Children and Adolescent Mental Health

Children and Adolescent Mental Health 

Children’s social and emotional wellbeing is not only important in its own right but also as a contributor to good physical health and as a factor in determining how well they do at school (National Institute for Health and Care Excellence, 2008).

    

Social and emotional wellbeing refers equally to: 

  • Emotional wellbeing (e.g. feeling happy and confident) 
  • Psychological wellbeing (e.g. feeling in control of one’s life, being resilient, and displaying assertiveness) 
  • Social wellbeing (e.g. the ability to have good relationships with family and friends) 

The Government is committed to make Children and Young People’s Mental Health (CAMHS) a priority.  About half of adults with mental health conditions experienced their first symptoms before they reached 14 years of age.  Children who develop mental health problems will need additional timely treatment from the appropriate mental health service supported by the wider services around the child. In 2014 NHS England commissioned a review of CAMHS which found that many children and young people did not receive timely support.  

     

This section cannot be read in isolation and further reading needs to be carried out around, adult mental health, drug use, alcohol issues, domestic abuse, children in need and safeguarding to name a few.

Nationally there is concern over the quality of services commissioned for children and young people requiring mental health services. This has been encapsulated in the House of Commons Select Committee’s (Health Committee) 3rd report of 28th October 2014 concerning Children's and adolescents' mental health and CAMHS. The report stated:

    

‘There are serious and deeply ingrained problems with the commissioning and provision of Children's and Adolescents' mental health services. These run through the whole system from prevention and early intervention through to inpatient services for the most vulnerable young people”

for more information visit Parliament Publications website.

    

The NHS England “Model Specification for Child and Adolescent Mental Health Services: Targeted and Specialist levels (Tiers 2/3)” sets out a clear framework for the development of services. It establishes that “all service specifications for CAMHS should sit within an agreed, integrated, strategic plan developed by multi-agency partnerships that takes account of the breath of services for children and young people”.

 

For more information visit the Child and Adolescent Mental Health (PDF document)

     

The National Institute for Health and Care Excellence have published  clinical guidance and quality standards, including:

Department of Health and NHS England  (2015) Future in Mind is the government’s report from the Children and Young People’s Mental Health Taskforce which was set up as a result of the Health Select Committees inquiry into CAMHS (Health Select Committee, 2014).  The report sets out the government’s ambition for the improvement of CAMHS. 

For more information visit Children's Mental Health PDF

     

Department of Health (2011) No Health Without Mental Health: A cross-Government mental health outcomes strategy for people of all ages (2011) sets out an ambition for putting mental health services on an equal footing to physical health services.

    

Department of Health (2010) Getting it right for children and young people: Overcoming cultural barriers in the NHS so as to meet their needs

     

The Marmot Review (2010) Fair Society, Healthy Lives: Strategic Review of Health Inequalities in England

     

Mental Health Foundation  (2015) Fundamental Facts About Mental Health 

If you would more information visit Mental Health Foundation website

     

Promoting children and young people’s emotional health and wellbeing; a whole school and college approach (PHE, 2015)

         

Counselling in schools: a blueprint for the future; departmental advice for school leaders and counsellors (Department for Education, 2015).

        

Local Context

Berkshire completed a comprehensive engagement exercise about Berkshire Child and Adolescent Mental Health Services (CAMHS) during spring 2014. Views were gathered from children and young people, parents and foster carers, staff who work in the service, GPs and others who refer into the service and others with an interest in the service.The results of this, including the findings and recommendations are available on the Berkshire Clinical Commissioning Groups’ (CCGs) websites.  

Wokingham have developed a Joint CCG and LA Wokingham Emotional Health and Wellbeing Strategy setting out our need, demand for services, our range of provision, gaps and priorities for improvement. This strategy is informed by best practice and research and has been informed by the views of children young people, parents and carers and practitioners. The strategy and action plan aim to lead to better health outcomes by identifying a work programme for the 2015 to 2017 period that will resolve identified service delivery issues.

