C are for Children and Young People Why is it different What is the current experience Dr Liz FellowSmith Crisis care lead CampA Faculty RCPsych Aims Consider issues specific to CYP in crisis ID: 573592
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Slide1
Mental Health Crisis Care for Children and Young People: Why is it different? What is the current experience?
Dr Liz Fellow-Smith
Crisis care lead
C&A Faculty
RCPsychSlide2
Aims Consider issues specific to CYP in crisisSummarise C&A Faculty (RCPsych) survey of members Outline Faculty health based place of safety position statementSlide3
Why is it different? Some challenges are differentSome aspects are the same Slide4
Similarities Parity of access to appropriate 24 hour servicesAccess to mental health advice \ single point of accessFocus on resolving the reasons for crisesQuality standardsSlide5
Why is it different? Many crises are not mental health driven Prevalence of serious mental health disorder increases in mid-later adolescenceSafeguarding and social care issues need to be considered
Different legal frameworks
PoS
for assessment needed – different to a
HBPoSSlide6
Why is it different? Pathways into and beyond crisis assessment are differentDifferent model of MH care: no crisis teams, court diversion, liaison services, local beds, out-of-hours provision etcDemand is less – varies with age
Stand alone or integrated services?
Integrate with AMH or CSC?Slide7
Why is it different? Require developmentally appropriate assessments environment – bespoke \ A&E \ AMH wards?Staff with expertise in CYP
Age + developmental need –
eg
intellectual disability, autism Slide8
Crisis care concordatCrises in police cells
CAMHs transformation plans
‘Future in Mind’
Psychiatric liaison
Urgent emergency care
Adult mental health
Transition
Social care
Education
Young person in crisis
Tier 4 review
Paediatrics
A&E
Court diversion Slide9
Day time access to urgent careOut of Hours access to urgent careAccess to crisis \ outreach servicesAssessment of S136 Faculty Survey:
CAMHs Psychiatrists experience & current provision of crisis care
March 2015Slide10
Responses = 202
No. analysed = 180 Slide11
Areas covered by responses Slide12
16-18 year olds Most have some provision in CAMHs\crisis services – interface with adult services importantSome have no provision - relies on goodwill Many – default is A&E due to limited capacity <16 years Range ...
Duty clinician
No provision – all to A&E
Access dependent on capacity
Access to urgent care:
day time
arrangements Slide13
Inconsistent access & crisis\outreach modelsCAMHs 24 hours 5 areasCAMHS\AMH 24 hours 4 areasCAMHs evenings 8 areasCAMHs\AMH evenings 2 areasCAMHs 9-5pm 1 area>16 only 3 areasNo provision many
Access to urgent care:
access to crisis \ outreach teams Slide14
Arrangements within acute trusts vary‘we have seven local acute hospitals in our Trust area all with different policies’A&E emphasis on discharge not ‘safe pathway’Access to medical and paeds beds variesMH liaison \crisis teams in some A&Es - adult or CAMHs
Arrangements vary with time of day – often not 24 hour.
Access to urgent care:
A&E and self harm presentations Slide15
OoH
CAMHs
provisionSlide16
CAMHs cover\advice for a wide area – not direct service: - 2 or 3 tiers of medical cover - MDT 1st on-call (W Yorkshire) - Outreach RMN 1st on-call - clinical manager & CAMHs cons (Swindon)CAMHs Consultant only: - face:face
\
tel
only
All specialty
consultant on-call
No cover
Access to urgent care:
OoH
provisionSlide17
S136 detained & assessed inS136 suites on adult wards (majority)A&EPolice cellsS136 suites adolescent unitSome areas no provisionNo clarity – ad hoc – takes hours to sort
Access to urgent care:
S136 \ custody response Slide18
Increasing numbers presenting via S136 - why?? Delays- Fri–Mon no SW assessment - in PoSLimited Tier 4 bedsno social placements availableS136 distant from home – impact on discharge possibilities
Access to urgent care:
S136 \ custody response Slide19
OUTCOME16-18 yrs
11-15 yrs
<11 yrs
no
significant MH disorder - discharged - requiring
social care placement or urgent social care intervention
121
27
%
63
32.5
%
8
32%
no
significant MH disorder -
admitted
informally
to a MH inpatient unit as no alternative placement
25
5.5%
15
8%
3
12%
MH disorder -
discharged
for CAMHs
followup
145 32.5%
31%
6 24%
significant MH disorder -
admitted
informally
to a MH inpatient unit
62
14%
23
12
%
6
24
%
significant MH disorder - admitted under
Mental
Health Act
to an inpatient unit94 21% 32 16.5%2 8%TOTAL ASSESSED 44719325
Access to urgent care:
S136 assessments undertaken past 2 yearsSlide20
HUGE VARIATIONNo uniform standards or commissioning for <16s, 16-18 urgent care provisionAccess to crisis care or outreach servicesDay time urgent accessOut of hours urgent accessSelf harm assessment serviceEvident problems along whole pathway
Sig
probs
with social care access & placements
Some well functioning \ developing models
Access to urgent care:
Conclusions Slide21
Defining a health based place of safety (S136) & crisis assessment sites:Faculty Position StatementConfusion ‘crisis’ = ‘mental health’S136 = all crisis presentationsPlace of Safety = place for all assessments
Crisis outreach teams exist Slide22
Thank youelizabeth.fellow-smith@wlmht.nhs.ukSlide23
What is different about crisis care for children and young people that makes it more challenging to deliver?Claire Bethel -Deputy DirectorChildren and Young People’s Mental Health and Wellbeing TeamSlide24
The vision for changeThe Government’s aspirations are that by 2020 we would want to see:
Improved access for parents to evidence-based programmes of intervention and support
Improved crisis care: right place, right time, close to home
Professionals who work with children and young people trained in child development and mental health
Timely access to clinically effective support
A better offer for the most vulnerable children and young people
A smooth and planned transition from children’s to adult mental health services
More evidence-based, outcomes focused treatments
More visible and accessible support
Improved transparency and accountability across whole system
Improved public awareness less fear, stigma and discrimination
Information and self-help available via online tools and apps Slide25
Future in mind Co-chaired by Department of Health and NHS England, working closely with Department of EducationFormal consultation with 1600 young
people and 770 health
professionals
Key
themes
:
Promoting resilience, prevention and early
intervention
Improving
access to effective support – a system without
tiers
Care
for the most
vulnerable
Accountability
and
transparency
Developing
the workforce
£1.4 bn pledged over the next 5 years, including £150m for community services for eating disorders Slide26
Delivering transformation: an integrated approach
Emphasis on building resilience, promoting good mental health and wellbeing, prevention and early intervention.
Cross-sector collaboration – NHS, public health, Local Authority, education, voluntary sector and youth justice.
Improve transparency and accountability across the whole system – being clear about how resources are being used in each area and providing evidence to support collaborative decision making.
A clear joined-up approach to support all, including the most vulnerable.
Sustain a culture of continuous evidence-based service improvement delivered by a workforce with the right skills, competencies and experience.
Leads to: a step change in how care is provided, moving away from services defined around systems to one defined around need.