Hillingdon CAMHS Local Transformation Steven Vaughan-Smith, Pranay Chakravorti and Kuda Chiweda 08th December 2016

Needs Assessment 75% of all Adult mental health issues ( excluding Dementia) start before the age of 18 years Nationally 6% of the MH budget is spent on CAMHS 1 in 10 of u18s have a MH issue Anorexia has the highest mortality rate of any psychiatric disorder, from medical complications associated with the illness as well as suicide. Research has found that 20% of anorexia sufferers will die prematurely from their illness. CNWL, who provides specialist CAMHS services in Hillingdon receive 70% of referrals from GPs, with other sources including A&E, Child Health, Local Authority and other Mental Health Trusts. The CAMHS caseload in Hillingdon increased during 2014/5 so that at the end of the year was around a third bigger than it was at the start of the year. This reflects the increased awareness of mental health, increased complexity. The most significant rise in referrals has been for those children and young people with issues of deliberate self harm.  

Five year CAMHS Transformation In November 2014 Norman Lamb MP Care Minister set up a Taskforce to review CAMHS given the number of issues raised in terms of length of waits for treatments and the number of CYPs placed in inpatients around the country. He concluded…“isn’t just about funding. What is needed is a fundamental shift in culture. A whole system approach is needed focusing on prevention of mental ill health, early intervention and recovery. We owe this to young people. It is with their future in mind that we must all commit to, and invest in this challenge.” June 2015 In March the Government announced £250M , for 5 years to transform CAMHS so that by 2020 more CYPs would receive evidence based treatment . Hillingdon has received £611k for CAMHS Transformation funding (Eating Disorders, Out Of Hours, Crisis, Self Harm and Learning Disabilities.

CAMHS current Model

Proposed New THRIVE Model Shift resources in lower quadrants to the upper quadrants to ensure support whilst waiting for treatment and post treatment

Hillingdon CAMHS 5 year Transformation plan Increased co-production Move from Stepped care Model to the THRIVE Model- developing pathways such as LD/MH/ASD; Self Harm, Crisis and Intensive Increase in Evidence based therapies Increase in early intervention and help for all ages from Oct 2016 Targeted support to Vulnerable groups Increased support/joint working with Schools Reduction in inpatient care

Proposed New Projects, using NHSE funding Developing Outcomes based services (revision of service specification) Ensuring the service pathways are communicate to the children, young peoples and families and Children’s workforce in Hillingdon Reducing the waiting times for CAMH Service Evaluation of Self Harm, Crisis and Intensive support service Evaluation of comprehensive LD service for children with mental health, challenging behaviour and autism Evaluation of a Community Eating Disorder service Understanding the role of Schools/College in emotional well-being and commissioning services such as counselling Development of primary CAMHS for non MH specialist staff (2017/18) Development of MH training for the Children’s workforce (2017/18) Introducing co-production including parents and carers (January – March 2017) Sign off the Hillingdon Autism Strategy

Hillingdon Perinatal Services In early 2015 HCCG commissioned a Perinatal Service from CNWL : 0.4 Specialist Psychiatrist 1.0 Specialist CPN (Band 7) 0.5 Psychologist Band 7 & IAPT To provide : specialist psychiatric review and case management for women at risk of developing moderate-severe mental disorder during the perinatal period To provide some additional specialist psychology capacity to treat women post natal To provide specialist leadership through training, providing support and consultation to primary care, adult mental health services and maternity services

NHSE Proposed Perinatal Service NHSE (Adults) awarded £2m across NW London developing Access & Waiting Time Targets, additional funding Revised Model to be up and running by March 2017

Next Steps LBH and HCCG to jointly commission a pathway without tiers, focusses on treating children and young people in the right place at the right time which: Promotes prevention and early intervention Improves access to effective support Provides smooth care pathways at pre-crisis and crisis points and avoids unnecessary admissions to inpatients care Delivers step down alongside inpatient provision Introduce a single point of access in April 2017