The Lancashire and South Cumbria Children and Young People's Emotional Wellbeing and Mental Health Transformation team are currently working with providers to redesign mental health services.
The Children and Adolescent Mental Health Services (CAMHS) Redesign covers all NHS funded mental health services for children and young people from birth to their 19th birthday in Lancashire and South Cumbria.
WHAT DOES IT LOOK LIKE NOW?
Some young people may have an issue including school and not open 52 weeks of the year.
Want to access services on their services and in their time. – kooth.com 50% will use this service. Power remains with the young person. Once engaged more inclined to then engage with services if further help is needed.
Families may worry about a label and their child entering services.
Behavioural schools – stigmatizing and increase anxiety for those children who have behavioural problems.
Education is getting better but still stigma in schools and with health professionals
Want help early without issue.
Need = continuality between physical and mental health. Mental health not given same priority.
Any point in rebranding? Unless the stigma is addressed, anything it’s called will eventually become negative.
Get the care in hospital but when you get home there’s no support
Information given out on discharge needs to be geared to young people :
Need somewhere to care for young people who are in crisis needing assessment or short term place:
Often families have other children at home to look after
The adult model is better :
Crisis café idea – but how could it work in dispersed geographical area – virtual solution? – use another existing centre?
24/7 service poss via 111? Poss by Skype
Could be something that exists nationally already but ideally access to records and knowledge of local service & parents, child & YP and professionals.
Telephone line for people in emotional distress as well as MH problem – the YP feels like they’re in crisis
My time waiting list too long
16 – 18 year old missing out
No crisis support
How many hospital admissions before you receive help
No 24/7 crisis for CAMHs
Contact number is not friendly for youngpeople in crisis
CAHMs risk assessment area not detailed – they are rushed
When crisis happens at night time or weekend children have to wait on childless wards
What support for families / carers?
No help in crisis for FASD …
Listen to your people before it’s too late
What is a crisis??Lack of clarity & criteria about who can access CAIS
In children’s OT we liaised with Adult Social Care OT’s simple pathway of how to handover children with equipment.Shared / joint visit 6 months prior to transitioning (have it electronically v basic)
Adult services don’t take CYP mental health issues seriously enough – we need to work more closely
Child & adult services need to work together to create family approach to support – not enough emphasis on earlier intervention in adult services.
CAMHS should NOT discharge until young person is “ready”
Need YP services to think out of the box in terms of committing i.e. services for 14 – 24 yrs
Preparation for change in legal services for young person – need to manage parents expectations and work with YP to understand their rights and responsibilities as an adult – especially important for children with co-morbidity.
Depends on age at entry to CAMHS
6 months prior to 18th birthday CAMHS contact adult services – or appropriate age depending on maturity / needs
Adult service will have a “line worker” – joint visits with CAMHS worker / adult service worker
Need to be discussing transition way before 17 and a half, needs more preparation with young person and family
Family need enough information about difference in adult and children approach to manage expectation
Joint working identified transitions meetings once a month between child and adult services to promote discussions around potential need
Clarity around what may be available in next services
Get the transition right not working at the moment.
How can early intervention happen without trained professionals.
No policy or seamless approach.
Adult digital provision … supports transition.
Not enough joined up approach between child and adult mental health services
First step – not considered until post 18. How can ‘transition’ happen?
First steps – define what you do?
Postcode lottery – access to wider psychological therapies eg attachment + trauma focused expertise and therapy= less ie referrals as helping to identify and ‘treat’ underlying cause.
Mental Health F.A volunteers next steps?
Cumbria is split – How can Cumbria offer an equitable service across the county?
Waiting list is unacceptable
Buildings inaccessible to wheelchair users
Lack of other options
People are unaware how to access services
No out of hours support
Information about services is poor
Initial access is timely but access to actual treatment is too long
No self referral in Cumbria
Difficult getting access to psychiatry
Was there not meant to be a Cumbria hub?
North/South split of CAMHS
Difficulty with high number of referrals being rejected
Young people don’t feel professionals take them seriously
The service is not accessible or friendly for young people
Can’t get help early enough
Triage is done in North Cumbria. How is that accessible from South Cumbria?
Not enough consideration of family/school views
Too long to access support
Care Of The Most Vulnerable
We’re working with same group of kids
How do we support YP/families who are “Non-engaging”
No service for young people with eating disorders. “postcode lottery” for very vulnerable (physical risk).
Getting support shouldn’t depending on having a specific condition
Working well – interface with children’s centre support – my time including early help
Gaps age 11 in ASD/LD Morecambe.
