1. Falling off the cliff: young people in a mental health service Dr Uju Ugochukwu (Consultant Psychiatrist, EI & Youth) Dr Sarah Maxwell (Consultant Psychiatrist, CAMHS & Youth) Norfolk and Suffolk NHS Foundation Trust

2. Background and what we did Development of youth mental health service Quantitative mapping project –Description of the characteristics of 14 – 25 year olds within the service –Description of mental health services available to young people in Norfolk Data from Trust Informatics Department

3. Findings September 2010 to August 2011 Total number of referrals for CAMHS and AMHS = 7,476 Number of individual patients = 5,196 2,280 referrals were either, re-referrals or individuals passed between teams

4. All referrals by age and gender Sept 2010 to August 2011 Proportion of referrals accepted

8. Conclusion and Recommendations Teenage boys are not referred –behavioural presentations –seen in other services e.g. youth offending teams Reduced contact for 18 to 20 year olds –engagement –not meeting criteria –Stigma Many young people are either being re-referred or moved from service to service hence repeated assessments –New service needs to track care pathways to avoid repeated assessments

9. Conclusion and Recommendations Lots of data which needs system around it to make it useful to clinicians Services working with young people need to be clear about what they offer and work collaboratively to avoid duplication

10. How to get ideas heard: influencing change in the NHS Dr Sarah Maxwell (Consultant Psychiatrist, CAMHS & Youth) Norfolk and Suffolk NHS Foundation Trust Dr Uju Ugochukwu (Consultant Psychiatrist, Early Intervention & Youth) Norfolk and Suffolk NHS Foundation Trust

11. What we did Background Qualitative project –Interviewed 9 key individuals involved in the development of a new service including those with clinical, academic and management backgrounds –Identified themes and developed a set of questions –Recorded and transcribed each interview –Looked for common themes using colour codes –Timeline

12. Findings

13. Four key areas Organisational context Team/champion skills Individual skills Political astuteness Keep the goal insight

14. Organisational Context Taking advantage of what was happening in the organisation and using that to take own ideas forward “the Trust was looking at its vision and we very clearly felt that a … service should be part of it” “services uneven across the piste …” New senior executive

15. A champion (team of champions) “It has been a really good example to other areas of how it works very well, working collaboratively and I think other areas have looked at that and thought … it doesn't’t have to be a them and us arrangement” Complementary skills Can do attitude Enthusiasm Determination “You need a kernel of individuals … who are enthusiastic and who have access to some clout”

16. “ Organisations need developers and controllers to change and innovate” “alongside the developers there has to be managers with different styles of management, just like alongside innovative clinicians there has to be people who will actually do the work”

17. Political Astuteness “…I think the timings were really quite fortuitous really, and we were riding our luck.” “…not only were they full of ideas … but they were able and know how to make the organisation tick” “..they’ve got a political understanding which is quite important too.” “... came and visited … and thought it was a very good thing … this is the way forward, this is a great thing and being convinced by the data”

18. Keep the goal in sight Ability to be flexible whilst keeping the goal in sight

19. www.slideshare.net

20. Challenges Enormous quantity of data How to present in a concise & meaningful manner Doing qualitative research! Writing it up into something meaningful Confidentiality Each meeting generated new ideas to follow up and so more to do! Juggling work, CLAHRC and home life

21. Other things that we've done Setting up YMH service in Great Yarmouth and Waveney Involvement of young people Partnership with other statutory and non- statutory agencies – Case discussion groups Presentation to different groups Future research

22. Acknowledgements Professor Ian Goodyer Dr Belinda Lennox Dr Cecily Morrison Dr Eivor Oborn Valerie Gage, Kevin Brown, (NSFT Informatics dept) CLAHRC including ALS Study participants