You don’t need to look far to hear about the pressures and challenges of supporting children and young people with mental health problems and the concern of families. The number of referrals to specialist children’s mental health services has increased by 26 per cent over the last five years according to research by the Education Policy Institute (EPI). Concern around the length of time taken to help children and young people with mental health issues continues to rise. Addressing this will remain a Partnership priority now and in the foreseeable future.
Our Partnership lead for children and adolescent mental health services (CAMHS) new models of care is Thea Stein; CEO for Leeds Community Healthcare NHS Trust CAMHS is used as a term for all services that work with children and young people who have difficulties with their emotional or behavioural wellbeing. Our six local areas (Bradford Craven and District; Calderdale, Harrogate, Kirklees, Leeds and Wakefield) have a number of different support services available. Thea and colleagues are looking at how we can work together across the area to implement new models of care to improve children and young people’s mental health – so that services are fair, sustainable and good practice is shared.
Improving children and young people’s mental health outcomes by 2020 is also national priority.
The Children’s Mental Health Taskforce report Future in Mind sets out a clear direction for local leadership across the system. Commissioners and providers need to work together to improve mental health services by ensuring children and young people have access to high quality services when and where they are needed most. And that’s what we are doing.
There are particular concerns for the wellbeing of children and young people who are looked-after, either in foster care or children's homes. The prevalence of mental illness is significantly higher in looked-after children than equivalent populations. Out-of-area placement of children is common in England, despite the law insisting that it should only be done in exceptional cases and only for reasons that benefit the child.
When we talk about out of area placement what we mean is the distance a child or young person needs to travel to receive specialist support – and in some cases to access a hospital bed for urgent and crisis care.
Understandably this creates a great deal of worry for families and carers – and most importantly can hinder rather than help the health outcomes for children and young people. So despite best intentions, it doesn’t always have the positive impact we want to see – we are working on this.
Although the rise of social media has meant we are more connected than ever before, the reliance on social media can also have a detrimental effect on children and young people’s mental health. The report, Social media and children’s mental health: a review of the evidence scrutinises the latest evidence on the digital lives of young people, the benefits and risks associated with using social media.
It is therefore safe to say we are living in a complex world where mental health is equally as important as physical health and the joining of the two seems logical yet can in reality be hard to achieve with the funding we receive.
West Yorkshire and Harrogate Health and Care Partnership includes mental health providers (South West Yorkshire Partnership NHS Trust, Leeds and York Partnership NHS Foundation Trust, Bradford District Care NHS Foundation Trust; and Leeds Community Healthcare NHS Trust). Thanks to closer working relationships between the four organisations and the introduction in April 2018 to new models of care for children and adolescent mental health services (CAMHS) some progress is being made.
Our ambition to support more children and young people with mental health problems closer to home is heading in the right direction. However we’re not there yet and we know more must be done – one child on a waiting list for a length of time, or going out of area for care – is one too many. Care provided closer to home has better health outcomes than most hospital admissions and is also better for families and carers - reducing travel time and unnecessary anxiety.
Latest Partnership information shows that by adopting a shared approach across West Yorkshire and Harrogate that the number and length of hospital stays for children and young people across the area has reduced in the last six months from 708 occupied days in April 2018 to 536 in September 2018.
The money saved has meant that is has been possible to commit funding to organisations across the area for £500k worth of investment in community services - ensuring more children and young people are cared for closer to home. The introduction of a new care navigator role has also seen twenty one children and young people supported locally in the last six months without hospital admission.
We know that early help can make a real difference to children and young people’s lives. Yet these services can be poor in terms of assessment waiting times.
Simon Stevens, CEO for NHS England highlighted that mental health for children and young people is a key priority for the long term plan. However, any real improvement could take more than five years because of a lack of staff, even if efforts to address emerging mental problems earlier working with schools, and employing more non-psychiatrists, proved successful.
More funding is therefore needed now and in the long term. The introduction of new care models alone won’t deliver the change we want to see – we need continual investment, especially if we want to help children and young people sooner rather than later so they have better health and wellbeing as adults.
Working in partnership with other organisations, including the police and community organisations is central to this approach. You can see evidence of this through the introduction of mental health care navigators who support families and enable other health professionals to focus on specialist decision-making and the safer spaces work for children and young people in mental health crisis. This way of working provides alternatives to bed days whilst reducing unnecessary A&E attendance. Bradford’s crisis care partnership and first response services have received national recognition for this work and we want to roll out this good practice wider.
Our work is also supported by a £13m capital investment from NHS England to build a new Children and Adolescent Mental Health Unit in Leeds. Led by Leeds Community Health Care NHS Trust on behalf of the Partnership, the new purpose built specialist CAMHS unit is due to be completed in the next two year. It will support young people suffering complex mental illness, for example severe personality and eating disorders. There are currently eight general adolescent beds for patients across West Yorkshire which is provided by Leeds Community NHS Healthcare Trust in Leeds. This new unit will bring a significant increase in capacity and provide 18 specialist places and four psychiatric intensive care unit (PICU) beds. These ‘extra’ beds are in part due to reallocating hospital beds across the country so that young people get specialised inpatient care nearer to where they live.
