To receive updates on mental health support for vulnerable communities in Wokingham

Ingrid Slade, Consultant in Public Health and Andy Fitton, Assistant Director of Joint Commissioning, NHS Berkshire West CCG, provided an update on mental health support for vulnerable communities in Wokingham.

During the discussion of this item, the following points were made:

·       The Health Overview and Scrutiny Committee had submitted a number of questions previously around mental health and wellbeing.

·       Nearly half of all mental health issues experienced in adulthood would have begun by the age of 15 and three quarters by the age of 18.  Poor mental health in young people could impact on their life chances in the future.

·       Ingrid Slade outlined the impact of Covid on the population mental health.  The impact of Covid was still largely unknown.  A significant negative impact on children and young people’s emotional wellbeing was likely.  Whilst there had been some research regarding the additional benefits of being at home with both parents, the impact of missed education, social interaction and lockdown, meant that the impact was likely to be largely negative.

·       There had been a self-reported survey published by Public Health England which had shown that health and wellbeing had worsened since the beginning of the pandemic and that there was high levels of anxiety and lower level of happiness following the first lockdown, which had endured.  It was likely that trends in Wokingham would be similar. 

·       The Public Health team would be publishing a local mental health needs assessment which would cover the whole of the life course, by the end of the year, to help plan future services.

·       Current services for children and young people included:

Ø  CAMHS Service (including the Berkshire Eating Disorder Service (BEDS).  This was commissioned by the CCG and delivered by Berkshire Healthcare Foundation Trust (BHFT)

Ø  Mental Health Support Team (MHST) project for secondary schools.

Ø  A new ‘Tier 2’ offer to support emotional health and wellbeing in children and young people – jointly commissioned by the Council and the CCG and delivered by BHFT.

·       Andy Fitton referred to specialist services for children and young people with an escalated condition, often around anxiety and depression.

·       The mental health referrals into the Common Point of Entry (CPE) for Berkshire West had been affected by lockdown, from a low of 42 to a high of 336.  Much of this related to lock down and access to professionals.  Also, early in the pandemic, many people had withdrawn from accessing even primary care.  Whilst numbers had reduced over the last few months it was not back down to the very low level.

·       Andy Fitton highlighted the current number of those waiting for the Specialist CAMHS team and also the Anxiety and Depression team and the current wait times.  Members asked if it was possible to have a break down of those receiving treatment in Wokingham.  Andy Fitton agreed to feed back to the Committee.

·       The BEDS team, the eating disorder team for those aged 8 to 18, had been established following a national drive to have a specific clinical input into this service.  Numbers and the complexity of presentations had risen following the pandemic, which was in line with the national position.  Both regionally and nationally, more children were requiring an inpatient service.

·       Andy Fitton provided an overview of the Tier 2 service.  A rethought and reshaped emotional wellbeing model had been redeveloped for children with mild to moderate mental health issues.  It was a mixture of assessment and direct intervention, as well as training and support to providers such as schools.

·       An Emotional Health Assessment and Triage Service (Emotional Wellbeing Hub) was being established that would act as the front door locally.

·       Funding had been awarded a year and a half before, to set up the first Wokingham Mental Health Support team.  It was a dedicated team supporting a cohort of schools totalling approximately 8,000 pupils, both secondary and primary.  The team would include a range of specialists such as a Senior Educational Psychologist and a Senior Specialist CAMHS Practitioner, in addition to those trained via Reading University to become Educational Mental Health Practitioners.  They would support and engage and provide direct intervention to children, particularly around anxiety and depression.  Wokingham would require a minimum of three teams within 10 years.  Given the level of housing development within the Borough it was possible that a fourth team would be required in the future.  Work would continue with NHS England and when funding became available more teams would be established.

·       Ingrid Slade referred to anxiety and depression data.  The Committee has asked previously if prevalence data suggested issues amongst particular groups or not.

·       Data around under 18’s mental health disorders was unfortunately limited. 

