Herefordshire CAMHS Dr Clair ire Middle dle Lead Psychologist - - PowerPoint PPT Presentation

Children and Young People’s Mental Health

Herefordshire CAMHS

Dr Clair ire Middle dle

Lead Psychologist Hereford CAMHS

1. What percentage of young people in this country has a diagnosable mental health condition? 2. What percentage of adolescents experience a mental health problem in any given year? 3. What percentage of mental health problems are established by age 14? 4. What percentage of mental health problems are established by age 24?. 5. How many times more likely are children with behavioural disorders i) to be dependent on drugs ii) to die before the age of 30 iii) end up in prison.

quiz

What are we talking about?

• 1 in 10 children in this country has a diagnosable

mental health condition.

• 20% of adolescents may experience a mental health

problem in any given year.

• 50% of mental health problems are established by

age 14 and 75% by age 24.

• The long-term effects can be crippling:

children with behavioural disorders are 4 times more likely to be dependent on drugs, 6 times more likely to die before the age of 30, and 20 times more likely to end up in prison.

Local

If one in ten children in this county has a diagnosable mental health condition, that’s 3,170 under 16 year olds If add the number of children and young people with poor emotional resilience, this is estimated to increase to 8,620 children and young people.

How do we understand children’s mental health Children mental health has to be understood in the context of systems they live in

(Bronfenbrenner 1979)

Effects of context and environment

• Children are powerless to change their context

and environment.

• The Adverse Childhood Experiences Research

brings this into sharp relief

Adverse Childhood Experiences (ACEs)

• Trauma is not just those obvious and serious

trauma

• Trauma is subjected – based in the meaning

and experience of the person

• We know reactions to trauma are individual

influenced by previous experiences, resilience and support available

Rethinking trauma

Adverse Childhood Experiences (ACEs)

How do ACEs Affect Health? Through stress:

Frequent or prolonged exposure to ACEs can create toxic stress which can damage the developing brain

• f a child and

affect overall health.

We are the sum of what we have experienced

Trauma Loss Neglect Inconsistency Deprivation Low self esteem Poor attention Shame Poor identity formation Unable to trust Hitting out Controlling behaviours Seeking reassurance Sabotage Isolation Dependency

Effects of toxic stress

Adverse Childhood Experiences (ACEs)

Strategy

Future in Mind (2015) set out guidance for improvements in mental health services for children and young people Under the Children and Young People’s Partnership for the county, there is a Children and Young People’s Mental Health Partnership.

P.S. In 2015/16, this plan was rated as in the top 20 (out of 121 plans) in England.

• Heavily influenced by ‘adult mental health’
• Leads to a ‘within child’ model
• Activity is measured by direct contacts
• Administration is organised around a ‘named

child’

• Evidence base organised around ‘disorders’

located within the individual (Nice Guidelines)

• Medication entirely locates the problem within

the child

• Expectation to ‘fix’ the child is pervasive

Outdated models of children’s mental health?

The Adverse Childhood Experiences Research seriously challenges this –as it clearly demonstrates that life experiences and physical and mental health are inextricably linked

With-in child model

‘Tier’ system

We formulate what may be contributing to the difficulties and try and intervene accordingly - but the pressure to work primarily with the individual child is everywhere.

How do we understand children’s mental health in CAMHS?

FAMILY SCHOOL COMMUNITY SOCIETY CHILD

Psychological Formulation

• Services are designed in such a way that they

don’t meet the needs of all

• The more severe the ACEs, the less appropriate

traditional services are

• Parent’s and children are can feel ‘blamed’ for

‘failure to engage’

• Mental Health professionals are measured on

‘outcomes’ and so feel like they are failing when children don’t ‘fit’ the service

• Resources are put into turning away

‘inappropriate referrals’

One size doesn’t fit all?

