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1. INTRODUCTION |
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We have previously reported to HOSC that, as a system, we are committed to providing a strong start in life for our children and young people. Our strategy is one for our whole population which should support the journey from birth to old age. This includes key objectives across prevention, integration and supporting transition: Ø Prevention: Supporting a good start in life, including delivering a whole systems approach to healthy weight, and promoting emotional wellbeing and good physical mental health in children and families. Ø Integrated care: enabling primary, community and acute services: Our vision is to provide more responsive support for children and young people when they experience poor mental health or are in crisis so that they can access services when, where and how they choose, embracing digital and social media. Ø Supporting transition to adult services: A more joined-up multidisciplinary approach as our children and young people transition to adult services is essential for increasing independence. Children and young people’s services is a key priority for us as, and the wider system as we continue to work to support improved access to, and experience of services across Sussex, including East Sussex. Our ambition is that by 2025, all people with mental health problems in Sussex will have access to high quality, evidenced-based care and treatment delivered by integrated statutory, local authority and third sector services that are accessible and well connected with the wider community, intervene as early as possible in someone’s life journey to prevent mental ill health. Our mission is that we will work together as an Integrated Care System, bringing together patient, statutory, third sector and local authority expertise, to design, develop, commission and oversee high quality, innovative and integrated care and treatment pathways for people with mental health problems. Our published Foundations for our Future Programme and key transformation work programmes described in the Local Transformation Plan will support us to meet this ambition and deliver the requirements of the NHS Long Term Plan. Within this context, this report relates to specialist Children and Adolescent Mental Health Services (CAMHS), provided by Sussex Partnership NHS Trust (SPFT). This is within the wider context of investment, improvement and system working within our integrated health and care system to address the increased need and complexity, exacerbated by Covid that we have seen locally, and reflected nationally. SPFT provide specialist mental health assessment and interventions in a range of evidence-based modalities. The service also provides specialist assessment for Autistic Spectrum Condition (ASC), Attention Deficit Hyperactivity Disorder (ADHD) and Neurodevelopmental Disorders (ND). Interventions include both talking therapies and medication, noting ND Assessments and medication titration and review requires specialist training. This constitutes provision for those children and young people with moderate and severe mental health presentations who would benefit from treatment from an evidenced based intervention. Mild to moderate emotional well-being and mental health services are provided by other partners within East Sussex and have been the subject of previous reports to the HOSC.
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2. REPORT |
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The previous report to HOSC detailed the significant additional investment prioritised by Sussex into services for children and young people 2021/22, this represented an additional £2.4m for East Sussex. The majority of this targeted our CAMHS and Mental Health Support in Schools workstreams that are included in this report. For 2022/23, further additional investment forms parts of our plans across Sussex and we will continue to monitor and report on this.
The investment is targeted at delivering the NHS Long Term Plan and local priorities; addressing any underlying capacity gaps and increase access to services; responding to the challenges associated with the adverse impact of Covid-19 on our children and young people and service. We are particularly focusing on those children and young people waiting the longest, ensuring good access to eating disorder services, and better supporting young people in crisis.
The following gives information about the need we are seeing and the increase in referrals and complexity, together with the action we are taking to support this. We recognise there is more to do and continue to prioritise this work within SPFT and across the system as a whole, balancing the importance of access to serves, managing risk and targeting our ability to invest further.
Specialist CAMHS provides a range of mental health direct interventions with psychiatry and medication where required as well as an urgent response where there is a mental health crisis services which include:
· Community targeted services for diagnosable mental health issues such as low mood, anxiety, depression, relationship with food, self-harming behaviour, PTSD, etc. · Specialist services for vulnerable groups such as children in care, children with learning disabilities. · Contribute to the diagnosis of neurodiverse conditions such as ADHD, ASC · Urgent help Service for those in crisis, at risk of admission or stepping down from admission · Intensive home treatment services · Early Intervention psychosis (ages 14 to 65) · Family eating disorder services · Day services for those stepping down from inpatient admission · Child forensic and adolescent mental health services (FCAMHS) · Specialist inpatient services at Chalkhill.
Within this context, and the important context of the continued increasing need we are seeing within our children and young people’s community, this report specifically details the current picture within CAMHS Services within East Sussex and the improvements we have been able to make since the last HOSC meeting in March 2022, with specific reference to key services, the need presenting, caseloads and our response.
Open referrals have attended a treatment contact for their episode
This graph details the caseload for all young people who have been opened to our services and had at least one treatment appointment.
The total number of young people who are open to the service, waiting for treatment post assessment and waiting for an initial assessment is 6590 in August 2022.
