Agenda item

RESOLVED that the information in the report and points raised in discussion be noted.

The Chair welcomed Sir Norman Lamb – Chair of South London and Maudsley (SLaM) NHS Trust Council of Governors, Dr Omer Moghraby – Lead Clinician, CAMHS, Brenda Bartlett – Deputy Director of CAMHS, Harold Bennison – Director of CAMHS, to the meeting.

Harold Bennison gave a brief presentation summarising the information in the report (slides were tabled), followed by Sir Norman Lamb addressing the committee. It was noted that:

1.       SLaM NHS Trust was one of four pilot areas across England trialling a new approach called the Parent and Carer Race Equality Framework. This involvedsmental health trusts working with communities to identify gaps in the data and getting a clear picture of where inequality exists eg young black men are disproportionately affected by compulsory detention under Mental Health Act and more likely to be subject to restraint on the ward. By fully understanding the existing data and identifying where data gaps exist, the Trust will work to address and hopefully eradicate the inequalities.

2.       The other 3 Trusts involved in the pilot are located in Greater Manchester, East London and the East Midlands.

3.       The Board of Governors was working on a vision and had reached broad agreement that directly confronting race dimension would be a core element of the vision. This was important both in terms of services to communities, but also internally as an organisation. Addressing over-representation of some ethnic groups within the organisation in disciplinary action was given as an example.

4.       Reverse mentoring for all members of the Board was being put in place. All Board members would be linked up with a member of BAME staff to properly understand the experience of BAME staff within the organisation.

5.       The Trust was working alongside local authorities and had been involved in a prevention summit, taking the approach of mental health as a public health issue. Communities were experiencing rising stress due to the fallout of the COVID-19 pandemic and the impact on employment, health, education, isolation, etc. By April the Trust expected to have an action plan in place, covering whole of South London. Nationally, SLaM NHS Trust was leading the way on dealing with the mental health impact of the pandemic.

6.       CAMHS was working in schools, using CBT in primary schools for whole class work, with good results and the potential to roll out nationally

7.       Australia had created a model youth service called ‘Head Space’ which was easy access, non-stigmatised and available on a self-referral basis. It covered all issues of importance to children and young people, in addition to mental health. Currently in the UK too many people are waiting too long or not getting onto waiting list because of high thresholds. Sir Norman argued that the government should fund something like Head Space in the UK. Stepped timely care is better than over pathologising and sitting on a long waiting list. Early access to help is essential for good mental health outcomes.

A Q&A followed and the following was noted:

1.       There had been a significant improvement in both the number of children and young people on the waiting list and the waiting time, compared with this time last year. The waiting time was reducing incrementally and activities to improve the waiting list were sustainable. Staff now understood that although it is usual for service users to have to wait, it is not acceptable.

2.       Those on the waiting list were being contacted to see if they needed to be reprioritised.

3.       Primary to secondary transition was a key trigger point. The work of the Mental Health Schools Team (MHST) was starting to impact and the MHST had received a high number of referrals.

4.       Sometimes the police responded to situations particularly those involving young black men and mental health difficulties, in a way that caused the situation to escalate.  There was a known link between poor mental health and gang activity.

5.       The future of improved mental health support depended on collaboration with the police, local authority, community and other stakeholders. SLaM was already working with police and other stakeholders, in recognising how mental health issues might present and how the impact of their power might affect the young person.

6.       Where appropriate, providing young people with visual aids such as sunflower lanyards or cards that say, for example, “I’ve got autism” could be useful in helping the police to recognise that they may need to change their approach.

7.       The Budget Cuts item on the agenda includes a proposal to have closer collaboration between the Multi Agency Safeguarding Hub (MASH) and CAMHS front doors. Lewisham Children’s Commissioners have looked at what has been done in Croydon and Kingston with referrals going through MASH then being referred on to CAMHS if there is a mental health component. As long as it is properly planned and staffed, it can work well. To be successful, large groups of referrers, for example schools or GPs, would need to be involved well in advance so that they understand the new system. It would need to be as easy as possible for referrers to refer difficulties on to CAMHS so that when the referrer approaches the front door, any redirecting happens internally. Ultimately the goal would be to enable self-referral. There is already a self-referral pathway for eating disorders.

8.       SLaM has increased funding to CAMHS and frontline staff and there is a tangible difference within the service. Culture change within the service has attracted quality staff. Funding remains a challenge.

9.       £500m announced in the Spending Review is not expected to be enough to meet the increased demand that has come about because of Covid.

The Chair thanked Sir Norman for his involvement and invited him to attend future committee meetings where CAMHS featured on the agenda, to which Sir Norman agreed.

RESOLVED that the information in the report and points raised in discussion be noted.