Costs and use of resources

• We rely on the information from referrers,

families, schools to determine this

• We seek to ensure that we accurately

understand the difficulties to the best of our abilities

• We want to avoid unhelpful, inaccurate

diagnoses and focus on children’s strengths and resources

Giving children the right help, at the right time, in the right place

Consequences of abuse and neglect

In severe cases of abuse and neglect ‘symptoms

• f disorder’ and ‘signals of distress’ are

indistinguishable Romanian Orphanage Studies (1990’s)

Is it helpful to label a child with ADHD when their behaviour is in response to their environment, yet they present in the same way . Elspeth Webb (2014)

Behaviour and ADHD

Based on the evidence that brain development and environment are inextricably linked Starts from the view that signs of distress in children are signs that something is wrong in the environment NOT that something is wrong in the child.

New models of children’s mental health

27

Source: Future in Mind Overview by 2020

Key Areas of transformation

Improved crisis care right place, right time, close to home Improved transparency & accountability across whole system A better offer for the most vulnerable children & young people Improved public awareness, less fear, stigma & discrimination Timely access to clinically support More evidenced-based

• utcomes focussed

treatments More visible & accessible support Professionals who work with CYP trained in child development & MH Model built around the needs of CYP, and move away from the tiers model Improved access for parents to evidence-based programmes of intervention & support

• Give message that distress is not a sign of

disorder but rather a signal to the world that all is not right somewhere in their world

• Let the adults in their lives make changes

before a decision is made whether the child would benefit from therapy

• De-stigmatise mental health
• Offer intervention where it seems helpful

How are CAMHS raising to the challenge?

• Family/systemic based approach
• More training offered by CAMHS to our

partners

• More consultation offered to adults caring

for/supporting children

• Development of specialist services addressing

key mental health needs

How are we doing this?

Research shows that schools who are understanding of children’s emotional and attachment needs are able to:

• Raise attainment
• Make less use of exclusions
• Lower the number of recorded behaviour incidents
• Improve children’s life chances
• Improve staff wellbeing and confidence (including in adult self-

regulation)

Training: Being attachment aware

Local Performance

• Waiting times: CAMHS

is contracted to see CYP in under 4 weeks from referral to assessment; 18 weeks from referral to treatment.

• Most CYP are seen

within 4 weeks for an assessment but can be seen on the same day if the referral is urgent.

• 75%+ of CYP receive

treatment within 10 weeks of referral.

Local Performance

Hereford CAMHS ‘benchmarks’ performance against national services and near neighbours (in terms of geography and also those who deliver services in similar rural localities). Regionally and nationally, Hereford CAMHS performs highly regarding access and waiting times.

What’s new? Eating Disorders Team

New monies have enabled us to develop an Eating Disorders Team. We have 1.6 WTE staff to:

• Assess and treat CYP with Eating Disorders,
• Support the wider CYP workforce to develop skills to feel

confident in identifying eating disorders in CYP, how to refer to Hereford CAMHS and how to support CYP while they are receiving treatment. There are national targets attached to this – in urgent cases, CYP must receive treatment within 7 days of referral, and in routine cases, treatment must start within 28 days of referral.

What’s new? CAMHS Duty Team

Our duty team can be contacted on 01432 842233 to discuss any concerns you have about a CYP’s mental health. They can provide general advice, signposting suggestions and information about making a referral. They can be contacted for urgent advice when you are concerned that a CYP may be at significant risk of harm to themselves or

• thers related to mental ill health. They will advise you if

they think you need to contact MASH. Where a person has suicidal ideas and/or a suicide plan, contact the CAMHS duty team on 01432 842233.

• Case consultation & supervision to social care

teams, Youth Justice Team, Children’s Ward to support carers and professionals meet young people’s emotional and psychological needs

• Improving access worker – offering specialist

assessments and advice for young people where a clinic based model is unlikely to be helpful

New posts:

Referral Criteria

Hereford CAMHS will accept referrals from professionals, for CYP up to age of 18, with and without a diagnosed learning disability, experiencing moderate to severe mental ill health

• r distress and where interventions at Tiers 1 and 2

have been tried but have not resolved the issues. Where a person has suicidal ideas and/or a suicide plan, contact the CAMHS duty team on 01432 842233.

