3 There are significant benefits from early intervention Early intervention saves money. These programmes return many £s for each £1 spent on the intervention: Social emotional programmes to prevent conduct disorder – £84 saved Bullying prevention – £14 saved Parenting interventions for children with conduct disorder – £8 saved Early intervention for the stage which precedes psychosis (Clinical High Risk State) – £10 saved
4 Key issues facing the system Access to existing services or lack of existing services –Acceptability and stigma –Visibility of services –Capacity Inappropriate and varying referral thresholds Transition from CAMHS whether to AMHS or other services Lack of data – paucity of current data, no CAMHS Minimum dataset flowing centrally (although funding secured to commence prevalence survey) Risk of perverse incentives Divestment in services puts pressures on a system which already fails to reach all of those who need it
5 Evidence of disinvestment CYP IAPT partnerships are reporting: Some areas have experienced disinvestment by the local authority, which will have a significant impact on service delivery. Significant cost improvement (i.e. efficiency) plans e.g. 14% by Trusts in some areas in addition to Local Authority disinvestment Cuts in staff or reduction in numbers of experienced staff and replacing with more junior staff. Rising numbers of routine and emergency presentations
6 Some young people can’t access treatment CYP IAPT will be transforming CAMHS services covering 68% of 0-19 population by 2015, but there will still some way to go. Disinvestment in mental health services for children and young people is making it hard for existing and future CYP IAPT sites to train staff, and to retain existing staff. There is strong anecdotal evidence that referral thresholds across England are varied, and some are inappropriate (i.e. restrictive diagnostic criteria).
7 CYP mental health has risen up the agenda Health Select Committee Inquiry NHS England review of Tier 4 services CMO’s Annual Report – Public Mental Health Priorities: Investing in the Evidence Commissioning of new prevalence survey Development of MindEd portal £150m investment in eating disorders and self-harm announced as part of Autumn Statement
8 Children and Young People’s Mental Health and Well-Being Taskforce Announced in August 2014 Co-chaired by Jon Rouse, Department of Health and Martin McShane, NHS England Brings together experts on children and young people’s mental health and those with knowledge of wider system transformation. Cross sector membership including education, social care and health. Will identify actions to help increase joined up working across the system and improve outcomes for children and young people’s mental health. Will involve the key national organisations accountable for policy, commissioning and delivery of services. Will report in Spring 2015
9 The Taskforce set six priorities Everyone in the system should be able to access the best possible information Defining what a great local offer looks like How to create and sustain a co-ordinated local system Ensuring high quality and safe provision and the role that standards and regulation play Addressing capability and capacity and making best use of whatever resources are available Normalising access to support and treatment enabling young people to achieve meaningful outcomes – to fulfil ambitions and pursue prospects
10 The Taskforce will work through four Task and Finish Groups Taskforce Task and Finish Groups Group 1: Data and standards: the information to underpin decision making within the system and to drive up the quality of provision. Group 2: Prevention and access: Identifying the offer to children and young people across the education and care pathway Group 3: A co- ordinated system: sectors working together to commission and deliver services which meet the needs of young people across the care pathway. Group 4: Vulnerable groups and inequalities: a system which works for our most vulnerable children and young people.
12 Data and standards The group is considering : A shared set of core principles aligned with the CYP IAPT quality framework that underpins the CAMHS service transformation programme (outcomes focused, accessible services built around the needs of CYP and based on best evidence) A child mental health infrastructure with data and payment sysems, outcome measures, service standards and regulatory frameworks that align across the whole system – NHS, public health, social care and education to drive quality improvement in line with these shared core principles
13 Prevention and access The group is considering: role of early years services, schools, GPs and other universal services in supporting prevention and early identification how to improve communication and referral routes between universal and specialist services – with clear pathways the benefits of a range of service models to improve integration and access and overcome stigma, including ‘one stop shops’ and digital access improvements to crisis care and avoiding unnecessary use of in- patient provision through improving community provision how the children and young people’s workforces can be supported to deliver real change
14 A co-ordinated system Ways in which sectors should work together to commission and deliver services to meet the needs of young people across the care pathway And identifying the system levers which will enable change to take place Joint commissioning across sectors Funding and investment, including pooling of budgets Remodelling the Tiers system, greater clarity of roles and responsibilities Increased accountability/ownership of shared outcomes Stronger evidence base and more accessible information to support commissioning decisions
15 Vulnerable groups and inequalities Many vulnerable groups (e.g. those in youth justice system, adopted, looked after children, learning disabled). Difficulty in accessing services Some services use strict diagnostic criteria which don’t apply to all vulnerable groups Lack of joined up commissioning – how can we overcome this? How can we encourage better information sharing between agencies?
16 The Taskforce is setting up pilots to identify good practice Collaborative commissioning pilots Local areas were invited to submit proposals outlining how they might go further with collaborative joint commissioning arrangements for children’s mental health services. Successful proposals to be announced shortly. We will identify existing good practice and emerging thinking from the pilots to inform the Taskforce report.
17 And learning from experts (inc. experts by experience) Cross-sector membership, including experts by experience Additional engagement of children, young people, families Additional engagement of professionals from across a variety of sectors working with children and young people Seeking views in a variety of ways – using face-to-face, digital, print media etc.
18 Especially children and young people Recognise importance of UN Convention on the Rights of the Child Children and young people have views and experiences to share which will help improve what matters most to them. We need to go to them and ensure they know what’s changed as a result of their input We have signed a contract with Young Minds to seek these views, and those of family members. They are conducting a large scale digital survey and running focus groups. Young people’s views will then become a central part informing the recommendations of the Taskforce.
19 The Taskforce will make a difference This is the first time we have looked at the whole system, working closely with NHS England The timing is right to influence the next Spending Review, and to take advantage of the new Government in May 2015 The Taskforce is focused on solutions
20 There are lots of ways to get involved with the Taskforce For queries or problems, please contact CYPMHTaskforce@dh.gsi.gov.uk. Follow the latest Taskforce news, and feed in your views, on Twitter using #CYPMHTaskforce or #youngmentalhealth. More information on the Taskforce and the Task and Finish Groups can be found here: https://www.gov.uk/government/groups/children-and- young-peoples-mental-health-and-well-being-taskforcehttps://www.gov.uk/government/groups/children-and- young-peoples-mental-health-and-well-being-taskforce Survey for professionals: https://www.gov.uk/government/consultations/improving-children-and- young-peoples-mental-health-services https://www.gov.uk/government/consultations/improving-children-and- young-peoples-mental-health-services Survey for children and young people: https://www.surveymonkey.com/s/cytaskforce https://www.surveymonkey.com/s/cytaskforce Survey for parents and carers: https://www.surveymonkey.com/s/parenttaskforce https://www.surveymonkey.com/s/parenttaskforce