This demonstrates the increase in caseload for the East Sussex CAMHS teams year on year, which represents a 29% increase since the pre-pandemic period. As a result of the increase a greater percentage of clinical time is occupied by providing treatment which impacts on the number of numbers of assessments which can be completed and removed from the waiting list. Post pandemic CAMHS has experienced an increased level of complexity - coupled with the increased numbers of referrals - meaning that we are having to treat more young people and for longer. There is evidence of COVID-19 suppressed demand within this caseload as some assessment/treatment interventions were not possible during the pandemic, such as ADOS assessments, the assessment method used for autism diagnosis.
The number of referrals accepted has significantly increased. This is because it reflects the number that the Single Point of Advice (SPoA) have received and deemed appropriate for specialist CAMHS. This improves the effectiveness of the pathway as CAMHS only receive referrals from the SPoA appropriate for their service with other referral supported through different services.
Number of young people waiting for assessment
There are currently 1873 young people who are awaiting assessment. Young people are prioritised to ensure those needing to be seen most urgently receive the assessment and treatment they need. We aim to assess young people within 4 weeks and whilst this target is not consistently achieved, our work to prioritise need and develop our services continues within the context and resources available. As previously reported, those children and young people waiting the longest, including exclusively those over 52 weeks are awaiting a neurodevelopmental assessment.
Our service clinically prioritises those young people in greatest need and we review levels of concern and urgency of those young people we are unable to see immediately. Prior to accepting a child or young person, information gathered through the triage process supports prioritisation of cases to be seen. Working with partners in East Sussex, we have responded to any increase in specific needs of our young people. Where there has been an increase in concern, we have focussed resources to see young people earlier and highlighted any concerns to the relevant agencies. We also look at wider help we can offer and have delivered multi-agency, targeted help to vulnerable young people, including providing additional resources and focussed communications.
Once a young person has been accepted for assessment and treatment the service will contact the family to ensure they are aware of what to do if they are concerned about changes in their child's mental health. This will include speaking directly to a clinician. In addition, families are proactively contacted through a 'keeping in touch letter'.
To meet the Sussex wide aspiration to reduce the number of patients waiting more than 52 weeks for assessment and to transform the management, oversight and reporting of referral to assessment and referral to treatment waiting times Sussex Partnership established a waiting times transformation programme chaired by the Executive Team. The programme plan has taken forward improvements to reporting of waiting times, data quality improvement, clinical validation of over 5000 patient records, development of recovery improvement plans and associated trajectories and works closely with colleagues across the ICS to ensure the total elective recovery is accurate and understood. One key development has been the development of locality led weekly waiting times meetings which review the plans in place for patients waiting in excess of commissioned waiting time targets- this has resulted in resolution of over 300 patient pathways.
To address the significant increase in referrals to CAMHS in East Sussex, we have commenced a stepped care pilot in Hastings and Rother, with the intention to roll this out across the county over the next 12 months. This model will offer a family/carer information session to all new referrals, to provide information about our pathways and supporting their young person. Following an initial assessment, the majority of young people will be offered a trans-diagnostic evidenced based group intervention or Single Session Family work.
A review will take place post intervention and multi-disciplinary consideration will be given as to whether a more intensive specialist CAMHS provision is required. This model is being augmented with e-health supported brief interventions. The aim of the pilot is to provide more timely intervention to the majority of those referred to CAMHS whilst facilitating targeted intensive support to those with the most severe and/or complex presentations.
The number of discharges has increased. The service hold case review days to ensure that there is an ongoing need for treatment and to consider what support might need to be in place before a child/young people is discharged from the service. A transition lead has been appointed to manage transition to other services/agencies at appropriate times and to ensure good patient flow through the service.
CAMHS Investment Investment has been focused to support the increasing needs of children and young people in line with the aims of the NHS Long Term Plan for Mental Health. For the CAMHS service in East Sussex, the capacity of the CAMHS service has increased by 27%, (a total of 12.5 whole time equivalent staff). The vast majority of these staff are now in the new team. Further investment and transformation forms part of planning across Sussex within the context of continuing to improve access and experience for our children and young people. The neurodevelopmental pathway does require continued improvement as there are people waiting for assessment much longer that we would like. The following sections describe this in more detail.
Neurodevelopmental Pathways Significant work is underway across Sussex to address long waits within the Neurodevelopmental Pathway for all ages. This includes the development of a new all age pathway to improve the access and experience for local people, addressing concerns service users have raised.
Three Neurodevelopmental Hubs have been formed in each area the Trust operates; East Sussex, West Sussex, Brighton and Hove. These are led by Clinical Service Managers and are an amalgamation of ADHD and ASC service within the areas. The implementation, direction and clinical delivery of the hubs has oversight by SPFT CAMHS (Sussex) neurodevelopmental pathway lead. Investment into NDP has provided some additional resources in the hubs to increase service provision to meet need. However, the demand and capacity remains mismatched and service provision is not fully integrated. It is anticipated that this new workstream will address these deficits.
