[Papers to follow]

An update on Child and Adolescent Mental Health Services. The item aims to assist the committee in identifying gaps in provision and exploring opportunities for more effective commissioning of services.

The Associate Director of Children's Services and Specialist Primary Care Herefordshire and & Worcestershire Health and Care NHS Trust introduced the report and gave a slide presentation to the Committee. The key considerations included:

·       Understanding of children’s emotional and mental health needs and services provided to meet these needs in our community

·       Understanding of children’s neurodiversity needs and services provided to meet these needs in our community

·       Child and Adolescent Mental Health Services (CAMHS) including current waiting times, demand, work with partner agencies and use of specialist inpatient hospital resource (Tier 4 beds)

Following the presentation the report was opened up to the Committee, the principle points of the discussion are summarised below.

The Cabinet Member for Children and Young People gave an assurance about the connectivity to the work that was taking place within the Children and Young People’s Partnership Board and the Herefordshire and Worcestershire Health and Care NHS Trust. A meeting had been arranged between the Cabinet Member for Children and Young People, and Elaine Cook-Tippins and Dr Katie Powell of the NHS Trust to discuss a range of issues.

The Cabinet Member for Children and Young People explained that they would like hear more about support for children and families on waiting lists. A request to share more information about ACE (Adverse Childhood Experience) was made, with a view to opening up discussion about how trauma informed responses should be handled in future.

In response to a question from the committee, the Consultant Child and Adolescent Psychiatrist from Herefordshire and Worcestershire Health and Care NHS Trust explained that if a child was undertaken for a CAMHS appointment, the clinicians there were trained and skilled in what to screen for in terms of ACEs. The clinician team were also trained in how to put in a MARF (multi-agency referral form). If concerns about a child hit a threshold the team would communicate (with parental or child consent) with social care and other primary care services, but would not routinely link in with other services unless asked to.

In response to a question asked by the committee it was explained that mechanisms were in place to stop children falling through the gaps during long periods when they weren’t at school and that CAMHS continued to promote its services at the end of school terms. The largest number of referrals came from GPs and it was noted that data demonstrated that the mental health and wellbeing of some children improved when they were away from school - as they were removed from bullying/hostile environments and had less anxiety around school work. However, many children with neurodiversity-related were found to struggle with the lack of routine.

The Associate Director confirmed to the Committee that Herefordshire had shorter waiting lists for referrals than Worcestershire.

The Committee discussed and highlighted the importance of pastoral care and good nutrition in relation to the mental wellbeing of young people. 

The Consultant Child and Adolescent Psychiatrist highlighted the distinction between mental health and mental illness.  A separate cohort of individuals with learning disabilities and neurodevelopmental needs was identified, these had specific needs that were not related to mental illness. It was pointed out that there was a general misunderstanding that those with mental health or neurodevelopmental difficulties needed to seek assistance from CAMHS and that changing this narrative would be extremely helpful. It was also noted that there was a lot that schools and universal providers could do to encourage good mental health/wellbeing to prevent people reaching the stage of mental illness.

The Committee raised concerns about people not knowing where to turn for support with their issues, especially the growing cohort of children with autism and ADHD who were on waiting lists for a diagnosis.

In response to a question from the Committee, the Assistant Director explained that the national target for assessment treatment was 18 weeks and that this figure was set by government. The Assistant Director pointed out whilst waiting people were sent a letter with emergency contacts and signposting for online counselling and forums such as Kooth, which were accessible immediately.

It was explained that all referrals that came in were reviewed by a specialist mental health clinician and prioritised in relation to urgency. If urgent factors were identified then a child could be seen or parent contacted on the same day.

The Committee heard about the WEST (Wellbeing Education Support Teams) pilot scheme and the timelines, selection criteria and funding involved. It was explained that 48% of schools in Herefordshire were involved in the scheme and that selection criteria had included areas of deprivation, education factors and sign up from schools. The initial aim was to target the most vulnerable children and young people and areas of need first. An announcement on extension funding for the pilot was anticipated after the next election.  

In response to a question from the Committee the Consultant Child and Adolescent Psychiatrist explained that children with lower level depression and anxiety who attended schools where WEST wasn’t in place would be referred by GPs, schools or CAMHS to the CLD Trust. For children who were homebound there was an assessment service for mental illness, which would link up with social care to assist with family support an intervention where required.

A sharp and disproportionate (compared to boys) rise in the percentage of girls being recorded as having a probable mental disorder between the year 2017 and 2021 was largely attributed to an almost 400% increase in reported eating disorders over that period and these types of disorders tended to impact girls more than boys.

The general rise in recorded mental disorders during the period 2017-2021 was put down to factors around Covid, such as children being exposed to increased domestic violence and alcohol abuse, along with reduced access to traditional support networks such as friends, teachers, teaching assistants, youth centres and wider family care. 

The Committee highlighted concerns about the general lack (especially in rural areas) of wider support networks, such as youth clubs and youth centres, available to children. It was noted that these had historically provided a ‘pressure valve’ for young people to speak with other young people and adults outside of the family and system.

The Committee highlighted the importance of ensuring the working partnership was utilising the strong family relationship and day-to-day connections that schools had with parents and children.

The Assistant Director explained that there was a mental health lead in each school and they worked very closely with social care in relation to the most vulnerable children.

The Lead Commissioner Children, Young People & Maternity NHS Herefordshire and Worcestershire ICB explained to the Committee that each school had a public health school nurse, who was permanently attached to the school and was required to respond to needs identified in the school by young people, family members or teachers. The nurses provided one-to-one support to pupils and advice for teachers and parents in dealing with lower level anxiety and depression that might be influencing attendance and other areas of performance. 

The Lead Commissioner Children, Young People & Maternity NHS Herefordshire and Worcestershire Integrated Care Board explained to the Committee that an all-age autism strategy was currently being consulted on, which contained significant recommendations on redesigning the pathway to services.

The strategy would aim join up local authorities with health, education and voluntary sectors to support the delivery of the things those with neurodiversity related needs were saying were most important. In broad terms the strategy had six key priorities, it was all-age and covered areas including employment, housing and managing long term health needs rather than focusing on diagnosis. It was noted that there were clearly times when an individual would require a diagnosis, but that a diagnosis alone would not help the individual to cope with autism. Therefore the strategy would focus on individuals developing skills that they would need to manage their lifelong circumstances, access to education, employment and leisure facilities.

The Committee heard that data relating to outcomes had been impacted and compromised by a recent cyber-attack on the NHS system, but going forward more detailed information would be available on outcomes.

It was explained that the assessment paperwork for the CAMHS service had been reviewed and developed so that at the point of assessment  the young person could say what they want, why they were there and what their expected outcomes were.

It was explained local provisions had not changed specifically in relation to the needs of children experiencing gender dysphoria, although this could change as part of a newly commissioned under 19s national service.  

The Corporate Director Children & Young People, stated that they would be happy to work with the Committee in in terms of exploring how the strong relationships between schools and families could be fully utilised by the Council and agencies within the wider partnership.

The Statutory Scrutiny Officer suggested that a training session for the Committee members be put in place to sharpen their understanding in regards to youth provision and what the Council and the partnership could and were required to provide.

At the end of the discussion the committee note a number of actions:

Action: To add the Autism Strategy and associated action plan to the Committee’s work programme.

Action: For a training session around youth provision to be arranged.