Agenda item

Children and Young People’s Mental Health and Emotional Wellbeing

For the Committee to consider the current offer in Oldham for Children and Young People’s Mental Health and Emotional Wellbeing.

Minutes:

The Committee received a report presenting an overview of the current offer for children and young people’s mental health and emotional wellbeing in Oldham.  The report presented as appendices, and as a basis for the Committee’s consideration, two documents that had been produced recently.

 

The first appended document was the CAMHS Local Transformational Plan (LTP) annual refresh 2019 compiled by Oldham CCG in association with its partners and building on the ambition identified within the original 2015 CAMHS LTP for children and young people in Oldham requiring emotional wellbeing and mental health support.  The annual refresh focuses on the changes and impacts the additional LTP investment had brought about and the LTP continues to be developed in accordance with local need and priorities.

 

Healthwatch had been invited by the CCG and Oldham Council to undertake a review of young people’s mental health services to ensure that the transformation of services reflects the needs and wants of families.  The Healthwatch report, the second appended document, presented the approach undertaken to the review, the analysis of responses received, highlighted areas that were working well as a result of changes introduced by the LTP and areas for improvement, and the recommendations arising from the review.

 

The Committee received a presentation from Dr Keith Jeffrey - Clinical Director for Mental Health (NHS Oldham CCG), Angela Welsh – Senior Commissioning Business Partner (NHS Oldham CCG), Oldham Cares, Julie Farley – Manager, Healthwatch Oldham, and Mike Bridges – Public Health Specialist, Oldham Council on the background to and the issues arising from the two documents considered.

 

CCG’s had been given the responsibility to develop, in association with local partners, CAMHS LTPs in response to the government’s policy document ‘Future in Mind’.  LTPs set out how local services would invest resources to improve children and young people’s mental health with the intention that these would be a ‘living document’ requiring an annual refresh.  Some of the changes introduced as a result of the LTP were considered, including work with schools and development of specialist services, both considered in more detail at section 1.2 - 1.3 of the Annual Refresh report.  Improvements in early access and the usefulness of better signposting were further noted and, in response to a query, Members were advised that eating disorder treatments ran from Hubs in Bury, which Oldham residents would access, and in Stockport.

 

In early 2019 Healthwatch had worked in partnership with local services and schools to gather feedback from families about their experience of using children and young people’s mental health services and the review findings were being shared with commissioners and providers to help inform the current redesign of services in Oldham.  The review comprised 90 families who had volunteered to complete questionnaires and/or participate in Focus Group interviews and 35 volunteer professionals.  There were acknowledged issues with the representative nature of the review participants and, in response to Members’ queries as to whether a lack of black, Asian and minority ethnic (BAME) engagement was reflective of either service use or the form of the engagement activity and as to the reasons for an uneven geographical response, it was advised that no judgement of the reasons had been made pending further investigation.  If BAME communities were not accessing services, an investigation into what the knowledge and understanding of services provided would need to be undertaken.  If services were being accessed, a targeted individual approach could be needed to gain consultation responses. A Member suggested there was limited awareness of mental health in the BAME community and queried how this might be addressed.  Reference was made to work being done in schools and connections starting to be made.  There was not clear signposting to self-help for families, and this needed to be developed to get the word out about mental health issues and support.

 

In general, the Healthwatch review had reinforced the perceptions of commissioners and previous feedback from families that service improvements over the last few months are going in the right direction and responding to the needs of young people/families.  However, further adjustments were needed to ‘fine tune’ some service redesign to improve the patient experience and promote self-help options, and the experiences of young people and families had highlighted issues with the treatment for children and young people presenting with both mental health issues and Autism Spectrum Disorder. 

 

Some positive experiences of the service were reported, with over 70% feeling that Healthy Young Minds Oldham (HYM) is very professional and confidential.  It was, however, noted that both referral waiting times and waiting times between treatments were considered too long.  It was acknowledged that while key performance indicators indicated good performance, family feedback indicated there was a need to do better.  It was felt that the new single point of access and triage would help address the issues of referral and of families being passed around services, with families indicating a welcome for a single point of access offering a ‘menu’ of treatments, sessions for parents on how to help their child between treatments and post-discharge, and the improving of the young person’s experience when accessing urgent care with a mental health crisis.  Regarding expressed concerns about weekend service cover, a GM Crisis Pathway had been introduced from January 2019 so improvements should be seen to be coming through.