The use independent sector provision to support assessment Work to support those waiting longest has included working with an external provider to provide assessments for children and young people on our waiting lists for assessment of Autistic Spectrum Condition. This programme is being delivered as planned as is supporting 600 children and young people to be assessed by December 2022. Of these 203 are from East Sussex. The attendance rate has been 97.4% and qualitive feedback reflects satisfaction for parents not just about receiving an assessment but also the process of transfer which was an important and key component.
Eating Disorder Services As previously reported, there has been an increase in the number of number of young people referred into specialist CAMHS services, including the Sussex wide eating disorder service, since the second wave of the pandemic. This has had an adverse impact on access to services and led to increases in waiting times and waiting list sizes together with an increase in service caseloads. The information below shows the increases we have seen and the action we are taking to address this. This has been, and continues to be a key priority for Sussex.
Eating Disorder referrals in all of Sussex
The numbers of referrals received for children and young people with an eating disorder peaked in October 2020. They have remained relatively high throughout the pandemic and have continued at a higher level than pre-pandemic.
Sussex Family Eating Disorder Service Caseload
Sussex Family Eating Disorder Service - Performance against waiting times standards
There is a nationally prescribed access and waiting time target for children and young people’s eating disorder services for urgent referrals to be seen within 1 week (7 days) and routine referrals to be assessed within 4 weeks (28 days). This has been a key focus of investment and improvement and the graph demonstrates the considerable improvements the team has made in meeting the access and waiting time standard for both urgent and routine referrals. We expect to be able to maintain the improved access and ensure the target continues to be met through the actions we are taking. It should be noted that parental and patient choice regarding appointments can sometimes impact the time to be seen.
Eating Disorder Day Service Specialist eating disorder services and associated services in Sussex have been experiencing an unprecedented increase in demand during the pandemic, together with some historic challenges. Young people with eating disorders are presenting at a later time, and often with more acute needs. This high level of need has led to an increase in medical hospital admissions to paediatrics and Specialist Eating Disorder Units.
A key improvement being implemented is the Spring Tide CAMHS Eating Disorder Day Service will be based at Aldrington House in Hove. This service is for young people aged 11-18 who are already known to specialist Child and Adolescent Mental Health Services (CAMHS) with a diagnosis of anorexia nervosa. The service is set to launch in October 2022.
The introduction of this new service will bring an integrated care pathway, with the aim of reducing and avoiding hospital admissions when safe to do so whilst treating young people and families closer to home.
The new service will offer education, groups, individual therapy and meal support, for up to 10 young people at a time, as well as support for families. Led by a multi-disciplinary team, the service will operate Monday-Friday, with young people attending between 10am and 4pm. There will be flexibility for families to join for a meal in the evening as part of their care plan. It will be a 14-week programme around term times including two half terms, with a four-week programme offered over the summer holidays.
Crisis intervention - Duty and Liaison Team
The Duty and Liaison team comprises clinical and support staff. They assess young people who have presented to A&E with self-harm and suicidal ideation, as well as fulfilling a duty function for community CAMHS teams which includes responding to contacts made directly from parents, the young person themselves, or other professionals such as school staff. Increasingly this urgent clinical work is focused on managing acute levels of clinical risk.
This graph shows all elements of the service's work. The red section details the clinical contacts made by the liaison team, for all those young people who have presented in hospital and where further work undertaken to support safe and sustained discharge, including any multi-agency working required. The blue section details the number of hospital-based assessments within acute trust which have taken place and are remaining at a higher level than previously.
East Sussex Duty and Liaison team are currently piloting a Dialectical Behaviour Therapy (DBT) skills workshop. This is offered to all young people who have presented to A%E with self-harm and/suicidal ideation and are awaiting assessment and/or treatment. This is a skills group/workshop for teens that will focus on helping them to manage stressful, or distressing situations. Parents are also invited to attend. The skills covered in the group are mindfulness, brief skills to cope with distress, taking a step back to think about a situation and understanding how emotions influence us and how we can feel more in control of our lives. The skills group/workshop is held weekly and consists of 4 one-hour sessions and is run online via Zoom. In addition, a specific task and finish group was set up with East Sussex Healthcare Trust to improve the patient pathway for young people with mental health needs.
Other areas of interest for the HOSC to note
There are a range of services that SPFT provide or support that focus on the emotional health and well-being of our children and young people, and our strategy and partnership work continues to develop improved availability and access to services for our local popualations to suppot emotional health and well-being. The following sections describes some of this work that SPFT leads on or supports.
i-Rock i-Rock is a Youth Mental Health drop-in service for young people aged 14-25 located in Hastings, Eastbourne and Newhaven. This is the service data from November 2021- June 2022 the last reporting period.
