CYP MH Workforce and Priorities SW CYP MH Clinical Network July 2018

Dr Christine Curle Clinical Lead, SW CYP MH CN

Govt. commitment following 5YFV is to: Improved access to services at an earlier stage: 70,000 C&YPs gaining access to EBP interventions with focus on prevention and wellbeing Services accessible at the right time:7 days a week, 24 hours a day when needed. ‘No one experiencing a MH crisis is turned away. Services delivered in a more integrated way: eg more MH services in physical health settings. Embedding MH services into the NHS: Better data, right workforce, investment in research & leadership to deliver best outcomes.

The CAMHS context 70,000 additional CYPs with diagnosable mental health need to be seen by 2020/21. Access and wait times – 1 week for CYPs with an urgent eating disorder, 4 weeks for routine. CYPs on the EIP pathway will be seen within 2 weeks of referral for NICE approved package of care. Referral rates to Tier 3 CAMHS have increased greatly in recent years, with the number of cases rising by more than 40% between 2003 and 2009/10. (Joint Commissioning Panel for MH, 2011) CAMHS demonstrated an increase in demand for services (2.5% in 2015/16 but likely to be significantly higher in subsequent years) (NHS Benchmarking, 2017)

Transformational Change in CAMHS Imposed change – emotional and physical impact on workforce. CYP IAPT – culture change Training in evidence based practice Using Routine Outcome Monitoring, Routine Experience Monitoring Working with users of services as collaborators in their Care Data, data, data – increased scrutiny and assurance. New staff – Target to have additional 1,700 new staff in CAMHS by 2020/21

The nature of the job: Service pressures - Working with increasing numbers of self-harming and suicidal young people. Holding increasing levels of risk in the community. Expectation of 24/7 service. On-call out of hours in addition to 9-5. Insufficient in-patient beds of the right type or number in region to meet needs currently.

The nature of the job. Working with children and young people who have been sexually/physically/emotionally abused. Increasing demand for services for emotionally dysregulated, anxious or depressed children and young people Increasing demand to work with children and young people with complex co-morbid conditions such as mental health difficulties and autistic spectrum disorder Working with children and young people in relation to their behaviour/emotional health means working with complex systems including parents/education/social care and possibly acute services

“Suicide is the second leading cause of death in children and adolescents and occurs at higher rate in this population than any other age group.” Edwards, J.K., 2018

All our staff need to be: Highly skilled in partnership working, integrated care and co-production with those who access MH services and their carers Technologically adept Values-driven Able to provide physical as well as MH care. Able to innovate Able to develop their skills, knowledge and competencies to reflect the changing outcomes required.

The sheer scale and complexity of the service wide growth and transformation needed will require: Aligned actions from Providers Commissioners Local government Third sector partners Support from HEE and ALBs

Where are we now? For all age MH services, the NHS funds 214,000 specialist MH posts in England of which 20,000 are vacant filled by agency or bank staff, with significant geographical and service specific variations. Data on attrition suggests that the NHS loses 10,000 MH staff each year (10.5% in 2012/13; 13.6% 2015/16 cf 8.6% in physical care). Given the existing vacancy rate (for MH nurses) and the wider factors that may influence supply, it is imperative that we do all we can to understand the causes of attrition and turnover and take urgent steps (nationally and locally) to address them.

Where are we now? Psychiatry is under pressure from the need to rapidly expand services, a high attrition rate and the early retirement effect from the MHO scheme. 5YFV for Mental Health requires significant expansion of the psychology and psychological therapies workforce to deliver greater access to psychological healthcare. This includes all work streams, but particularly Children and Young Peoples’ MH. As part of the workforce plan HEE will seek to improve available data on the non-NHS workforce

The challenge The NHS employs over 1.3m people and should be an exemplar in creating a mentally healthy workplace: reducing stress and improving wellbeing, supporting staff who develop mental health problems and welcoming them back to work when they are ready. If we are committed to improving the mental health of our staff, then we must recognise and tackle the stigma that still exists about mental illness within the NHS in general and mental health services in particular. We need to make it easier for mental health staff to ask for and receive help, and every employer should sign up to Time to Change or similar.

The Network’s Role To support commissioners and providers to develop integrated workforce plans, delivered through a process led by commissioners in partnership with service providers including NHS, voluntary sector and LA provision. achieve the Government target of 1,700 additional staff in CAMHS

‘Everything comes down to the people, both right now and in the future: we must pay attention now if we are to expect results in 10, 15, 20 years. People are long term’. (NHS leadership review: Lord Rose 2015).