Working together as part of WY&H HCP has given us the opportunity to share skills and expertise to further improve children and young people mental health services, including the development of community intensive services as well as specialist inpatient support where needed – and we are making the most of this.
We are working hard to share good practice and prevent children and young people travelling out of West Yorkshire for specialist care. Although the move towards one model for inpatient services for children and young people across the area is seeing benefits, more needs to be done to provide a consistent, sustainable and fair service for those in crisis and in need of intensive home based treatment. And of course reducing the waiting list for assessment and treatment is important to us.
Finally Congratulations to Leeds and York Partnership NHS Foundation Trust’s Personality Disorders Service (winners), their recently-launched CONNECT Adult Eating Disorders Service (winners) and their LGBT+ Rainbow Alliance network (highly commended) for all their success at the recent Positive Practice in Mental Health Awards 2018. Well done also to the Cellar Trust in Shipley, who took home gold in the crisis and acute care category at the same event. The Cellar Trust service supports vulnerable people needing urgent mental health support across Bradford, Airedale, Wharfedale and Craven.
Have a good weekend
Sara
What else has been happening this week?
Stroke programme
The stroke programme met on Wednesday. The meeting was chaired by Dr Andy Withers, who is also Chair of the West Yorkshire and Harrogate Clinical Forum. Members received an update on the work we are doing to further improve stroke care across the area for example, the technology and stroke clinical network developments. The meeting also included sharing with members the feedback from the follow up conversation that took place at the West Yorkshire Joint Health and Overview Scrutiny Committee on 8 October. The stroke programme will be presenting a paper to the West Yorkshire and Harrogate Joint Committee of Clinical Commissioning Groups for their consideration (6 November).
Wakefield Peer Review – pilot
Wakefield had the opportunity this week to showcase their work as part of a pilot “Peer Review” which is taking place across their local health and social care system.
Wakefield is the first local area across West Yorkshire and Harrogate Health and Care Partnership to do this and they are keen to share the outcome of the review openly and honestly across the area.
Organised by the Local Government Association, NHS Providers, NHS Commissioners and NHS Confed the review took place over three days, with meetings and conversations taking place with both Wakefield staff and Partnership colleagues.
The team discussed joined up care, the challenges they face, achievements so far and ambitions for the future. The peer review team included colleagues from the Local Government Association; a councillor; health improvement advisor; CEO from Locala Community Partnership; the voluntary community sector; nursing and other areas of the Partnership. The peer review team looked at five elements of integration work, including how well the vision and key priorities for Wakefield are articulated across our Partnership.
West Yorkshire and Harrogate Health and Care Partnership Public Health Co- ordination Group
The group met on Thursday. It is chaired by Dr Ian Cameron, Director for Public Health for Leeds City Council. There was an update on the alcohol, tobacco and workforce programmes.
Public Health England (PHE) campaigns will be launched soon for mental health and cardiovascular disease (heart and blood vessels). Every year 1 in 4 people in the UK experience a mental health problem. It directly affects our overall health and wellbeing, quality of life, and life expectancy. This is why Public Health England (PHE), with support from some of the most respected organisations in this field, is launching a high-profile national mental health campaign on behalf of the Government called ‘Every Mind Matters’. Ahead of the PHE launch of this campaign next year, a pilot will be conducted in the Midlands (started 10th October 2018 - World Mental Health Day). This pilot will help assess the impact and whether the campaign effectively promotes self-care rather than creating additional pressure on local NHS services. It will also help to fine-tune our approach for the national launch. We will keep you updated.
What’s happening next week?
- National Partnership leads (also known as STPs, ICS) including clinicians will meet on Tuesday. Professor Don Berwick, international visiting fellow at the King’s Fund, and former president of the Institute for Healthcare Improvement, will be attending the day. The meeting will include an update on the long-term plan.
- Leeds Self-Management Partnership and the West Yorkshire and Harrogate Personalised care programme meet on Thursday.
- National Care Leavers’ Week (21st to 31st October) is about highlighting the needs of care leavers, and encouraging the agencies responsible for looking after them to work in a coordinated and effective way. Find out more here.
What’s coming up?
- Baby Week 12-18 November in Leeds is a partnership between health, the council and voluntary organisations. You can find out more here.
- Self-Care Week 12-18 November is an annual national awareness week that focuses on embedding support for self-care across communities, families and generations. This year’s strap line is ‘Choosing Self Care for Life’. For ideas on how to run Self Care Week visit the Self Care Forum.