Agenda item

30.1     The Committee considered a briefing on Child and Adolescent Mental Health Services (CAMHS), and Children’s and Young People’s Emotional Wellbeing and Mental Health by the Sussex Partnership NHS Foundation Trust (SPFT) and the Sussex Health and Care Partnership (SHCP). A copy of the presentation slides used for the briefing is included under item 5 of the agenda for the meeting.

30.2     The Committee noted that some early support is provided via referrals from schools and asked what happens if children are excluded or not in school for another reason.

30.3     Alison Wallis, Clinical Director (SPFT) outlined that although there are referrals from schools, referrals cans also be made by GP’s or via self-referral. However, it is acknowledged that providing help and support is much more difficult if children or young people are not known to services. SPFT are working to increase the knowledge and information about mental health and wellbeing services (e.g. the i-Rock project), so that they are visible in the community and services are easier to access. Rachel Walker, Operational Director (SPFT) added that school support teams are also working with Pupil Referral units and special schools to enable access to services.

30.4     The slides in the briefing indicate that there are long waiting times for some services. The Committee asked what prioritisation is there for those who have been waiting and when does SPFT expect to see a significant improvement in waiting times.

30.5     Rachel Walker responded that those waiting for Autistic Spectrum Condition (ASC) services will be seen over the current calendar year, so all people waiting for an assessment will be seen this year, this is because an independent provider has been sourced to support with the those waiting the longest for assessment. There is also a system wide response to expand capacity and tackle the increase in demand. Work is also being undertaken to understand why there has been an increase in young people needing services. It is acknowledged that waiting times are too long and are impacting on outcomes for young people. Work is underway to make sure services recover and young people receive the services they need.

30.6     The Committee asked where the additional investment had been spent on services, particularly CAMHS, and what difference had this made?

30.7     Rachel Walker outlined that the additional investment had been spent on Autism assessments with approximately 600 assessments transferred to an external provider. Money has been spent on recruiting additional staff for Attention Deficit Hyperactivity Disorder (ADHD) services, which has a prevalence rate which is three to four times higher in East Sussex than in either Brighton and Hove or West Sussex.  Additional staff have also been recruited to provide Cognitive Behavioural Therapy (CBT), with the majority of referrals being for depression and anxiety. The additional money is being focussed on where there are the largest number of referrals and on those that have been waiting the longest. The additional funding will continue into the next year and beyond in order to achieve the ambitions of the NHS Long term Plan.

30.8     Alison Wallis added that there had also been a significant investment in Eating Disorder services and having an on duty crisis team. During Covid there has been an increase in urgent assessment work, and investment has been used to enable the service to work more quickly and efficiently. It was also clarified that all of the investment of £2.4 million has been carried forward in to 2022/23 and SPFT will continue with investment to improve pathways and outcomes.

30.9     The Committee asked why there is a higher number of ADHD referrals.

30.10   Rachel Walker responded that East Sussex is an outlier in terms of the number of ADHD referrals and the reason for this is not well understood. Work is underway with the Director of Children’s Services to understand why there has been an increase in demand for ADHD services.

30.11   The Committee noted that the Mental Health Support Teams (MHSTs) in schools will not all be in place until 2024. The Committee asked why there is a delay and how could Mental Health Support Teams could be provided for all schools.

30.12   Rachel Walker explained that the delay in implementing MHSTs in schools is due to it being a staggered programme with different cohorts of schools.  At the end of the programme 51% of schools will have MHSTs and how to fund the remaining 49% of schools is being explored with the Local Authority in East Sussex.

30.13   The long waiting times for ADHD referrals have the potential to have knock effects for children’s education, exclusions and getting an Education, Health and Care Plan (EHCP). What interim measures can be put in place to tackle this and what services are there available to help prevent eating disorders.

30.14   Alison Wallis responded that in terms of waiting times for ADHD referrals, a number of new posts have been created to tackle this, so there will be an improvement. In the meantime, SPFT work closely with social care colleagues to provide support including parenting support to deal with behaviours prior to diagnosis. SPFT has also worked with GPs to help provide information and support prior to diagnosis. For eating disorders, psychologists in the team have been providing education support to other colleagues to help pick up children and young people with eating disorders. Rachel Walker added that schools can help with surveillance as parents do not always notice weight loss as they are with their children all the time. SPFT also has a relationship with Beat, who are an eating disorder charity, to help promote messages and information around prevention.

30.15   The Committee noted that some service users did not want to engage digitally, and others might not have tablets, PCs or smart phones to be able to access services this way. The Committee asked if this represents an additional challenge to providing services and what is SPFT doing about this.

30.16   Alison Wallis outlined that in the first lockdown SPFT used a matrix of factors to assess referrals, so they were clear about which young people needed to come into a clinic. The factors included how unwell the young people were, digital access, home environment and whether they could get to a clinic safely. SPFT is having explicit conversations about the methods used for clinical assessments and is open about the constraints (e.g. from building constraints, digital access, and the method that works best). SPFT is taking a blended approach and is using virtual methods where they work and are appropriate (e.g. using virtual methods for follow up ADHD assessment meetings).

30.17   The Committee asked how the service approaches situations where the parents of young people needing treatment are not engaged, and how the transition to adult services is managed to ensure ongoing care.

30.18   Rachel Walker commented that when a child is not brought to appointments informs whether a family is engaged in treatment. It is important that families are involved in treatment but there are also circumstances where it is important to see a child alone for safeguarding reasons. SPFT works with Children’s Services in such circumstances when a child is not brought to appointments to ensure parents are involved with treatment. Alison Wallis added that it is vital to engage parents to look at what the young person is finding difficult. A skills based approach is taken to help and safely negotiate fears and anxieties “worry fears”. It is also important for the young person to have a trusted adult to work with.

30.19   Rachel Walker outlined that the cut off for transition to adult services is at 18 years of age, but a tailored approach is taken for each young person. At 17 years of age a young person can be discharged from CAMHS if they no longer need services. If they need adult services work will be undertaken in the 17^th year to transition the young person into adult services. It should be noted that parents and carers have a different role in adult services, but family engagement remains important. More work will be done on transitions for Looked After Children, young people with special needs and those young people that are more vulnerable.

30.20   The Committee asked what short term interventions, such as medication, could be made whilst waiting for an ADHD referral, and how SPFT deals with digital poverty if most communication and information is delivered that way.

30.21   Rachel Walker responded that SPFT will continue to work on reducing waiting times and the additional staff will have an impact. There is an acknowledgement that children and young people need to be seen in a timely way, but there are challenges in prescribing medication before an assessment has taken place due to the lack of an adequate evidence base. Alison Wallis added that for ADHD there are NICE guidelines where evidence needs to be triangulated from an assessment and developmental histories to make sure the diagnosis is right before medication is prescribed. It is especially important with young children not to mis-diagnose or over diagnose as poor attention can be caused by other things such as trauma.

30.22   In terms of digital exclusion, access to information technology and equipment can be provided by i-Rock and at schools. Printed materials are also available via i-Rock and schools.

30.23   The Chair thanked those attending the meeting for the presentation and answering the Committee’s questions.

30.24   The Committee RESOLVED to:

1) Note the report; and

2) Request an update report at the 22 September 2022 HOSC meeting to update the Committee on referrals and assessment waiting times, the use of additional investment and the impact it is having on the provision of services, especially for CAMHS.