Agenda item

To consider an information note of the Joint Commissioning Manager and CAMHS Co-ordinator.

The attached information note provides the Scrutiny Committee with background information to inform their discussions on mental health service provision for 16-18 year olds. The report also identifies gaps in service and opportunities for improvement.

A joint report of the CAMHS Commissioning Manager and the CAMHS Co-ordinator was submitted (copies of which had been circulated) detailing provision of Mental Health Services in Stockport for 16-17 year olds, identifying gaps/shortfalls in service and opportunities for service improvement. The report also detailed information on service provision from partner organisations.

Alison Caven (Joint Commissioning Manager, Children and Young People, Stockport CCG), Mark Chidgey (Director of Provider Management, Stockport CCG), Gina Evans (Joint Commissioning Lead, Mental Health, Stockport CCG), Dr Heinke Otto (Consultant Adolescent Psychiatrist, Pennine Care NHS Foundation Trust) and Donna Sager (Service Director (Commissioning & Transformation), Stockport Council) attended the meeting to answer councillors’ questions.

The following issues were highlighted:-

·         Difficulties for 16+ who were no longer able to access tier 2 school based services trying to access adult services.

·         Lack of community based services for those stepping down from tier 3.

·         Difficulties in responding to the volume of referrals to Central Youth.

·         For those with Learning Disabilities, the age range covered was only up to 16. Those with neurological issues were becoming increasingly prevalent within the service.

·         In relation to care leavers, the KITE service was only provided up to 18, although mental and emotional vulnerability may continue well beyond this.

·         Unlike adult mental health services, the criteria of risk assessment for children was not as robust so where a young person had a diagnosis of a mild condition they may nonetheless be at high risk of harm as conditions may escalate quickly.

·         Fragmentation of services was more pronounced in children’s services. There were often a range of smaller, specialist services being provided but changes in need would mean a referral to a further service and the disengagement by a young person. A more integrated, centralised service may be beneficial in reducing this problem.

·         Young people’s mental health problems were often caused by vulnerability factors rather than medical conditions, which was often the case with adults. This meant that diagnoses were less stable and support more complicated to provide.

Members asked a number of questions and made comments in respect of the following:-

·         The idea of a centralise hub for service users to reduce the number of referrals between smaller, specialist services. There was a danger that smaller teams were more protective of their resources and referrals. It was acknowledged that there was already a single point of referral into the system that was managed by the Pennine Care NHS Foundation Trust.

·         The different age threshold for service users was a cause of concern, and wherever possible this should be standardised to 18. This would then help improve transition from children’s to adult services which could be complemented through more centralised and co-ordinated provision.

·         Services would often continue to see users even if their problems changed rather than risk them being lost to a service and not getting support. However, this created problems with service capacity.

·         Diagnosis of mental health problems in adolescence was problematic as was often socially caused and linked to a traumatic episode. Early intervention in these circumstances was important. Those with mild to moderate conditions can often cope with their problems while at school because of the more structured environment but their conditions can escalate on the transition to college etc.

·         There was often a greater prevalence of mental health problems for people with learning disabilities. There was an upward trend and the interventions required were becoming increasing significant, often being pharmaceutical. In many cases these young people would be identifiable through the SEND register.

·         A number of schools in Stockport bought in services from Beacon Counselling. Statutory partners were very supportive of and encouraged this kind of 3^rd sector activity. Many colleges also made provision, but there was no way to ensure this happened in all settings.

·         There was no nationally targeted resource to support young people during the transition from one educational setting to another (secondary to college etc.), and support mechanisms such as Team Around the Child (TAC) would also cease when the pupil left school.

·         Does the currently model of service delivery for young people best meet their needs and engage them, i.e., a professional in a room talking to a young person? Would a mobile phone app be more appropriate?

RESOLVED – (1) That the report be noted and those involved in the discussion be thanked for their attendance and presentation.

(2) That the CAMHS Commissioning Manager be requested to provide an additional report to the next meeting including:-

·         further statistical information about the number of services users, age and gender profiles etc.;

·         the number of self-referrals made to Central Youth; and

·         details of which services were jointly funded by the Council and NHS bodies.