Agenda item

8.1

The Committee received a joint report of the Director of Inclusion and Learning Services (Sheffield City Council) and the Director of Commissioning and Performance (Sheffield Clinical Commissioning Group), providing an update on the Children and Young People’s Mental Health Transformation Programme.

8.2

In attendance for this item were Councillor Jackie Drayton (Cabinet Member for Children and Families), Owen Jones (Commissioning Manager, Sheffield City Council/Sheffield Clinical Commissioning Group), Bethan Plant (Public Health Lead, Sheffield City Council), Nicola Ennis (Service Manager, Child and Adolescent Mental Health Service (CAMHS)/ Sheffield Children’s Foundation Trust), Jim Millns (Deputy Director of Mental Health Transformation and Integrated Commissioning, Sheffield Clinical Commissioning Group/Sheffield City Council/Sheffield HSCT), David Higham-Pullen (Associate Director, Sheffield Children’s Foundation Trust) and Doctor Jeff Perring (Medical Director, Sheffield Children’s Foundation Trust).

8.3

The report was supported by a presentation, with Bethan Plant reporting on the development of the Plan, in 2015, in response to the national Future In Mind paper, the demand and waiting times for CAMHS and the support currently available for vulnerable children and young people in the City; Nicola Ennis reporting on the feedback from children and young people and transitions; and Owen Jones reporting on special educational needs and disabilities and mental health, reducing stigma in mental health, the work being undertaken with schools, Mental Health Support Teams (MASTs) and the Sheffield Healthy Minds Programme, and recommendations and next steps.

8.4

Councillor Jackie Drayton reported that there had been a number of challenges associated with the Programme, and a considerable amount of work had been undertaken to reduce waiting times for CAMHS.  The efforts of all partners in the City had been hampered by insufficient Government funding for Health Services, and the work undertaken as part of the Programme had made people more aware of the services available, thereby resulting in an increase in demand.  Councillor Drayton stated that there had been particular challenges in connection with the transition of children and young people to adult mental health services, and that there was a need for the Authority to keep lobbying the Government for additional funding for all the relevant services, in addition to the funding allocated towards projects.  She expressed her thanks and appreciation to the excellent work undertaken by this Committee some years ago, in connection with the scrutiny exercise on mental health services in the City. 

8.5

Members of the Committee raised questions, and the following responses were provided:-

·             It was very difficult to provide a definitive answer as to why there had been an increase in referrals to CAMHS, but it was believed that the increase, which was a national issue, was due to a combination of factors.  In addition, following the work undertaken to improve access to the Service, this had also been a contributory factor to the increase. 

·             A triage service was operated every day in CAMHS where, following an initial assessment, the children and young people were either accepted for further treatment by the Service, or signposted to other services.  The majority of referrals to CAMHS were from health services, educational psychologists and GPs.  The Service had run a pilot in terms of taking referrals from schools but, following an audit of this, it had been determined that such a service could not be maintained due to the level of workload involved.

·             CAHMS had seen a recent increase in the number of children and young people making reference to suicidal thoughts on their referral forms.  It was not possible to confirm whether such references were being made in an attempt to ensure they were seen quicker by the Service.  Such children and young people would be assessed in the normal manner.  There was a lot more pressure on children and young people today, which could be attributed to a number of factors, including pressures arising from social media.

·             It was noted that it was becoming increasingly difficult to recruit  specialist staff to traditional roles in CAMHS, and to provide service during the week. As such, the Service was looking at innovative practice to increase access to its services at outside ‘normal working hours’, and staff recruitment drivers via open days, connecting better with the City’s universities to encourage training and vocation in the area of children’s mental health.  

·             It was accepted that if children and young people were seen and assessed earlier by CAMHS, there was a strongly likelihood that there would be a better outcome for them.  Commissioners and CAMHS have explored different pathways, including developing rapid response and community treatment teams, and were always looking at ways to find out how children and young people could be seen by services quicker when they had a need.

·             CAMHS continued to implement the six appointment model for lower level presenting issues in order to improve patient throughput and release capacity for more complex cases.  The model comprised up to six appointments, with not all children and young people requiring all six.  Every effort was made to try and be more efficient during the sessions so that staff time could be freed up to work on other cases and more complex cases.

·             Current suicide rates amongst children and young people in Sheffield were comparatively low with other core cities, but were rising.  The Clinical Commissioning Group (CCG), Sheffield City Council Public Health Team and CAMHS were working on a pure-time surveillance model, which enabled the different services to share information as quickly as possible.  It also helped to enable the services to identify particular suicide clusters in the City.  As it was a new model, there was no data available as yet.  There was also an increasing trend in respect of self-harm by children and young people, which was believed to be due to a number of contributing factors but again, there were no details in terms of the numbers involved.

·             It was accepted that there was little support for those parents of children and young people suffering from emotional wellbeing and mental health problems, who also had similar problems themselves.  Whilst there was a parents’ participation group, where they were able to provide feedback and influence policies and procedures, this was not deemed a suitable forum at which they could seek help and support themselves.  CAMHS made parents aware of the various services available to them. 

·             There was a considerable amount of work undertaken in terms of interventions in an attempt to stop children and young people with emotional wellbeing and mental health problems from being excluded from school.  The CAHMS-led Healthy Minds Programme had proved very successful in terms of helping to identify the emotional and mental health needs of children and young people, thereby enabling support to be provided in schools.  A pilot involving 33 schools was working very well, and was providing schools with direct support from CAMHS clinicians in working with the most vulnerable children and young people. 