 

With regard to professionals’ views, almost 50% had reported seeing improvements in children and young people’s mental health services in the previous year, though a lack of services or coordinated response for those with dual mental health and autism spectrum condition/ADHD was again noted.  In response to a query concerning the professionals’ view, it was noted that many service changes had occurred in past eight months, that services appeared to be moving in the right direction and that a significant increase might be anticipated in the next review.  With regard to dual presentations, work had gone in to raise awareness in schools and while things were moving in the right direction, it was acknowledged that more work needed to be done in this area.

 

The review had considered that a ‘whole school approach’ was helping raise awareness and build the confidence of teachers to initiate conversations about mental health and offer low level support in respect of, for example, exam anxiety, behaviours etc.  Building on this, families would welcome better communication and coordination between services and the blurring of boundaries between mainstream, low level and acute services reflecting a view that the differing levels of support worked in ‘silos’, easy access to self-help advice from outset, and assistance for families falling outside standard service criteria and who struggle to access any formal support.  A Member queried circumstances where parental concern about anxiety might not be reflected in the threshold for referral.  Members were advised of work in schools around resilience and to give teachers the confidence to start conversations

 

A number of other issues raised only by individual families but which appeared as maybe needing further consideration included transition between Children’s and Adult Mental Health Services, the experiences of foster families, the experiences of BAME families accessing young people’s mental health services, and the experiences of young people with dual mental health and drug/alcohol issues.

 

The Children and Young People’s Mental Wellbeing Partnership would take  ownership of the Healthwatch review’s findings and recommendations, building them into the ongoing transformation programme for children and young people’s mental health services, and Healthwatch and partners would be considering a follow up review in 18 months to understand the impact of current and planned service improvements and to gather the views of BAME families.

 

The presentation considered further the Whole School Approach which was based on a quality assurance framework to support schools produced by Pennine Care NHS Foundation Trust and supported by further publications providing support and advice to schools in addressing the emotional health and mental wellbeing of children and young people.  The eight principles underpinning the whole school approach comprise

·           management and leadership;

·           the school/college ethos and environment;

·           the curriculum, teaching and learning;

·           the student voice;

·           staff development, health and wellbeing;

·           identifying needs and monitoring impacts;

·           working with parents and carers; and

·           co-ordinated support.

 

The Oldham Whole School Approach to emotional health and mental wellbeing therefore sought to

·        boost the capacity of schools and colleges to complete self-assessments and develop school or college action plans;

·        provide training for staff from every school to deliver robust class room based programmes to promote resilience and mental health;

·        offer needs based support to schools and colleges to allow them to source additional mental health support to meet immediate needs of pupils;

·        actively engage with school senior leaders, designated mental health leads and SENCO’s; and

·        encourage all schools to complete the CORC mental wellbeing survey to them help measure mental health and wellbeing in particular year groups.

 

It was considered that the approach had proved to be successful with schools engaged and producing better partnership working.  The approach had received Greater Manchester (GM) and national recognition, and similar work was being promoted across GM in a ‘mentally healthy schools’ project.  In response to a query concerning evidence as to the use and benefits of the approach, a tender had been invited for a University evaluation exercise and the DfE were looking at interventions and feedback from teachers.

 

Noting the focus on schools, a Member asked about any focus on young parents and the under-5s.  Dr Jeffery noted that attention to perinatal services was ongoing but possibly a little behind children and young people, suggesting that the Committee might wish to invite the newly appointed Clinical Director for Children to consider such matters.  Considering the contribution that Sure Start Centres might make in identifying those who show early signs of mental health issues, the Committee was advised that the Assistant Director for Education (SEND) was looking at this.

 

In response to a query concerning causes of mental health issues, the Panel noted that this was a complex issue but variously suggested factors including social media, austerity, the lack of services, and constant changes to the system in terms of both the workforce and organisations leading to fractured services.  Responding to a further query as to the impact of domestic violence, Mike Bridges undertook to circulate a slide and notes concerning mental health risk factors and preventative strategies.

 

In conclusion, Dr Jeffery commended Mike Bridges for the work undertaken with schools.  The Chair supported the remark and further thanked the Panel for their presentation and report to the Committee.

 

RESOLVED that the update of the CAMHS Local Transformational Plan and the findings of the Healthwatch review of Children and Young People’s Mental Health Services be noted.

 

Supporting documents: