Isle of Wight Child & Adolescent Mental Health Service

Local Transformation Planning Workshop October 2015

Introduction• Social, emotional and behavioural skills underlie almost every aspect of school, home and

community life, including effective learning and getting on with other people. In 2014 Public Health England published “improving Young People’s Health and Wellbeing” this acknowledges the principle that treating different, specific health issues separately will not tackle the overall wellbeing of our current generation of young people. Young people’s mental and physical health is intertwined and at the heart of their health and wellbeing is their relationship with others.

• Mental illness is associated with:– deprivation, – low income, – unemployment, – poor education, – poorer physical health

and – increased health-risk behaviours.

• 10% of children and young people have a mental disorder, and many more are unhappy or dissatisfied with their lives. We know that a large proportion of these young people will not be accessing appropriate support when they first need it. This is likely to result in them only coming to the attention of services once they reach a crisis. This is a big issue as 75% of mental health problems start in childhood.

National Direction of TravelThere are a number of national policies that inform the national direction of travel:

The Cross government mental health outcomes strategy for people of all ages (2011) No Health Without Mental Health Strategyidentifies six objectives:• More people have good mental health• More people with mental health problems will recover• More people with mental health problems will have good physical health• More people will have a positive experience of care and support • Fewer people will suffer avoidable harm• Fewer people will experience stigma and discrimination

Closing the Gap: Priorities for essential change to mental health, was published in January 2014 and supports the No Health without mental health objectives and aims to bridge the gap between the long term ambition and short term action. It sets out 25 areas where people can expect to see and experience the fastest changes in the next two to three years.

The Mental Health Crisis Care Concordat was published in February 2014, it has been signed by more than 20 national organisations in a bid to drive up standards of care for people experiencing crisis such as suicidal thoughts or significant anxiety. It sets out the standards of care people should expect if they suffer a mental health crisis and details how the emergency services should respond. Future in Mind – Promoting, protecting and improving our children and young people’s mental health and wellbeing (2015) Published In March 2015 by the Department of Health and NHS England Future in mind sets out to promote, protect and improve children and young people’s mental health with an emphasis on all agencies working across boundaries to develop seamless flow between services and to acknowledge that children and young people do not neatly fit into boxes or tiers of service. This new publication focuses on 5 key themes: • Promote resilience and early prevention• Improve access• Care for the most vulnerable• Accountability and transparency• Develop the workforce

National Facts & Figures Mental health affects everyone:• There are at least 850,000 children in the UK who have a diagnosed mental

health condition. • 1 in 10 children aged between 5 and 16 years have a clinically diagnosable mental

health problem and many continue to have mental health problems into adulthood.

• By applying this 1 in 10 measure to the Island’s population, around 1,800 young people aged 5 to 16 could be experiencing mental health problems.

• Half of all diagnosable mental health conditions start before the age of 14 and 75% by the age of 21.

• The long-term costs associated with childhood mental health problems are estimated to be £2.35bn and the short-term costs £1.58bn.

• The annual cost of mental illness during childhood and adolescence per child ranges from £11,030 to £59,130.

• The Centre for Mental Health has estimated that the economic and social costs of mental health problems in England in 2009-10 were £105.2bn.

Local ContextThe Isle of Wight has a population of 138,392 of which 27,731 (20.9%) are children and young people under the age of 18.

Compared to the England average the Isle of Wight has: • Worse rates for teenage pregnancy • Higher levels of self-harm • Higher hospital admissions for those with a mental health condition • Higher rates of young people under 18 admitted to hospital because they have a

condition wholly related to alcohol

0

100

200

300

400

500

600

2007/08 - 2009/10 2008/09 - 2010/11 2009/10 - 2011/12 2010/11 - 2012/13

Rate p

er 100,

000

Young People Hospital Admissions for Self Harm: rate per 100,000 aged 10 - 24 years

Isle of Wight

South East

England

Local Data:

100

300

500

700

900

1100

1300

Baseline Referral Data for IW CAMHS 2014-2015

Num

ber o

f C&

YP

CCAMHS Youth Trust YMCA Barnardo's

Clinical Staff

16 3 1.2 1.83

Admin Staff

4.7 1.25 0.8 0.73

2.5

7.5

12.5

17.5

22.5

IW CAMHS Workforce WTE

Num

ber o

f WTE

Total Referrals = 2198 Total Workforce = 29.51

Eating Disorders – Local Data • Current CCAMHS total caseload of young people between the age of 11 and 18

with a diagnosis of Anorexia Nervosa = 16 (2 male and 14 female).