Referral Criteria

Referrals that are unlikely to be accepted for CAMHS or CAMHS LD Children and young people who display inappropriate or challenging behaviour in school and who have not received input from any relevant educational support services Children and young people whose behaviour, although challenging, is age appropriate, for example, tantrums in 3 year olds Children and young people with behavioural problems in the context of inconsistent parenting without previous parenting support being offered and accessed, and in the context of a child or young person not having a mental health difficulty.

Referral Criteria

Referrals that are unlikely to be accepted for CAMHS or CAMHS LD Children and young people where behaviour problems are primarily home based, and have not had any input from other services e.g. Social Services, Parenting, Children’s Centres etc Children and young people with Autism who do not have mental health problems Children and young people whose problems are primarily school based (Educational Psychologists and Learning and Behavioural Support Services should be contacted in the first instance) Children and young people who only require provision of continence products Children and young people who only have physical health problems

Referral Criteria

School Refusal/Separation Anxiety Disorder Schools should access Educational Psychologists and Behavioural Support Services prior to referral. A summary of the schools’ involvement and action taken is essential prior to a referral. CAMHS does not accept referrals for short term non- attendance at school. Please refer only when the following conditions apply:

• When there is severe difficulty in the child attending school, often amounting

to a prolonged absence and in the context of problems other than just parenting

• When the child experiences severe emotional upset when faced with the

prospect of attending school. This may be demonstrated by excessive fearfulness, anxiety, temper, misery and complaints of feeling unwell without any physical cause

• When an underlying mental health problem is suspected.

Referral Criteria

Neurodevelopmental Difficulties (including ADHD and ASC) This group of children should have already received assessment, advice and some management from Tier 1 & 2 and/or Community Paediatrics prior to referral to Specialist CAMHS.

• Difficulties should have significant and longstanding and impact on daily living
• Should be present in more than one setting
• We will consider alterative explanations of the difficulties, i.e. effects of

developmental trauma, parenting etc

Referral Criteria

Depression/anxiety/post traumatic stress/obsessive compulsive disorder

• Those who have not responded to interventions in Tier 1 or Tier 2 (The CLD

Trust) after 2-3 months

• Where risk is a concern, self-harm, suicide, exploitation by others
• High levels of complexity indicating a complex care plan involved multiple

professionals

Referrals to CAMHS LD

Developmental and Learning Disabilities It is preferable that the child receive an assessment from a Community Paediatrician prior to a referral to CAMHS LD. The reasons for a referral to CAMHS LD may include:

• Significant difficulties with the CYP’s behaviour at home
• Unusual or very fixed interests and bizarre or unusual behaviours
• Reduced capacity to cope with the demands of everyday life, including

transitioning through adolescence and puberty.

• Marked preference for routine and difficulties adapting to change

Referrals to CAMHS LD

• Behaviour arising from developmental problems that challenges their

relationship with parents/carers

• Interpersonal difficulties (i.e. building and maintaining relationships) within the

family unit

• Children with significant attachment needs (including high levels of controlling

behaviour)

• Children who have experienced abuse and / or neglect
• Children who are struggling to adjust to being in the Looked After Care system

Referrals to Hereford CAMHS 2015/16 2016/17 2017/18

1075 1110 1129

3% increase on previous year 1.7% increase on previous year

Future CAMHS

• new developments

Green Paper

A Green Paper on children's mental health provision was published in December 2017.

• A mental health lead in every school and college
• Mental Health Support Teams working with schools

and colleges

• Shorter waiting times
• Improved mental health services for YP aged 16-25
• Improving understanding of mental health

https://www.gov.uk/government/consultations/transforming-children-and- young-peoples-mental-health-provision-a-green-paper

Until then….

• Increased collaborative work with schools
• Offering training, advice, consultation
• Recognising that children’s mental health is

inexplicably links to their context and environment and we all can contribute to this