·             With regard to staff workloads and wellbeing, the staff within CAMHS were given clear targets in terms of workloads, and received regular clinical and management support in connection with their roles and responsibilities.  The staff were also encouraged to help and support each other, and make sure any concerns were raised with management.  The Sheffield Children’s Foundation Trust (SCFT) was currently looking to provide more emotional support for staff. 

·             Following the receipt of a referral notice, CAMHS would write to the family, confirming receipt of the notice, and indicating that they will be offered a service.  They would then be contacted again, nearer the time, to confirm the date and time of an appointment.  They would also be sent reminders of this by text, a service which had been introduced following feedback from parents.  If, for any reason, the appointment had to be cancelled, every effort possible would be made to arrange a further appointment at the earliest possible opportunity.  If, in the case of cancelled appointments, any safeguarding issues were identified, this position would be monitored, and relevant action taken. 

·             There were no significant problems with regard to waiting times for children and young people with eating disorders and, in the case of those people with serious problems, arrangements would be made for them to be assessed within a week.  If the condition was deemed to be a threat to the child or young person’s health, they would be referred to hospital.

·             An audit had been undertaken of the pilot project of direct referrals to CAMHS from schools, which had been implemented as part of a wider response to the SEND inspection. The feedback received from schools regarding the difficulties of gaining access to the Service had been positive, significantly improving links between CAMHS and schools, particularly in relation to supporting pupils with SEND and learning difficulties. However, it was noted in the audit that the pilot had taken a considerable level of resource, which had been considered to be unsustainable as a city-wide service with current resources in CAMHS.  CAMHS would continue to work closely with schools, and provide advice in terms of how the Service could assist, or signpost the pupils to other services.

·             Whilst there had been improved information-sharing between the various services working with children and young people, such as CAMHS or social services, there were still issues with regard to children and young people telling their story only once, and not having to repeat it to the different services.  Such problems existed as each service looked at the issues from a different angle, and asked different questions.  Collaborative work across the different agencies was ongoing to try and resolve this problem.

·             As part of the assessments of children and young people, questions were asked with regard to the circumstances of the wider family.  The services were looking at introducing a whole- family model, which would comprise a more joined up approach.  It was, however, accepted that this could be a challenge on the basis that the therapeutic models could differ between children and young people and adults. 

·             A new all-age eating disorder pathway had been finalised, in consultation with staff, service users and parents/carers, which was currently working very well.  Introducing a similar pathway for children and young people with mental health issues would be considerably more complex.  However, the services were looking to develop this pathway further, and were developing a pilot in schools regarding such a pathway for children and young people with emotional health and wellbeing issues, which would hopefully help to reduce the number of referrals to CAMHS. 

·             National and local evidence in Sheffield had identified systemic reasons as to why children and young people were experiencing an increase in emotional health and wellbeing issues. Sheffield had an experienced clinical lead for the Healthy Minds Programme in Sheffield, who was exploring responses to the increase, such as identifying holistic assessments around causes, such as childhood trauma and attachment issues.

·             The main focus of the Healthy Minds Programme was to look at pupils’ emotional health and wellbeing issues.  Those schools involved in the Programme had engaged very well, and the work undertaken had highlighted some excellent partnership work between CAMHS, the schools and Learn Sheffield.   The introduction of the Programme had resulted in an increase in referrals from Special Educational Needs Co-ordinators (SENCOs), as well as teachers.  As part of the Programme, staff, pupils and parents/carers were asked to complete a questionnaire, results of which had indicated that the most common areas relating to emotional health and wellbeing issues included lack of sleep, low mood, depression and anxiety.  Sheffield had received a high number of responses to the questionnaire, which would help shape future interventions and practice in this area.   The Programme had helped to introduce a different culture in schools, which had been viewed as a very positive step. 

·             It was very hard to identify any specific factors which were contributing to the increase in referrals to CAMHS.  On the basis that the increase in referrals was likely to continue, the Service was looking at best ways to manage this. 

·             The CCG received funding from the Government, which was considered insufficient by Councillor Jackie Drayton and the commissioners, to meet need fully in Sheffield. The Group continued to review and improve the contact with SCFT CAMHS and to fund the specialist Multi-Agency Psychology Service (MAPS) for the looked after children cohort in Sheffield. It was noted that Sheffield, as with other cities in the UK, was not fully equipped financially to meet the level of demand for mental health services for children and young people.  Present expenditure on mental health services for children and young people in Sheffield amounted to approximately £10 million and in respect of adults, approximately £140 million.

8.6

RESOLVED: That the Committee:-

(a)      notes the information contained in the joint report now submitted, the information reported as part of the presentation and the responses to the questions raised;

(b)      recognises and acknowledges the challenges and increased service demand on CAMHS and other services, particularly acknowledging the importance of establishing robust early intervention and early identification of children and young people experiencing emotional wellbeing and mental health problems;

(c)      notes the current financial position, and continues to encourage stronger links with schools, particularly with regard to exclusions and whole family support; and

(d)      thanks Councillor Jackie Drayton, Bethan Plant, Nicola Ennis, Jim Millns, David Hignam-Pullen and Dr Jeff Perring for attending the meeting, and responding to the questions raised.