Agenda Item No.
THE VALE OF GLAMORGAN COUNCIL
CABINET: 6TH OCTOBER 2014
REFERENCE FROM SCRUTINY COMMITTEE (SOCIAL CARE AND HEALTH): 1ST SEPTEMBER 2014
PRESENTATION: CHILD AND ADOLESCENT MENTAL HEALTH SERVICES (CAMHS), MRS. R. WHITTLE, COMMISSIONING LEAD – CARDIFF AND VALE CAMHS AND DR. J. DOWNEY, CLINICAL PSYCHOLOGY LEAD – CAMHS NETWORK –
The Commissioning Lead for the Cardiff and Vale CAMHS Network commenced the presentation by providing a brief background summary of the situation. In October 2012, the Welsh Government published a document entitled Together for Mental Healthâ€. This replaced previous age specific guidelines.
Childhood mental health problems were common, with one in ten children having a diagnosable emotional health problem. The level of emotional mental health problems in our young population was increasing. The main increase had not been in severe functional illness but the recognition of stress, anxiety, depression and behavioural issues including risk taking which may develop into enduring problems. Support required was complicated by the need for a multiagency approach, local authority services, third sector, carers and families. Education, parenting services and health all had a vital role to play as well.
CAMHS services for children and young people were provided by the Managed Clinical Network hosted by the Cwm Taf Health Board. They linked closely with child health and adult mental health services provided by the Cardiff and Vale UHB. The Network provided:
· Primary mental health services
· Community CAMHS services
· Community Intensive Treatment Team (CITT)
· In-patient Tier 4 services to five health boards – as above and Hywel Dda Health Board (HDHB), Abertawe Bro Morgannwg Health Board (ABHB) and lower Powys
· Forensic Adolescent Consultation Team (FACT) – all Wales.
In describing the drivers for change, the Commissioning Lead informed the Committee that the service was relatively small and was facing increased demand. Health Inspection Wales and Welsh Audit Office reports on CAMHS would help drive the service forward as would children and young people committee reviews. Ministerial questions and concerns were also a factor, as were complaints from referrers and agencies about delays, referral not being accepted and lack of services. Increase in admissions via Accident and Emergency was a considerable factor along with the lack of support to specific groups with mental health problems but with no functional mental illness (e.g. Looked After Children, Youth Offending Services and difficult behaviour).
In October 2013, the UHB commenced a work programme to agree a sustainable service model for emotional and mental health services. It was clear that there were many complex issues with multiple perspectives relating to the need and the service delivery model. Every partner had a different expectation and perception of what CAMHS and other partners should provide. The workshop in January 2014 identified five key areas of work to be taken forwards.
The first area related to primary mental health support. Currently, two services were providing different functions, these being the Primary Mental Health Team and the Part 1 Team. This created confusion among referrers and service users. A main aim of the programme was to create one integrated service combining both functions that included a clear referral pathway.
The second area of work was specific to clients whose behaviour involved risk-taking. It was considered that this was everyone’s business, not just the specialist CAMHS service. Young people tended to bounce around the system and not get the help they required. The programme aim was to develop and implement a multi-disciplinary / multiagency response to support those children and young people where a professional judged that they need urgent assessment and support. This included those with risky behaviour who today were likely to present at the Emergency Unit. These young people required:
· mental health assessment / risk assessment
· a place of safety
· a multi-disciplinary strategy meeting
· a risk management plan (including support package).
The third aspect of the area of work revolved around specialist NHS CAMHS services. These are provided to children with an identified psychiatric disorder (e.g. depression, psychosis, ADHD, etc.). The aim of the programme was to create a clear service specification for the population to enable appropriate commissioning.
The fourth area was around improving links to specialist services at Tier 4. Currently, the inpatient unit (tertiary service) Wales was based at Ty Llidiard, Princess of Wales Hospital in Bridgend. When it was built, the unit was made up of two wards, one a 14 bed unit and the other a 5 bed unit. Presently, only the 14 bed unit was staffed and this provided a discharge liaison service. The aim of the programme was to work with Welsh Health Specialised Services Committee (WHSSC) to commission and secure the necessary services to meet the needs of the population.
The final area of work related to Service User engagement. It was the aim of the programme for commissioning to be informed by what young people had told the service. It was important for close working arrangements with third sector partners to run focus groups and, working through partners, to access young people to gather feedback.
A Committee Member raised concern regarding delays in arranging appointments for children to see a consultant and the impact this could have on the young person’s school education. The Commissioning Lead informed Members that they recognised a number of issues that were raised by the Committee Member and that they had dealt with a number of complaints relating to access. The service was currently looking at the appropriateness of responses and it was important to recognise mental health issues and the need to look at the whole range of support services available.
At this point, the Clinical Psychology Lead advised Members that the availability of services had been affected by the current level of budget cuts. At present, the service was made up of 12 full time equivalent posts and 5 medical practitioners to cover the whole of Cardiff and the Vale of Glamorgan. All clients were assigned to the CAMHS service and the new legislation had affected how the service performed.
In response to a query concerning the support of those individuals who may not be appropriate for CAMHS support, the Committee was advised that the Part 1 team was required to provide a brief assessment and provide short term intervention to individuals. There was a recognised gap for children and young people who suffered with risk-taking behaviours, but the service did not want to negatively label children with a mental health problem. In essence, the current programme was around unpicking all the pieces of the service and putting it back together and there was a need to evaluate whether adequate resources were available. There was also a need to look at the population group where the main risk factor had been identified. However, it was impractical to expect 12 full time equivalent staff members to handle the current level of service demand.
A Committee Member, in referring to previous comments regarding the funding of the service within Wales, sought clarification as to whether there was any evidence to support this view. The Clinical Psychology Lead stated that they had recently looked at benchmarking for comparable areas and it had been identified that there was a 60% budget deficit compared to areas within England. The only way to improve the situation was for an integrated and multi-agency approach that worked with all agencies, particularly with schools and youth services. Further to this point, a Committee Member questioned as to who was responsible for the lack of funding and whether there were any suggestions that would improve the situation. The Commissioning Lead advised that the funding issue was very well known within Health. The service needed to undertake a review to assess the resources available.
Following a query regarding the timescales of the programme, the Committee was advised that there was a need to wait for formal feedback, but in terms of providing mental health services there was a requirement to prioritise where the service was best hosted. The service currently worked with all age ranges and the service may need to assess whether it focused on children’s service. The evaluation of options would be concluded by the end of September and the current work was focused on the risk-taking behaviour of children and young. This was going to be long and complicated and would include a pilot on a small scale. There was a need to identify when peak time for demand occurred. The service was aware that many young people appear in A&E between 14:00 and 15:00 hours on a Monday and Tuesday, but the service needed to properly assess what triggered episodes in children and young people.
The Director of Social Services advised that a briefing note will be distributed to Members, outlining the Council’s perspective in respect of the issues raised during the presentation.
The Committee expressed a desire for an update report detailing progress to be provided within 12 months’ time.
Having considered the above, the Committee
(1) T H A T the presentation and minutes from this meeting be referred to Cabinet.
(2) T H A T a further update report be presented in 12 months’ time.
Reasons for recommendations
(1) To inform Cabinet of the changes to the CAMHS service and to highlight issues affecting an important service area.
(2) To provide oversight and scrutiny of an important service area.
Attached as Appendix – Report to Scrutiny Committee (Social Care and Health): 1st September, 2014