·       Ingrid Slade referred to the Mental Health of Children and Young People in England survey which had been carried out in 2017.  The survey had concluded that approximately 11.2% of 5-15 year olds had a mental health disorder (in its broadest terms).  This would equate to around 3500 in Wokingham.  The Survey had also found that at that time in 11-16 year olds, boys and girls were equally likely to have a mental health disorder.  Nationally around 1 in 7 11-16 year olds had a mental health disorder.  1 in 6 17-19 year olds had a mental health disorder but females in this age bracket were twice as likely to have a mental health disorder.

·       The data provided did not include those who had not been reported via primary care.  It was possible that young men were more reluctant to present to their GP.

·       There was an increase in anxiety and depression by age.  An increase in diagnosis was expected in the following months as a result of Covid.

·       The Committee had previously questioned what the current and planned activities were with regards to suicide prevention. 

·       Ingrid Slade indicated that this was an important part of the Public Health Team’s efforts to promote good mental health and wellbeing.  It was part of the multi-agency Berkshire Suicide Prevention Group which collaborated on surveillance initiatives to combat suicide.

·       Overall suicide rates in Wokingham and neighbouring boroughs had not changed following Covid.  Across Berkshire 61 suicides had been reported in 2020, 9 of which had been Wokingham residents and of these, 2 had been under 18.

·       The Berkshire Suicide Prevention Group had looked at the surveillance data and a small spike in female suicides had been noted.  A subgroup had been formed to look into this and had found that there was an over representation of health and social care workers and other supporting front line roles.   BHFT was looking at how support could be improved for staff at times of high service level and demand. 

·       Andy Fitton provided an update on Willow House, the inpatient facility run by BHFT and commissioned by NHS England.  Willow House used to be an inpatient facility for those aged 12-18 years old with severe mental health needs.  It had been based in Wokingham Hospital.  Since March 2021 it had been replaced by a new community based service.  Members were informed that the new service could treat more young people at the same time.  An inpatient facility would still be available for those that needed it.

·       In response to a Member question regarding bids for further MHST’s, Andy Fitton stated that Wokingham would not be getting further teams in the near future but they would continue to advocate for the area.  NHS England asked that a bid be put together to think about where resource would next be put for the MHSTs across the Integrated Care System and where resource could best meet the need.

·       Members asked about early results from the Mental Health Support Teams.  Andy Fitton stated that they had only been running 6 months, so it was encouraging that 67 young people had already been referred to the service for support.   Evidence based tools were being used so a scale of change would be expected.  Work was also being done to support parents so that they had a better understanding of the issues that their child was facing.  Members questioned whether people often came back to the service and were informed that it depended on the individual.

·       A Member asked about whether anecdotal evidence suggested that eating disorders were increasing amongst boys and girls.  Andy Fitton commented that historically there was a higher referral rate of females.  Whilst numbers were increasing, he did not believe that the proportionality was changing.  He agreed to check this and feed back to the Committee.

·       CAMHS waiting times were discussed.  Members asked how those waiting were supported as they waited and what was being done to further reduce waiting lists.  Andy Fitton commented that there would be increased investment in CAMHS over the next 3 years and support being offered, was being looked at.

·       With regards to the Common Point of Entry, a Member questioned how many patients were currently receiving the service, and was referred to the case load figures for the Specialist CAMHS team (477 at the end of March in Berkshire West) and the Anxiety and Depression team (279 at the end of March for Berkshire West).  In addition, some were going through specialist assessments.   Andy Fitton agreed to provide the Committee with discharge figures – not all those referred via the CPE would need to be referred to specialist CAHMS services.

·       A Member referred to the increased development in the Borough and the likelihood of a fourth MHST being required in the future.  Andy Fitton emphasised that the single indicator used for the MHSTs was approximately 1 per 8,000 pupils.

·       In response to a Member question, Andy Fitton clarified that funding for the MHST was guaranteed for a least 3 years.  Not all posts within the team were full time.

·       The Committee sought clarification as to why there had been a spike in suicides in health and social care and other front-line workers.  Ingrid Slade stated that these were often high stress jobs and the impact of Covid was still being seen.

·       A Member asked whether the Council had had an input into the decision around Willow House and was informed that the decision had been taken by NHS England and Berkshire Healthcare Foundation Trust.  The outcome of this decision would take some time to be fully seen.

RESOLVED:  That the updates on mental health support for vulnerable communities in Wokingham, be noted.