGHTS OF THE SESSION • Professor Bailey acknowledged that most people in the room haven’t heard of this coalition, but they have heard of its member organisations (Mental Health Foundation, YoungMinds, Place2Be, Youth Access, BPS, Youthnet, NSPCC, Centre for Mental Health, Tavistock Centre for Couple Therapy, RCP) and explained that they focus on parenting and the early years from conception • She said that the irrefutable truth was that ‘we need more money to provide services’ and expressed her concern as only a pittance is spent on prevention when it comes to children’s mental health • Professor Bailey called for the audiences to be more vocal about funding and its impact. She gave an example of the easy in which cancer research is funded, because those working in the area have been more vocal about the need and there is more agreement about what’s needed. • With 10% of mothers having perinatal mental health problems that have a huge impact on their children, 28% of pre-school children going through experiences that impact their development and 50% of adult mental health problems starting before the age of 15, she called for a whole schools approach and says guidance for schools is needed about fostering resilience • She urged the audiences to knock on the door of their local councillors and tell them about child mental health and why it matters. She also urged professionals to go their local library and ask if anyone wants to speak to them about mental health. They have done this in the North of England and it’s worked– young people have approached them to talk about mental health problems. Q&A HIGHLIGHTS 1) Recent reports have called for more universal provision in schools, but we still have a local piecemeal approach. What are your comments? We need to lobby government, but we need to present our recommendations in a non-threatening way. Use our skills to reframe what we’re asking for in terms and vocabulary that they find acceptable. We need to link up with the Department for Education. Emotional wellbeing in schools is ignored and is negatively impacted by the single-minded drive for exam results.
They are doing some helpful things in some places, but using different language. The education system’s priorities are the other way around (i.e. mental health is instrumental in educational achievement and performance at school) so we need to reframe our recommendations into their vocabulary and needs – make the case how this helps them to achieve what they want to achieve. Ofsted requirements shape what schools do, so they need to reflect schools’ work on promoting emotional and mental development in their assessments (and we need to push for this in a way that is non-confrontational, to avoid turning policy makers off). 2) Schools want to do more to support children’s wellbeing and holistic development, but are stuck at the local authority level. Response from a delegate who represented a local authority – Local Authorities can’t take money away from child protection so cuts are being made to parenting, domestic violence and other issues related to child mental health. They are, however, not in a position to provide the solution at the moment. Best place to invest money is in children. We’re approaching people in the wrong way and alienating potential allies. We need to apply our professional knowledge about framing ideas and make our suggestions “with a smile on our faces”.
Multi Agency Collaboration Dr Jane Padmore Consultant Nurse Child and Adolescent Mental Health Services (CAMHS) South London and Maudsley NHS Foundation Trust
HIGHLIGHTS OF THE SESSION • Dr Padmore outlined how collaborative working is a challenge because of different funding sources and different performance indicators for different agencies. This means that multi-agency groups are often torn in every direction by competing priorities. She has worked on collaborative projects that have had to be abandoned because the different departments failed to agree on aims – they realised that they’d all been using different terms, or using the same words to mean different things • She spoke about the “maze of services” that are difficult to navigate, but are working on related issues with the same groups (e.g. police, social work, sexual health, child protection, mental health) and quoted The Southwark Anti-Violence Unit (SAVU) as an example of how these services can come together to provide joined-up services. She asked that rather than parents handing over their child to a range of experts for care packages, they need to be supported to do it themselves and navigate the services available • Dr Padmore asked for research to be integrated into the work we do in order to evaluate their impact in longitudinal analyses. It is possible to interpret a brief flexibly? – e.g. many kids with conduct disorder have severe depression, so it may be appropriate to aim the intervention at depression instead of conduct disorder • She called for us to find common ground, treat each other with respect and be proactive about forging partnerships. Be diplomatic and make it work – use our professional skills when dealing with colleagues. Q&A HIGHLIGHTS 1) Do you have any advice on how to set up relationships across agencies? Go to places where agencies meet, find projects that overlap, and negotiate creative solutions (e.g. five schools chip in for a counsellor one day per week)
Councils and Health and Wellbeing Boards as Drivers of Improvement in Mental Health Services for Children and Young People Councillor David Simmonds Chairman Children and Young People Board
HIGHLIGHTS OF THE SESSION • Cllr Simmonds began by stating that 70% of all NHS money that is spent on you will be spent in the last 2 years of your life. And said that as a result of the transfer of public health services from central government to local authorities, Local Health and Wellbeing Boards give the public a direct say in public health. They can hold services accountable, and their decisions need to be agreed before budgets are allocated so this gives them real power. As budgets for young people will be transferred in 2016, he indicated that this would be a key time to influence the debate • Cllr Simmonds recommends speaking to the Lead Member for Children’s Services, the Director for Children’s Services, the Corporate Parenting team (for children in care) and the Safeguarding Children Board in the local areas to lobby for children’s mental health to be given greater priority • He asked that when Joint Strategic Needs Analyses are done, these need to reflect the mental health needs of the community and hence these ‘needs’ have to be represented to them so that they allocate resources appropriately. With a cut in council spending over the last 5 years, 30% less is now available for local government to spend on children’s services. The total spend on looked-after children is £4 billion – he asked if this is being spent on the right things? Given that children and young people have much higher mental health needs that the general population Q&A HIGHLIGHTS 1) Is there a danger that the most vulnerable children, whose families move often, will fall between the gaps if resources are allocated at the local level rather than centrally? Local Authorities still have responsibility for children even after they move out of their catchment area (this is only the case for children, not in any other area) 2) Are there plans to link councils and Health and Wellbeing Boards with NGOs and voluntary organisations? Yes – commissions can be given to external providers like NGOs and the voluntary sector. This becomes easier in the new set-up because local organisations are no longer dealing with the NHS and the council – they just need to go to one board.
THANK YOU Thank you for joining us at Mental Health of Children and Young People 2014 conference. The direction and insights from our steering group members and speakers helped identify and deliver a very relevant theme this year: ‘collaboration of mental health services for children and young people’. With some passionate and powerful perspectives from expert speakers, we believe we have initiated the conversation and hope to revisit it and further discuss progress in October next year with Mental Health of Children and Young People 2015. To those who were able to join us, it was an honour to host you. I understand that you have many obligations, and I appreciate your taking time from your busy schedule to join us. I hope that you found the event to be both interesting and informative. Again, I sincerely thank you for choosing to be a part of Mental Health of Children and Young People. See you next year! Pratima Pratima Fransua Conference Producer Maudsley Learning pratima@maudsleylearning.com 07554 582 679
With thanks to our Sponsors Associate
The Huntercombe Group is an independent provider of specialist healthcare services to and on behalf of the NHS. Our services include; Adult Mental Health, Specialist Brain Injury and CAMHS. We operate 56 hospitals and specialist centres across England and Scotland, our Child and Adolescent Mental Health Services, provide sensitive, skilled and effective treatment and care for children, young people and young adults (aged 11-25 years of age) with short-term mental distress or diagnosed mental illness (including eating disorders). Our passionate consultant led, multi-disciplinary teams, deliver evidence based age-appropriate care that empowers and promotes an individual’s independence through innovative, progressive and reversible care pathways that enhance an individual’s recovery.
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