No dedicated LD/ASD Staff in CAMHS Cumbria
Charity referrals are never taken seriously when we deal with the most vulnerable.
Lack of services that meet the needs of children with/or going through ASC assessment/diagnoses.
YP whos families/carers have own MH issues ‘normalise’ their behaviours as don’t know any different or are scared to ‘show up’ what goes on at home. Also parent/carers cant always support due to their own MH needs.
Who supports children with complex physical needs +/or with no voice.
No easy access to clinical psychology for C&YP with LD, ASC and their families.
Children/YP in need of tier 4 services but to access this means to separate from family and access via residential care – too far and exasperates issues. Also egs of children discharged without plan in place to support in return home
YP who have learnt to cope with their issues (we see drink, drugs, cse risk, abusive behaviour to siblings/self/family, self harm etc) sometimes are so entrenched in dealing with things their way are past it when CAMHS support becomes available and will not access the service
Significant % if students medically unfit for school are signed by CAMHS and then become isolated outside mainstream school and remain at HNTS for 1-3 years and struggle further post 16 transition to move on as so out of the ‘normal’ system.
Pupils in PRU/HNTS where need is clear have never been referred or have but won’t attend have huge needs that go unsupported
Need to support young people where parents themselves have MH issues
Evaluate what activity is currently going on
Family response to crisis – what can parents tap into?
Parents comments and forum to professionals
System – to bring her down, family/parents educational drop ins.
No dedicated working GRP for digital services in Cumbria CAMHS
Have People Forgotten how to Communicate?
Digital – noYP presence – made by adults / IT not friendly / helpful
WHAT DOES GOOD LOOK LIKE?
Teach resilience in school curriculum.
More education about mental health signs in training/universities of health professionals and teachers etc.
Going out to CYP and families so not meeting at clinic
Education around causes of mental health difficulties eg life events (managing it)
Having conversations at CAMHS workers with young people and families at initial meeting about tackling stigma. Eg although called mental health services this is something everyone experiences etc. challenging the stigma.
Work with adults/communities rather than CYP about stigma. – families and services etc.
Developed peer to peer support tackles stigma.
Parity of esteem. Education of physical health professionals. Could it be better?
Other professionals opting out if specialist mental health services are involved – should maintain multi-agency approach.
Cast in YPs locality – stop sending them away.
A protected characteristic
More education than in school with practical guides/tools to help low level support but sign posting into services.
Variety of options for CYP
Normalising – going into schools.
Meeting in a child/YP friendly setting.
Buddy/Peer lived experience.
Rebranding of CAMHS, - wider emotional wellbeing.
Professionals go to the children or YP
Peer to peer.
Stigma is not just children and YP is also other professionals
Stigma in teenagers – buddy system, use of digital media – support, kooth, facebook, service, Children and YP language.
More education in schools
More training and support for health professionals and teachers.
Whole system and whole family approach
Education and awareness raising need to consider services available beyond this.
Accredited training with school groups to run peer to peer
Better training for support workers/ teacher sin schools.
Immediate focus on bullying
More training for teachers in primary school
Clarity of information of how schools interact with CAMHS
Schools should promote healthy minds as well as healthy bodies
Teacher and school staff education
Education on ‘normalship’ feelings and emotions
Care leavers have presented workshops on mental health to reduce stigma.
All staff, volunteers and parents/ carers should be trained in mental health
Information’ drip feed’
The name doesn’t matter its attitude.
Raising awareness parity of esteem.
Culturally need to view mental and physical ill health equally.
Language and what do people understand by it?
More training and support for health professionals and teachers to stop prejudice and misconceptsperpetuate.
Not having to go to CAMHS
CAHMS staff working in GPs, schools, assessments/screening.
Parental responsibility: recognising the crisis management – parents & young person – need desire to change.
Responses of others to concerns – unnecessary escalation – need education
Pre Mode – self help packages for individuals Plan for Your Crisis!
Access to DBT! To avoid crisis
“Stay in Touch”Regular calls – letting YPs know there are people concerned and can be helpful
Well managed crisis beds / units place of safety
Access to child psychiatry urgently for MH Act Assessment – shouldn’t have to wait until Monday morning because no psychiatrist on call.
Adult psychiatrist not happy to do it and can’t do it for younger age group
Extra support on ward because parents can’t necessarily stay on the ward with their YP
Possible role for volunteers to be someone to talk to when young person on ward
Possible definition “When the people looking after the YP & the YP have run out of options”, can’t keep YP safe.(definition used in London – Mitch)
After – crisis care needs to be better – quick follow-up at home
Recognise causes of crisis – poverty!Need to address the cause.