     

Wokingham Safeguarding Children Board (WSCB)

    

To ensure the WSCB is able to deliver its statutory responsibilities it must:

  • Monitoring how well statutory agencies are carrying out their responsibility under section 11 of the Children Act 2004 to safeguard and promote the welfare of children, including their safe staffing arrangements.  
  • Setting up and running a programme of multi-agency safeguarding training 
  • Drawing up and monitoring the implementation of WSCB inter-agency procedures  
  •  Undertaking a Serious Case Review (SCR) when a child dies, and abuse or neglect is known or suspected to be a factor in the death; the purpose of SCRs is to establish the lessons to be learned from the case and how they will be acted upon, and as a consequence, improve inter-agency safeguarding of children 
  • Taking an overview of all child deaths (under 18 years) in the area, identifying any potentially contributory recurrent themes, circumstances, or possible limitations in service provision by one or more agencies.

More Information is available on the Wokingham Safeguarding Children Board website.       

The demand for CAMHS is rising. As a consequence services are being prioritised to ensure that urgent issues are assessed swiftly. This in turn means there are significant delays for some children and feedback from children and young people indicates some unmet need and dissatisfaction with services, notably regarding waiting times. It is clear that action is required to improve outcomes for children and young people and to increase public confidence in the service.

     

There is concern that vulnerable young people, and in particular some children in care and care leavers do not receive timely assistance. The Ofsted inspection of Wokingham’s Childrens Services and Safeguarding Childrens Board (published 05/01/16) found “young people do not have timely and effective access to CAMHS and therapeutic services to meet their assessed needs. The co-location of a CAMHS worker in the service for part of the week is a positive development but has not yet had a significant impact and care leavers wait too long for CAMHS services.” The “service”  in the quote being a reference to the Wokingham Early Help Hub.

     

Wokingham CCG and Wokingham Borough Council have developed an Emotional Health and Wellbeing strategy and action plan to establish a comprehensive programme to improve service delivery. 

     

Wokingham Borough Council works in close partnership with the Wokingham Clinical Commissioning Group (CCG), Berkshire Healthcare Foundation Trust, GPs, schools and the voluntary sector to support the emotional health and wellbeing of children and young people in Wokingham.

     

Prevalence

The following table shows the estimated current prevalence of mental health problems in children and young people in Wokingham. 

     

Prevelance of mental health in children

Increased usage of CAMHS, long waiting lists and uncertain mental health outcomes

     

We have high and increasing usage of both Child and Adolescent Mental Health Services across the children population but with a relatively low number of Children in Care supported by CAMHS. 

     

Using the estimates by Kurtz (1996) it is possible to estimate the number of children and young people who may experience mental health problems appropriate to a response from CAMHs at tiers 1, 2, 3 and 4.  Table 2 shows the estimates for children aged 17 years and under in Wokingham Borough.

    

Estimated mental health under 17

Admissions

In 2012/13 there were 26 young people admitted to Berkshire Adolescent Unit with mental ill health, which is an increase on 16 in 2011/12. The majority of these cases were female. The presenting problems were self-harm risk, eating disorders, psychosis and affective disorders, the most common problems were self-harm and psychosis.


Figure 1 &2 - 1 - young people hospital admissions for self harm, 2 - hospital admissions for mental health

Mental health hospital admissions

Source: Public Health England, 2015

 

In 2012/13 there were 715 referrals received by the local mental health trust, which 588 were appropriate to a response from Wokingham CAMHs tier 3 and tier 4. The majority (72 percent) of these referrals came from primary health care. 14 percent of referrals were waiting over 18 weeks for a first appointment. Of those that could be defined, the majority of cases were Autistic Spectrum Disorder (ASDs), emotional disorders, and hyperkinetic disorders.

    

ARC Counselling provided over 12,000 counselling sessions during 2014/15.  The most common presenting problems were for family, friendships, anxiety, anger and self-harm. The Youth Counselling service is being recommissioned in line with the joint agreed outcomes framework in 2016.