• Long term cases of over one year in treatment from January 2014 to December 2014 = 7. 2 of which have been in treatment for over two years and 3 for three years.

• New cases referred between January - September 2015 = 9.

• Of the total 16 young people currently being treated for Anorexia Nervosa 5 have been admitted for various periods of time to mainland adolescent psychiatric hospitals. These are often at a considerable distance from the Island due to bed availability. At this point in time only one is currently an inpatient.

Eating Disorders – Treatment OptionsThe treatment options that are provided are:-

Admission to the acute paediatric ward: to address those that are medically compromised and require careful intensive management to re-introduce eating to avoid re-feeding syndrome.This course of action involves :-• children’s ward nurses and consultant paediatrician,(Daily)• Dietician( can be daily)• Consultant psychiatrist(weekly), Inreach/outreach nurses(daily), family therapist(weekly), and clinical

psychologist(weekly), discussion at MDT risk review• Additional bank staff to supervise and support the ward (behaviour and meals 24hrs daily on occasions)

Treatment for patients not needing hospital admission:• Weekly involvement with Psychologist individual work• Regular Consultant psychiatrist appointment and discussion at daily MDT risk review• Weekly/fortnightly family therapy• Inreach/outreach daily support with meal /behaviour, psycho-social education support to establish stability.

Admission to adolescent eating disorder unit:• Arranged via NHS England Commissioners who identify vacant beds in England • Inreach/outreach to make referral and arrange admission as appropriate.• Undertake CPA reviews and weekly liaison with the hospital and weekly contact with family. • Attendance at the hospital for review can involve each clinician either by phone or face to face.• Attendance of AMP at MH tribunal ,follow up if discharged on CTO requires AMP and clinical team in regular reviews.

Priority Area 1: Promoting Emotional Health Resilience - The need to build the emotional health resilience of children and young people and their families by developing further early support across all services.

Priority Area 2: Improving Access - The need to ensure children and young people have increased access to appropriate services supporting their educational and mental health needs, from all agencies both statutory, independent and voluntary.

Priority Area 3: Developing Clear Care Pathways - The need to continue to develop the interface between community child and adolescent mental health services and the wider children’s workforce. Specifically to develop the ADHD/ASD pathways, recognising the emotional and mental health needs of this particular group of children and young people.

Priority Area 4: Ensuring the most vulnerable are supported - The need to ensure the most vulnerable children i.e. Looked after children, have timely access to a range of services to support their emotional well-being and mental health.

Priority Area 5: Developing the Workforce - The need to extend across the children’s workforce, training and understanding of the emotional well-being and mental health needs of Isle of Wight children and young people, to include Solihull training.

Round What are our Priorities and where are the Gaps?

Local Transformation Planning:

Following the publication of Future in Mind (March 2015) which proposed a wide range of measures to transform mental health services for children and young people, CCGs have been asked to submit Local Transformation Plans (LTPs) to implement the recommendations. Funding allocations for CCGs LTPs will be based on the assurance of detailed, locally agreed plans, and have been set in line with the standard CCG allocation formula. £1.25 billion funding was pledged for CAMHS in the March 2015 budget.

The IW CCG has been allocated £76,000 in the first instance to begin transforming the local CAMH Service with a further £191,000 allocated should we submit a successful transformation plan.

Current Local Investment:

2013-2014 2014-2015 2015-2016 (IW CCG to third sector = YTD Apr to Aug 15)

£0

£200,000

£400,000

£600,000

£800,000

£1,000,000

£1,200,000

£1,400,000

£1,600,000

£1,800,000

£2,000,000

CAMHS Investment

IW CCG to IW NHS Trust CCAMHS IW CCG to Third Sector Tier 2 Counselling ServiceIW LA to IW NHS Trust CCAMHS NHS England Spend on behalf of IW CCG Population