Young people accessing the i-Rock Service
The most common age of young people accessing i-Rock continues to be 14-17 years. 24% aged 14.
Young
people from all BAME groups access the service - 82% of
groups access the service - 82% of young people white
British.
Outcomes After accessing an initial triage in i-Rock young people are supported to access the most appropriate service. After one session 13% of young people were able to self-manage and did not require an onward referral. Examples of this often-including information about apps, anxiety management and coping with low moods, as well as advice on exercise, healthy living and general well-being. A further 42% of young people are offered follow-up sessions with i-Rock to prevent the need for onward referral to another service. 9% of young people are directly referred into an SPFT service due to their level of need and 12% to 3rd sector provisions.
The Careleavers Personal Health Budget Pilot
The Health and Well-being Project was set up with ESCC Through Care Service in October 2021 with funding from NHS England/SPFT as a pilot project looking to use Personalised Health Budgets to support Care experienced young people aged 16 years to 25 years identified as needing support with their mental health and well-being. Since the project started it has since been extended for a further year until March 2023, funded by the Sussex ICS, 16-25 workstream due to the reported benefits and difference the project was making. A video was produced with young people called Animate which tells their own stories of how the project has helped them.
The project has so far supported over 170 young people, the majority of who are aged between 16 to 21 years. Roughly 60% of referrals are male which represents a high number of Male Unaccompanied Asylum Seekers with whom the Through Care Service works.
The project has made connections with a large number of community groups, leisure centres as well as artists and musicians within East Sussex who have been able to provide individual activities and support to young people expressing a wish to take part in activity to help with their own Mental Well-being. The range of activities offered have included: horse therapy; gym memberships; boxing; bagpipe lessons; voice coaching and singing lessons; swimming and driving lessons; childcare; dental treatment and physiotherapy.
In addition to the video feedback from young people, the benefits and outcomes of the project is well summarised by a team social worker who stated that:
"The project has been brilliant, allowing the young people I support to experience activities which have such a positive impact on their lives. Highlights have included kitting out one of our UASC with a football kit, boots and a bike to travel to training with – he has since been scouted for Hastings United and has played in their FA cup under 18s matches. Three of my young people have been given the opportunity to play and learn the guitar through the project, and it’s been a joy to hear them play their guitars and see their smiling faces when they show me what they’ve learnt. Our UASC often arrive not knowing anyone, being able to support them into a positive activity in their new community makes such a difference, helping them feel more settled in their new area after what is often a traumatic journey to the UK".
A full evaluation of the impact of the project on outcomes for young people will be undertaken at the end of the year.
Mental Health Schools Team (MHST)
Our MHSTs are delivered in partnership with East Sussex County Council and Sussex Partnership NHS Foundation Trust. The key functions of our MHSTs are consistent with the national model as follows:
• Delivery of evidence-based interventions to support children and young people with mild to moderate mental health issues in schools.
• Supporting schools to develop a Whole School Approach to mental health and emotional well-being.
• Giving timely advice to school and college staff and liaising with external specialist services to help children and young people to get the right support and stay in education.
MHSTs employ a new workforce, that include (Trainee) Education Mental Health Practitioners (EMHP) who attend year long training at University of Sussex. EMHPs work alongside senior practitioners and clinical supervisors.
Chosen by young people, the East Sussex Service is called “Me and My Mind”. Since September 2019, four teams have been established, working in 55 schools. A new team starts this month (September 2022) which will cover a further 15 schools.
Referrals to the service to date are:
Sociodemographic, feedback, and clinical data has helped to inform areas to focus on. For example, the anxiety toolkit that has been developed in partnership with other East Sussex services has been shared with all East Sussex schools to enable them to support children and young people.
The MHSTs support schools to develop and implement plans for creating mentally healthy school environments that promote the prevention of mental health problems. This includes the identification of need and access to available services. The MHSTs foster a holistic approach that aims to increase knowledge of mental health and emotional well-being across the whole school community through delivery of workshops for parents and carers, children and young people. It provides training for school staff and develops and shares resources. The teams provide information, advice and guidance on strategies for supporting children and young people with their mental health and well-being. In light of parents and schools feedback, the MHSTs have specialist Special Educational Needs and Disabilities and parent / carer practitioners who work alongside the EMHPs to deliver support and interventions.
Conclusion This report provides an insight into the specialist services delivered through CAMHS, alongside some key services we are also supporting as part of our system wide approach to the emotional and mental health and well-being of our children and young people.
We remain committed to our focus on improving the access and experience our children and young people have in our services and recognise the challenge and importance of continuing to work with all partners across the whole pathway of services delivered to the population of East Sussex in which we play a key role.
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3. RECOMMENDATION(S) |
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For the committee to note the report. |
