The Committee had received a report in January 2016 regarding the Child and Adolescent Mental Health Transformation Plan and the Committee had agreed that it should be updated on its progress.
Members had also expressed a wish to look at the topic of Young Peoples Mental Health and gather information on the following: pathways; resources; gaps in services; access routes; and how services were informed by the Joint Strategic Needs Assessment (JSNA).
Mark Burdon, Commissioning Manager - Mental Health, North of England Commissioning Support Services attended the meeting to provide information primarily about the services available for young people.
In describing the pathways and access routes, Members were told that there was an open referral to CAMHS (Child and Adolescent Mental Health Services). For example schools, family members and GPs referred and a quarter of referrals came from that route and the numbers were rising. Some areas had co-located Primary Mental Health Workers with Early Help teams in Early Help hubs and there was a multi-agency diagnostic pathway for ASD (Autism Spectrum Disorder).
The structure for the services provided by TEWV (Tees Esk and Wear Valley Trust) was presented and it provided information on the range of services which included community and out-patients, early intervention, crisis and liaison and inpatient services. The early intervention in psychosis team went across the age range from age 14 to adulthood mainly because it was important that young people with mental health issues were picked up early and had the opportunity of an early intervention. The team also saw people at their first episode of psychosis or where a person was in an 'at risk mental state. The service offered appointments from 9am to 5pm Monday to Friday and offered some flexibility. There was a three year intervention period and family-based working was offered. There was a 2 week target to see people.
A new 24/7 crisis and liaison service had been established in June 2015 and was funded by money from the Transformation Plans. Early indications showed that it had cut admissions for Mental Health conditions for under 18 year olds.
Tees CAMHS which involved Hartlepool, Stockton on Tees, Middlesbrough and Redcar and Cleveland held an average caseload of 3,674 at any given time and each month 365 external referrals were made. The main source of referrals was primary health care and the main outcome of the assessment was referral to CAMHS.
A number of gaps in service were outlined and included the significant waiting lists to diagnose and support ASD. It was explained that this was due to it being a multi-agency pathway which was very complex, however the Trust were looking at what could be done to bring down the waiting time. There was also a high expected prevalence of conduct disorder in this area however there was little data on actual diagnoses or information on how well supported it was.
In terms of how services were informed by the JSNA it was explained that the JSNA was modular so some pages including mental health and learning disabilities were out of date. The main source of data used was from Public Health England and strategic direction was received from NHS England with local context input from partners.
In the discussion that followed, Members had concerns about waiting times based on anecdotal evidence they had heard. The committee was informed that recent figures that had been received showed an improvement in waiting times. In the first quarter of 2016/17 the average waiting time from referral to second appointment was 38 days however in the period up to September it had reduced to 15 days. However it was acknowledged that there were longer waiting times for ASD.
Members questioned how services were informed by the JSNA if it was out of date and asked what cognisance was given to other sources of information such as Directors of Public Health, information from Health and Wellbeing Boards, Healthwatch, young people etc. It was explained that the CCG would be responding to a recent paper on mental health by Healthwatch.
It was acknowledged that there was more to be done to improve the awareness of services. A discussion took place about how schools were key to that awareness raising and some examples of work in Redcar and Cleveland and Middlesbrough were given.
It was explained that there was a parity of esteem in mental health spending, for example if CCGs receive a 1% increase in their budget a 1% increase in spending on mental health must be made. Child and Adolescent mental health received 11% of spending from the mental health budget.
The Committee agreed that further information should be brought on this issue in 6 months time including specific information on
a) Suicide figures across the Tees Valley including age ranges and comparison with national figures.
b) Waiting times and how they are being addressed.
c) Update on the implementation of the Child and Adolescent Mental Health Transformation Plan.