Agenda item

Resolved:

The Committee asked that the following information be provided for inclusion in the final review report:

·         Further comparator data on waiting times for CAMHS.

·         Information on what will happen to embed learning from the HeadStart project so far if the bid for further funding does not succeed.

Caroline Hirst (Commissioner, Children & Young People) introduced the report and highlighted the following key points:

·         1 in 10 children will experience some form of mental health problem before they are 15.

·         The HeadStart project is funded by Big Lottery and is a great opportunity to boost universal and targeted mental health and emotional well-being provision within Lewisham, particularly around resilience. The HeadStart project has a series of priorities and targets with a steering group made up of young people.

·         Risk factors for mental health issues include poverty, being a Looked After Child (LAC), parental mental health, and those exposed to trauma.

·         Mental health provision is divided into a number of tiers. Tiers 3 and 4 are statutory provision dealing with the most serious cases. Tiers 1 and 2 are universal and targeted provision.

·         South London and Maudsley (SLaM) NHS Foundation Trust are commissioned to provide specialist child and adolescent mental health (CAMH) provision at Tiers 3 and 4.

·         Place2Be, a national charity, offer universal and targeted provision in 10 schools within the borough, 2 secondary and 8 primary. They provide a school based counselling service, which incorporates 1:1 appointments, group sessions and open access drop in sessions.

In response to questions from the Committee, Frankie Sulke (Executive Director for Children & Young People), Warwick Tomsett (Head of Targeted Services and Joint Commissioning), Caroline Hirst, Mick Atkinson (Head of Commissioning, Place2Be), Wendy Geraghty (Lead Clinician, Lewisham Children and Adolescent Mental Health Service) and Ruth Hutt (Public Health Consultant) provided the following information:

·         Suicide amongst young people is rare in Lewisham and is more common among young men than other groups. Self-harm is increasing and more common than suicide, whilst the suicide rate itself is static. There have been no suicides amongst children and young people in Lewisham since 2001. It is the intention of the HeadStart Programme, to build mechanisms of identification and increase opportunities for support, building resilience amongst the child population to reduce the likelihood of suicide.

·         While waiting times could be shorter for CAMHS, Lewisham is under the 12 week national target for waiting times and do well in this area in comparison to other  local authorities. 

·         CAMHS services work with young people with high levels of needs.  Young people who self-harm cannot be discharged from hospital without being seen by CAMHS.

·         Young people are directed to other family support services, if they don’t meet the threshold for CAMHS.

·         Nationally and locally there has been some debate regarding the ‘tiered’ approach to CAMH service.  The Department of Health is reviewing the current language and there are proposals to change this to a ‘system’ approach to the delivery of CAMHS. 

·         Part of the HeadStart project is a pilot online counselling service that provides a direct interface to clinical support and this service allows young people to refer themselves.

·         Lewisham CAMHS are fully engaged in the ongoing development of universal and targeted provision in the borough, offering strategic support and expertise to the HeadStart Lewisham programme. 

·         HeadStart Lewisham operates at three levels: universal provision in universal settings, to improve emotional literacy and identify vulnerable children; targeted provision for those identified as needing support; and intensive support for those with low levels of resilience, to prevent escalation of need.

·         Within the HeadStart programme there is a focus on domestic violence as a risk factor, which comes under the wider banner of those ‘exposed to trauma’.

·         Many schools invest in pastoral care and people across the borough are passionate about the emotional wellbeing of young people. The school nurse expansion programme will support the key principles of HeadStart and Lewisham and Greenwich NHS Trust continue to play an integral role on the HeadStart Steering Group.

·         Current provision at tiers 1 and 2 is limited and current resources are deliberately focused at tiers 3 and 4.  HeadStart Lewisham will play an important role when building capacity amongst the workforce

·         Those involved in HeadStart are aware that this is the first step, and efforts are being made to build on existing good practice, such as schools commissioning services from organisations such as Place2Be.

·         As part of the ‘test and learn’ phase of HeadStart, Young Minds, the national charity, have been commissioned to deliver the ‘Transition Curriculum’ across two school collaboratives. This involves parents and carers, as well as those delivering services in schools to identify gaps in provision. Schools were identified in partnership with the School Improvement Team.

·         Place2Be focuses on tier 1 and 2 preventative work, with the aim of inmproving emotional well-being.  Place2Be is already operating in a number of schools in the borough and through HeadStart we intend to open this out to more secondary schools.

·         We are also working with schools, the youth service and other providers when developing a youth led film, to support resilience in young people of this age group.

·         The stage two phase of HeadStart will support the development of expertise and resources, which will be embedded in existing services should we be unsuccessful at stage three.

·         There was a wellbeing survey offered out to all schools to provide a baseline of emotional needs for all 8-16 year olds. We intend to conduct a number of controlled trials to enable comparisons between schools not in HeadStart and those that are.

·         It is important to get the information and approaches right for mental health issues such as eating disorders and to get it right early. NICE guidance is used as a good practice guide for all services in the community and in specialist units.

·         Workforce development is a key focus so that professionals in partner organisations can identify issues earlier.

·         The online resource kit is currently under development, we hope to tender in the new year.  In the meantime the LBL Communications team have developed a page for Headstart on the Lewisham website.

·         The cost/benefit analysis of Place2Be’s work is difficult to estimate for Lewisham. Work has been done to produce a national cost-benefit analysis, which is a conservative calculation. Place2Be helps lots of young people that would never reach the specialist CAMHS threshold. The benefit is that it can build resilience into young adulthood. Issues can be identified early, so young people can manage through times of difficulty such as transition, exam pressure and family crises. 

The Committee then discussed the timeframe of the bid for the next round of HeadStart funding, the need for further comparator data on CAMHS waiting times and the need for more detail on a ‘Plan B’ if the HeadStart bid is unsuccessful.

Resolved:

The Committee asked that the following information be provided for inclusion in the final review report:

·         Further comparator data on waiting times for CAMHS.

·         Information on what will happen to embed learning from the HeadStart project so far if the bid for further funding does not succeed.