*Need a CAMHbulance?! – that can move around*
Trained designated nurse on the children’s ward who can support immediately
System working to empower the family, school etc(all those around the YP) to cope with the crisis
Seamless service – not have to wait until in crisis
Having a plan for what happens when in crisis -building resilience in the family-shouldn’t have to be really ill before can access a service
Outreach service so the people don’t have to go to hospital to get support
Really good information packs about adult services / induction to help ease anxieties
Joined up transition – flexible transition with age environment eg university/college
Clear transition – plan for all – planning 6 months prior to transition
Policy owned by both CAMHS and adult
Commonality of understanding across the whole patch
How do CYP reassess services?
Ready Steady Go Program (developed in Southampton – can google it) Transition Policy in CPFTStats age 11 yrs
Trust – “Go to Person”
Should be seamless / continuity (not re-telling same story)
Depends upon maturity – Choice of service (vulnerable age) + parent /carers
CLA-care leavers age up to 25 with same wrap around support
Not expecting a “new” adult to be capable of managing/responsible for their care / appointments immediately
CYP don’t miraculously become mature or fully developed to lead successful lives as people at the age of 18
Targeted early intervention for mental health for year 7 pupils to include digital wellbeing and access to more help.
Brave new approach to commissioning to support vulnerable young people aged 14-24 – to include child and adult services (health and social care)
Care leavers have worked on a leaflet to support young people with the transition from childrens to adult mental health services
More support in schools. Have more counsellors in schools.Students have classes for music lessons, so why not 20 – 30 mins weekly sessions
Staff on children wards need training on young people and mental health
Define what a crisis is and make it clear and consistent, but give / signpost to something else if it doesn’t meet the criteria
Crisis – What is a crisis?Who decides – what can be offered?
Being able to choose who you see
More joint working
Outreach services to engage with CYP who find it difficult to engage
Overall school awareness about the topics with teachers/pupils
Communication with all services involved
Face to face service in schools
Clear referral pathway
Family support worker linked to schools
Increased awareness – talking about issues within education
Ensure connect effectively to early help / children’s centre offer – will be different in different patches in terms of what is possible-key role in improving resilience in early years.
Single point of access??Where?How?
Better info on available services
Clear criteria guidelines and explanation if rejected.
Community or schools ‘drop in’
Environment / accessibility or CAMHS offices (ie – wheelchair user friendly)
Early intervention, clear signposting for early help
Health support for school pastoral leads (maybe MH champions network?)
Doctor Surgeries should give info on services
Where does it start?
Multi agency / disciplinary approach to requests for help
Targets only focus on initial assessment wait times
What point do we need to access…. How do we know?
Access to treatment – types of treatment available
Continuity of care, build up trusting relationship rather than see someone different each time
Highly skilled help at early intervention not just support in a crisis
Access to ‘treatment’ is major issue long waiting lists for therapy
Bring the services to town centres
More training to young people for peer support
Make sure people with LD and autism are seen as young people first
Trusted workers to attend first appointment
? Adolescent service ? 16-25yr
Family resilience support vital
Agencies need to be responsive and talk to each other, able to engage different ways.
Joined up strategic approach to thriving families not just for mental health – great model, let’s make it apply to all services!
Designed / Contributed to by users from within community
? use of passport / well being action plan
More time & improved
Local Services and the right support when needed
Everyone has knowledge and understanding of disabilities including hidden disabilities
Reduce mental health and improve physical and emotional
Leading from a early help approach
“Places of Safety” (Not children’s ward)
? Like home stay / night stop
My unit (friends/family) is included in my support
No criteria to be deemed as vulnerable
Service are joined up in their approach & share information and systems sharing
Family wrap around – improved respite for families
Need an attachment enabled approach. Especially for most complex young people.
More joint working with LD services and CAMHS
Initiatives to get alongside and engage the most vulnerable YP.
Fundamental change of approach around non-diagnosed mental health issues. Eg emerging personality disorder and several issues around emotional regulation.
Lets talk about attachment. Fundamental approach from universal through to high risk
Opportunity to use health and well being coaches to support families in their homes is already happening in cumbria for adults, want to start for children “barrow family partnership” – has funding in place to work with 5 schools.
