Croydon Joint Strategic Needs Assessment 2012/13:Emotional health and well-being of children and young people aged 0-18 Emerging findings Kate Naish: Public Health Strategic Lead – Young People

Why this JSNA Deep Dive was chosen? Tackling mental health problems early in life can improve a wide range of outcomes. Locally -high level of need and set to increase. Key priority for Croydon, particularly CFP and Be Healthy Task Group. Limited funding/capacity within specialist services, so review of local commissioning urgently needed. Widely recognised greater focus and prioritisation needed on early intervention which is cost effective and improves quality of life.

Aim of the JSNA –Deep Dive A population approach with respect to children and young people aged 0-18 years of age. Estimate & identify level/type of mental health need amongst this age group in Croydon, including vulnerable groups. Include consideration of perinatal mental health of pregnant women and new mothers. Consider national/local policy drivers and associated evidence base used to inform local service improvements. Review current CAMHS service provision and suggest opportunities for improvement and increased early intervention. Inform future commissioning and local strategy development.

Proposed Deep Dive Framework: Introduction: background, policy context and evidence base Needs Analysis: estimated need; trend analysis and projections, need amongst vulnerable groups of CYP; perinatal mental health Local services: universal and specialist Transition Issues – CAMHS to AMHS Views of stakeholders Investment in child and adolescent mental health Recommendations

Key Facts and figures 1 in 10 children aged 5-16 years has a clinically diagnosable mental health problem. At any one time million children have a diagnosable mental health condition. Half of those with lifetime mental health illness first experience symptoms by 14 yrs old and three-quarters before mid-20s. Rates of disorder rise steeply in middle to late adolescence. Although effective treatments are available only around 25% of those that need such treatment, receive it.

Croydon’s growing population

Prevalence Estimates Table 1: Estimated children with number of disorders (2012) Table 2: Estimated number of children/young people who may experience mental health problems appropriate to a response from CAMHS (2012) CroydonPercentageNumbers Conduct Disorders5.8%3263 Emotional Disorders3.7%2082 Being Hyperactive1.5%844 Less Common disorders1.3%731 CroydonPercentageNumbers Tier 115%13427 Tier 27.0%6266 Tier 31.85%1656 Tier %67

Projected need:

Tiered - Service Models

Stakeholders involved to support the emotional health and well-being of children and young people

JSNA Data Sources Epidemiology/Quantitative Needs Assessment - National/Local picture; - Comparison with other London boroughs; - Types of emotional health disorders being presented - Variation based on age/gender/ethnicity/distinct types of young people (e.g. LAC; young offenders; disabled young people inc. LDD and ADHD, ASD etc) - Info from other local sources:  Primary care data;  Education: schools data (inc. SEN)  A & E Data  Social Care Data Croydon Community Health Services Data  CAF and FEP Data  YOS data  Perinatal Mental Health data

JSNA Data Sources Service information and analysis - Locally commissioned services (e.g. Croydon Drop –In; Off the Record, SLAM Specialist CAMHS services etc). - Service data analysis  no of referrals (age/gender etc)  annual trend analysis  waiting lists times  demand vs. capacity (unmet need) - Other services offered by other non-commissioned organisations

GP Data For the period 2007/8-2011/12, the largest numbers of specific mental health disorders diagnosed amongst children and young people aged 0-18 were in descending order - Other autistic spectrum disorder; - Disorder of speech and language development; - Attention deficit disorder; - Anxiety disorder; - Childhood conduct disorder Those disorders with the highest incidence rates per 1000 per year included: -Asperger syndrome; other disorder of psychological development and learning disability.

A & E Attendances

Post-Natal Depression: FHNA

SLAM CAMHS Specialist Services

Croydon Drop-In

Off the Record

Consultation: Consultation undertaken with wide range of children and young people, including vulnerable groups Additional consultation undertaken with Croydon social workers and SLAM CAMHS practitioners. Wider stakeholder event held 19 th September to consult multi-agency partners across LA, NHS, voluntary sector, schools/colleges, parents and carers

Consultation Groups BME young people LAC (indigenous and UASC) Young people accessing Croydon Drop-In and Talkbus Outreach services Young carers Young offenders Croydon Youth Council Wider stakeholders and parents and carers

Consultation: CYP initial analysis High levels of stigma regarding emotional health and well-being and as a result considerable fear about accessing services. Majority of those consulted had been personally affected or knew someone affected with a mental health issue Young people cited that greater awareness and information is needed in relation to emotional health and well being, as well as information about general mental health disorders. Support and support found to be generally good for those who have received it Greater provision of support services is needed in schools and colleges.

Consultation: CYP initial analysis Need to improve awareness and advertising of local services, particularly counselling services Mental health issues not routinely discussed with parents and carers and peers are generally the people, children and young people would initially approach with their worries rather than other family members. Although many young people identified they would approach their GP for advice and support with a mental health issue, few had found it easy to talk to their GP and felt that their concerns were not taken seriously. The need for young people to have someone to talk these worries through with, were a key priority either for themselves or someone else they knew.

Emerging findings Paucity and limited available data within certain key services. Lack of awareness of local services and associated referral criteria. Lengthy waiting times for certain specialist CAMHS services (e.g. ASD and ADHD) Greater need for early identification and intervention for young people with mental health issues Greater focus on child and young people focused health promotion and education around emotional health required within universal settings, particularly schools and colleges

Evolving recommendations Develop CAMHS minimum data set and improve local service based information Improve communication and awareness of the range of local CAMHS services at all Tiers and within the statutory and voluntary sector Improve and increase awareness of CAMHS protocols and care pathways for referral, support and early intervention Improve multi-agency and partnership working around this area of priority

Review and increase early intervention initiatives and support available at Tiers 1 and 2 Address unacceptable waiting lists for specialist SLAM CAMHS services, through service review and creative solution focused initiatives (e.g. ASD/ADHD shared care protocol) Increase provision and support available in schools, using a ‘whole school approach’ to supporting pupils emotional well-being and resilience Improve and increase available training and education to practitioners in universal services

Improve identification and support of perinatal mental health difficulties by GPs Review local transition protocol in relation to joint working arrangements between CAMHS and AMHS Increase and improve involvement of children, young people and their families and carers in local planning and commissioning of services Develop a comprehensive children and young people’s emotional health and well-being strategy for Croydon for and beyond

Thank you!