To receive an update on Children's Emotional and Mental Health services (30 mins)
The Committee received an update on Children’s Emotional and Mental Health Services. Members of the Children’s Services Overview and Scrutiny Committee had also been invited to hear the update.
During the discussion of this item the following points were made:
· Sally Murray informed Members that Future in Mind – promoting, protecting and improving our children and young people’s mental health and wellbeing, the report of the government's Children and Young People’s Mental Health Taskforce, had been launched in March 2015. Future in Mind had provided a structure for planned changes in Berkshire West. There had been a move away from the tiering of services and an increased focus on prevention and early intervention.
· Hayley Rees informed the Committee that a draft emotional and mental health strategy had been produced which would run from 2018 to 2021. The strategy was focused on universal and early help.
· The strategy had been broken down into four priority areas; Better intelligence to aid and improve decision making; Support for schools and additional universal settings; Early identification and self-help and Improving Access. Agreed in principle, this was going through the consultation period. Engagement with the CCG and Voluntary Sector was being carried out and feedback was being sought from schools.
· A redesign of the Primary Children and Adolescent Mental Health Services (PCAMHS) had been proposed following review. Members were informed that the proposal brought together the early help offers in the Local Authority, Voluntary Sector and the commissioned Mental Health Service, front-loading specialist expertise early in the pathways. In addition the proposed model would look to bring referrals for the service through the Local Authority front door to be triaged at a multi-agency triage meeting attended by statutory, voluntary and health partners. This hub would be an expansion of the existing Early Help Hub. Triage meetings would be held on a weekly basis.
· Louise Noble indicated that Berkshire Healthcare NHS Foundation Trust (BHFT) were commissioned to deliver a range of emotional wellbeing and mental health services to children within the Borough.
· BHFT provided a Primary Child and Adolescent Mental Health service (CAMHS). It also provided Community Specialist CAMHS, support, advice, guidance and treatment for those up to 18 years old who had moderate/severe mental health difficulties and whose symptoms had a significant impact on their day to day lives.
· The Community Specialist CAMHS was made up of:
o Children Young People Families Health Hub (CAMHS Common Point of Entry)
o CAMHS Rapid Response Team
o Autism Assessment Team
o ADHD Pathway
o Cognitive Behavioural Therapy Service for Anxiety and Depression
o Community Eating Disorders Service
o Community Early Intervention Psychosis Service
o Locality Specialist Community Team for young people with more complex difficulties.
· In response to a question from Councillor Soane, Louise Noble clarified that self-harm was not a mental illness in itself but a behaviour.
· Members were reminded that not all young people who needed support from the crisis response team had an acute mental illness. Determining the appropriate response was vital.
· With regards to counselling Councillor Shepherd-DuBey commented that funding was an issue and that many schools did not have sufficient budget to commission counselling services. Sally Murray emphasised that the Clinical Commissioning Group provided ARC with £30,000 a year. Hayley Rees indicated that the local authority had a responsibility to work closely with the providers to ensure that local need was being met and that what was being delivered was appropriate. The Council also provided approximately £60,000 a year to ARC.
· Sally Murray provided further details of the Wokingham Borough Council School Link Project. There was a push to train social care, primary care, education and voluntary sector staff in early identification of emotional health and wellbeing issues. Staff involved in the project were qualified primary school mental health workers.
· Members were informed of the Young SHaRON service.
· The Committee discussed waiting times for services. In response to a question from Councillor Croy regarding 232 children and young people waiting over 12 weeks to see the Autism Assessment Team, Louise Noble commented that long waits were a national challenge. Collaborative work was undertaken to ensure that appropriate support was provided whilst the individual awaited a diagnosis. Lisa Humphreys emphasised that a diagnosis of autism did not automatically unlock access to more services. The presenting emotions and behaviours were considered and support provided at as an early stage as possible. Members were informed of parenting specialists that coached families in managing behaviours.
· Councillor Loyes asked whether the autism assessment wait times could be reduced further. Hayley Rees indicated that the achievement of an efficient, quality service was vital. Sally Murray indicated that the national average wait time for an autism diagnosis was 3.5 years.
· Councillor Croy commented that the 29% increase in referrals to PCAMHS on the previous year seemed high. He also noted that the caseload was very high for 2.4 WTE members of staff. Hayley Rees stated that the commissioning arrangements had been looked at as part of the development of the emotional wellbeing strategy. Whether the appropriate levels were being commissioned at had been considered. The expansion of the Early Help Hub would enable a more efficient distribution of resources. Workload and working as a whole system had also formed part of the review.
· Louise Noble emphasised that demand was increasing nationally. The system as a whole was seeking to understand adverse events that may occur in childhood and the effect that these may have and on growing resilience.
· Sally Murray highlighted the achievements of the West Berkshire Council Emotional Health Academy
· In response to a question from Councillor Shepherd-DuBey, Louise Noble commented that an increase in children with autism plus other conditions was being seen nationally. The percentage of children who had autism as the primary reason for their Education, Health and Care Plan in Wokingham and West Berkshire, was slightly higher than the national average.
· Members questioned whether a general increased willingness to discuss mental health issues could have contributed in the increased demand for services. Sally Murray commented that many young people were becoming more willing to talk about their own mental health and emotional wellbeing. Some celebrities such as Stormzy and Zoella had revealed their own issues in the media, which may encourage other young people to discuss their own concerns.
· In response to questions from Councillor Miall, Sally Murray emphasised that many independent schools commissioned their own counselling services. The CCG commissioned services for the whole Borough. Louise Nobles commented that independent schools could also refer pupils to CAMHS. Lisa Humphreys indicated that private and independent schools were also engaged through the Local Safeguarding Children’s Board. Home schooled children were also monitored.
1) the update on Children’s Emotional and Mental Health Services be noted;
2) Hayley Rees, Lisa Humphreys, Sally Murray and Louise Noble be thanked for their presentation.