     

Autistic Spectrum Disorder (ASD)

The European Commission (2005) highlights the problems associated with establishing the prevalence rates for ASD.  These include the absence of long-term studies of psychiatric case registers and inconsistencies of definition over time and between locations. 

CHIMAT report that using prevalence rates found by Baird et al (2006) and by Baron-Cohen et al (2009) the following  prevalence rates could apply to the Wokingham population.
 

Estimated numbers of children with autistic spectrum disorders

Vulnerable Groups

The following table summarises the number of children in Wokingham considered being in a group which is at a higher risk of poor mental health outcomes. Generally, compared to Regional and National rates, Wokingham has fewer children in these vulnerable groups. The exception to this the number of children who are identified as having ASD. 

    

Vulnerable groups in Wokingham
Healthwatch Wokingham has recently undertaken a survey amongst secondary aged pupils around their emotional health and wellbeing (Healthwatch Wokingham, 2015). Key findings are summarised below: 
  • 1 in 10 young people identified as been a carer:
  • These young people reported higher rates of emotional distress
  • Young carers found the help and support they received less useful than peers 
  • 43 Percent  of young people reported feeling stressed in the past three weeks 
  •  31 Percent reported sleep problems
  •  15 Percent felt anxiety
  • 14 Percent felt depressed
  • 13 Percent  had drank alcohol
  •  8 Percent had eating problems
  •  3 Percent tried drugs
  • 2 Percent experienced violence in the home 

 Females were more likely to report feeling emotional distress than males

The majority of young people reported talking to a friend or relative when they felt worried 

        

The third most common response was to do nothing

This was a more common response in males than females         
 

61 Percent reported that there was help at school for emotional problems

When asked what would make a difference in their lives young people’s responses broadly fell into the following categories

  • to be listened to
  • to be treated with respect
  • to feel safe and cared for
  • to be able to find help at the time they need it and not have to wait
  • to know where to find help
  • more people available at school to talk to when they need support
  • more emotional support 
  •  more family support
  • bullies to be dealt with

  • advice/workshops on how to relax, how to deal with stressful situations and pressure 

  • breakfast/lunch clubs at school

  • less family pressure and exam pressure      

             

Children and young people as well as adults can have emotional and mental health problems.  These problems are, for many children and young people, a natural response to difficult life circumstances.  However, some children and young people are more at risk and experience more severe problems. 

     

Children whose parents have a mental health problem, come from families where domestic abuse is an issue and those who have a low-income are more susceptible to experiencing emotional and mental health problems.  Other risk factors include children and young people who have a physical or learning disability, those who misuse drugs or alcohol, young offenders, teenage parents, lesbian, gay, bisexual or transgender (LGBT), looked after children, refugee or asylum seekers, and those who have been abused.

     

The data indicates that services are not fully meeting the needs of Wokingham’s children and young people. In particular there are concerns over the support provided to Wokingham’s highest priority children and young people – those in care, referred to the Youth Offending Service and in need. 

     

In addition there are delays in the ASD diagnostic pathway and the ADHD pathway and these need additional resources.
 

Alongside the recognition from CAMHs of the need to improve its service offer,partnership reviews have identified the need for all tiers of emotional health and wellbeing provision to work together as a better system, so that children and young people are identified early and access any support they need is provided quickly at the lowest and least restrictive tier possible.

    

All agencies should realise the benefits of co-production and working together to improve the mental health of children and young people.

  • Reduce waiting times
  • Increase tier 2 provision to ensure early intervention
  • Increase resources to meet demand
  • Free up CAMHS staff time to work with partner agencies 
  •  Improve support in schools
  •   Improve information about services on offer and how to access them
  •  Improve communications and administration
  •   Create a more young-person-friendly environment 
  • Provide better post-diagnostic support particularly around a diagnosis of ASD or ADHD
  • Provide better out of hours access and crisis support 
  • Provide a local 24/7 inpatient services