Agenda and minutes

To approve as a correct record and sign the Minutes of the meeting held on 3 September 2013.

The Minutes (copies of which had been circulated) of the meeting held on 3 September 2013 were approved as a correct record and signed by the Chair.

Councillors and officers were invited to declare any interests they had in any items on the agenda for the meeting.

The following interests were declared:-

Personal Interests

To consider a report of the Public Health Specialist

The attached documents provide information requested at the last meeting on the level of need for CAMHS in Stockport and a demographic profile of children and young people in the borough.

Duncan Weldrake, Public Health Specialist, submitted a report (copies of which had been circulated) providing additional data on prevalence of mental ill-health in young people in Stockport, and demographic data for the borough. The information had been provided in response to questions raised at the last extraordinary meeting. It was emphasised that providing accurate data was a challenge and extrapolation from national data had been necessary to establish some of the prevalence data.

The following comments were made/ issue raised:-

·         Over 6000 young people in Stockport were expected to have a mental health need, with the highest prevalence of disorders amongst boys.

·         The greater prevalence of mental health disorders was amongst older children, and the disorders often changed over time. The higher prevalence amongst older children may be due in part to different approaches to behaviour in primary and secondary schools.

·         There was no clear evidence that focussing resources on early years would prevent demand later in adolescence, although there may be benefit in targeting resources at under-5s with attachment issues. There were discussions taking place between partners on developing an attachment service.

·         Was children’s mental health sufficiently embedded within the neighbourhood management approach to tackling inequalities? Was the focus of work through Children’s Centres on parenting contributing to mental wellbeing? There was insufficient evidence at this stage. It may be that interventions skewed toward making children ‘ready to learn’ may not be addressing mental wellbeing adequately. It was important to ensure all partners and deliverers of services made mental health and wellbeing ‘their business’. Linking specialist mental health services into local service delivery mechanisms would assist with this.

·         There was not always a clear link between deprivation and children/ adolescent mental health disorders.

·         There was a gender bias in favour of females in respect of eating disorders although there were an increasing number of younger boys presenting.

·         Referrals were fewer from those from ethnic minority groups, although the scale of the issue was difficult to quantify. The lower rates may be because differing social groups managed problems differently, or it may be due to stigma. The Pennine Care NHS Foundation Trust had undertaken work to try to address possible stigma concerns amongst specific ethnic groups within its footprint.

RESOLVED – (1) That the report be noted.

(2) That the Democratic Services Manager be requested to invite a representative of Beacon Counselling to the next meeting of the CAMHS Review to discuss their work in schools.

To consider a report of the Joint Commissioning Manager.

This report presents some information about the need for CAMHS in Stockport and the current provision and highlights the challenges in ensuring universal access.

A report of the Joint Commissioning Manager (Children and Young People) was submitted (copies of which had been circulated) providing some additional statistical information requested by the Committee, information about the need for CAMHS in the Stockport, the current provision and particular challenges in ensuring universal access.

Alison Caven (Joint Commissioning Manager, Children and Young People, Stockport CCG), Dr Prathiba Chitsabesan (Consultant Child and Adolescent Psychiatrist, Pennine Care NHS Foundation Trust), Gina Evans (Joint Commissioning Lead, Mental Health, Stockport CCG), Donna Sager (Service Director (Commissioning & Transformation), Stockport Council) and Duncan Weldrake (Public Health Specialist, Stockport Council) attended the meeting to answer councillors’ questions.

Councillors asked questions and made comments on the information contacted in the report. The following issues were raised:-

·         A number of service users with Tier 4 conditions were being managed as part of Tier 3 Services as this often involved less severe interventions. There were a number of pathways in Tier 3 that were home-based/  non-in patient treatments.

·         Members expressed surprise at the numbers of referrals being made. In response it was stated that this partly reflected increased interventions and early identification. There had been a significant increase in diagnosis of neuro-developmental disorders (including ADHD, autism, Tourette’s syndrome). This in part reflected increasingly early interventions and identification, and parents who were increasingly willing to champion take-up of services. The additional pressures on services through greater referrals did not necessarily reflect increasing prevalence but may be because of increased awareness. The discrepancy between expected prevalence and referral should be explored further.

·         There was significant pressure on services to assess autistic spectrum disorders where assessments were taking up to 20 hours. There were a number of contributing factors, including a high number of repeat referrals because of continued concerns, despite no diagnosis. Compared to other local authorities, Stockport did not have a stringent referral threshold so there were significant numbers of referrals across the spectrum, many of which do not meet the diagnostic threshold and so could not access services they might need. Services were provided to meet a diagnosis, not need. Many of the most important interventions were not specialist mental health services but were needed long term from a range of partners. These services needed to be delivered in more co-ordinated and cost effective ways to ensure sustainability and improved outcomes.

·         Parents and carers often provided significant challenge to negative diagnoses, which accounted for many of the repeat referrals. In some cases a diagnosis of a learning disability was preferred by parents rather than the stigma associated with a mental ill-health diagnosis.

·         Where referrals did not meet the diagnostic criteria, parents would be advised to adopt some of the strategies and elements of the pathway (excluding medication), but there was often a reluctance or difficulties on the part of schools to commit resources to these interventions without a diagnosis. The Parenting Service also provided support in trying to resolve care issues.

·         Stockport had the highest level of special educational need statements in Greater Manchester, but changes to the schools funding regime would replace this with the introduction of High Needs Funding. These changes would relieve pressures on some services involved in supporting the statementing process, but was likely to cause confusion in the short term.

·         There was already work underway to address the problems with the autistic spectrum disorder assessments to streamline the process and reduce the time taken through the introduction of guidelines etc.

The Chair invited professionals and officers to identify those areas where improvements in service configuration and delivery would have the greatest impact on outcomes. In response, it was stated that integration of Tier 2 and 3 services into a single service would provide greater flexibility in delivery to make it more responsive to need, although there remained difficulties in achieving this because of clinical governance concerns.

It was also stated that a greater promotion of mental wellbeing  ...  view the full minutes text for item 4.