Facts on website -Sleeping well, healthy eating, digital after care, how to wind down eg parents given tips and complete ‘wind down’ routine with child etc
Out of hours services
Online – coping mechanism activities
Touring programme to raise awareness of website and create resource for schools,eg
Links to page from other sites – support , self help
Don’t necessarily want counselling in the middle of the night but do want support / access to ways to reduce anxiety / improve mood
Remote working – ‘counselling on line , will we access journaling on line’
One shop electronic show
Mindfulness – Sleep hygiene for the night
Responsibility = ability to respond
Young peoples forums on-line
Positive mental health education
Need to ensure that the learning from Rooth in Cumbria and survey re digital access (by CAMHS) are used in the developing of the new model
Create an app for young people to use in a crisis and who is there to help
Better access website / app for people to use when in need.Also, having blogs for people to refer to (tumblr) and Pinterest boards with self help and advice on them.
One Stop Shop for online help.One website with access to online counsellor.
Place for helplines
Online / digital to support NOT replace face 2 face
Digital well being is multi faceted
Emotional resilience programmes in school
Online signposting to help and support
Ask Liz Strickland for results of recent social media survey from young people in Cumbria over 1000 responses
Accounts for the service website to track status of referral and can make enquiries into when they will be seen
Accessible out of hours
Professional counselling and support
Wanting to hear real people’s experiences or mental health services and records
Peer support on line -facebook - specialise pages Quell -Kooth – Raising awareness
Needs – website with info – be able to see who you will be meeting and what to expect
Family drop ins – fun educational sessions -creating e-resource
Not to replace face to face
Redesign of 0 – 19 healthy child programme and early intervention services will include online emotional support for prevention and early intervention – WE NEED TO MAKE SURE THESE ALIGN
With redesign and not duplicate.
Central portal that could filter out South Cumbria / North Lancs so support clear.
CCC digital offer can link to specific CAMHs pathways so easier to access face to face
Digital supporting access figures MH SDS
Relevant topics and forums
Lists of alternatives / practical activities and actions to do when feeling “bad”.Put “Decider Skills” online?
Works both ways.Enables my child to keep in touch with people (she is not in full-time education) but causes acute hurt when she see her friends at events she hasn’t bee invited to.
ANY OTHER COMMENTS
More mental health awareness events – big football events.
L.A.C – need to be able to respond to large population of looked after children in South Cumbria. As children, as young adults and as they become parents themselves.
I agree that more parenting support and mental health awareness is needed but we need to ask parents where and how this is provided?
Parents peer support.
Parents should be kept involved – its incredibly difficult for a child to say I feel bad, and mental health services should be including the home – that is where the child spends most of their time.
We (parents) have been able to sit in during sessions and talk frankly with counsellor and child. This has been incredibly helpful and helped relieve the guilt that we feel.
Patient experience team already get a lot of feedback from clients/family.
Model of care
Clarity on the tier and thrive system models.
Cumbria being split into north and south. For example only 1 event in Barrow, the rest in Lancashire – looks like poorer relation. South Cumbria needs to be invested equally.
Frustrating having to tell story every time a new psychiatrist/counsellor. Continuity of psychiatrist would be helpful.
In use in cumbria 11-19.
Data sharing/ referrals/transfer of info.
Child/YP friendly building and rooms.
Kooth.com – free online and wellbeing service. - Carers a range of self-help and therapeutic support.
Chat with counsellor through text conversation – suits. YP’s way of communicating. Easy to relate – can be used when YPs are waiting for other services.
Is pressure on schools/young people to perform/achieve. Part of the problem – focus on academic not social/emotional resilience and early support? Need time to focus on healthy minds not passing tests.
Lack of staff to deliver NICE guideline treatments.
The CAMHS workers don’t want to have to tell people they’ve got to wait for months. You need to make it better for staff as well as patients.
Need to recognise how difficult it is to recruit staff in south cumbria.
More staff needed.
More staff and psychiatrists. Mental health team working with more agencies in community.
Major issues with recruitment times when posts become vacant.
Consider young persons needs and allow CAHMS worker the time to work with more complex cases – caseload weighting – not all young people can manage/access/recover with 1hr a week. More complex cases impact on workers jobs – plan allocation.
Workforce – consistent staff – having different psychiatrist/psychologist at each session saying different things is confusing
Staff being matched at assesments/screening stage – consistency of staff for YP. Not a single assessment and then a list to effectively start the whole process again 6 weeks later.
Assessment taking 3+ sessions with sane worker over set period of time. Support and intervention can be provided or YP referred to appropriate therapist within service (or stepped-down) (or discharged).
HOW DO YOU FEEL AFTER THE EVENT?
Why do we do it to young people?