Crisis Care for Children and Young People Sue Jennings and Steve Ryan on behalf of the HLP Children and Young Peoples Mental Health Programme

Alignment needs of children and young people with adults 2 Some things about the care of children and young people need to be considered in the same way and at the same time as for adults:  Parity of esteem  Access – timeliness, locality and community, expertise (including HBPoS and Tier 4 beds)  Respect – choice/options  Vulnerabilities – LD/ASD, offenders/gangs  The London Mental Health Crisis Commissioning Standards Half of all mental health problems in adults commence before 14 years, three- quarters by 18 years. At any one time 1 in 10 have a diagnosable mental health disorder and up to 1 in 12 will self harm Of those who self harm – one-half lost-to-follow-up and one quarter of these do not adhere to treatment

Where children and young people’s needs are different 3 Developmental status with its physical and psychological dimensions Legal and statutory considerations and obligations of the state defined by age and psychological maturity Families and school education are typical Inherent vulnerability and safeguarding (e.g. looked after children) Young people are exceptionally digitally aware and capable The relative numbers of presentations of crisis are smaller and the case-mix is different (lower use of Health- based Place of Safety) Imminently CYP being detained by Police on section 136 to be a never event

Issues we face 4  Health-based Places of Safety – very variable disposition by sector and access for children and young people variable  CAMHS professionals are a much smaller workforce and cannot provide direct comprehensive round the clock liaison care as currently constituted  Lack of clear policies and procedures in acute hospitals in placing children and young people if they need inpatient medical/mental health care  As for adults - transience, multiculturalism, unaccompanied minors, refugees and asylum seekers  Hospital admissions higher than England Average but admissions for self harm significantly lower and both appear to vary at least 4-fold across London – reasons being unclear

Our transformation recommendations for “in hours” care 5  Measure, understand and deal with variability  Local and timely – but we didn’t say how  Make use of London Ambulance Service Hub for guidance and triage  Education of the workforce  Sustainable collaborative (Strategic Planning Group) models of delivery  Universal and accessible safety and coping plans  Effective information sharing and access  Co-design  Recommendations on transition to adulthood

Opportunities 6 Voluntary sector Schools MH/Education pilots in schools National work: RCPsyc National Collaborating Centre Sustainability and Transformation Planning This summit Outreach models 3.5 Bexley INTERACT NE London model

Plans 7 Explicitly addressing of needs of children and young peoples in developing Health- based place of safety specifications. Ensuring that needs of children and young people are adopted into London Mental Health Crisis Commissioning Standards and use the same framework to shape progress:  Clarity and awareness of standard  Commissioning to standard  Workforce development  Behaviours and culture

Information held in silos and unavailable when needed Lack of interoperability Information governance and consent Lack of directory of services NHS Mental Health Ambulance A child or young person presents in mental health crisis Crisis plan & ongoing support in place towards recovery, preventing admission Police 111 CAMHS community care/outpatients Local authority care or accommodation/ care house Age appropriate adult medical ward/paediatric medical ward CAMHS inpatient psychiatric admission MH Act assessment in ED Further assessment and investigation (e.g. social, medical tests) Voluntary sector Mental Health Crisis Care 24 hour Emergency Department (ED) Pathway for Children & Young People Primary care 8 NHS care Primary Secondary ED LA social care Access available multiagency information relating to patient and services available Is there a patient-acceptable accessible, relevant, achievable safety and coping, diversion or referral plan? Y Y Are relevant professionals identifiable& contactable who can agree a safe plan and place of care not requiring the ED & acceptable to the CYP ? Non-ED crisis care/safety and coping plan Y Y N N N N On Section 136 of MHA? N N Y Y HBPoS for CYP HBPoS for CYP ED; risk assessment at triage then on-going; physical and mental health assessment in < 4hr ED; risk assessment at triage then on-going; physical and mental health assessment in < 4hr Interoperability roadmaps 111 and LAS MH clinical advice Co-ordinate my care MiDoS Lack of CAMHS professionals 24/7 Lack of directory of services and protocols Poor staff knowledge and training Waiting for RMN or HCA CAMHS emergency networks at U&E care network level MiDoS Telemedicine Staff think persons brought by police are offenders Police can be turned away from 1 st point of call Few designated HBPoS for CYP Lack of CAMHS staff and AMP OOH Poor ED staff attitude to MH and self-harm Transport issues Lack of knowledge and guidance for onward care Disputes and refusal on inpatient placement in hospital Education and training and good interagency liaison MDT Incident review Plans and SOPs in place for contingency Standards for ED and HBPoS Live bed board and MH crisis care network London Acute Care Standards for CYP Issues Possible solutions Quality and governance framework