Agenda item

To consider and comment on the recent transformation and changes in demand on emotional well-being and mental health in Sandwell.

The Board received a presentation outlining the changes to the Child and Adolescent Mental Health Service (CAMHS) since the Black Country Healthcare NHS Foundation Trust had taken over the lead provider role in July 2022, and how the increase in demand in recent years was being addressed. 

The changes in service delivery would ensure better collaboration with Voluntary and Community Sector partners, Primary Care Networks, Local Authorities and children, young people and their families. The changes it was hoped would enable easier and equitable access that would provide a better patient experience and improve outcomes. The consequent harmonisation of resources would ensure equity of access across the Black Country.

The Board noted the following key points in relation to the transformation:-:

·      Core CAMHS services for Sandwell had improved following investment which had increased capacity by 16 wholetime equivalent staff.

·      Investment had allowed for aligning the CAMHS service across the Black Country ensuring support up to the age of 18 years.

·      In-patient mental health beds for children and young people had moved from specialised commissioning through to provider collaboratives where BCHFT was a partner. The service as a gatekeeper for young people requiring in-patient facilities. Contracts with the in-patient providers would allow for a greater investment into preventative measures.

·      Eating disorders services had been aligned across the Black Country. Sandwell had benefited from being one of the first areas to receive the all age eating disorder provision.

·      There was an outreach team being developed in Sandwell that would be working with young people and adults in the community when they were not well enough to attend their out-patient appointment. They would also be supporting lower level services, ensuring everybody was aware of the pathways into specialist eating disorder service.

·      The service was taking part in the national FREED research project, which was looking into early intervention for young adults.

·      Young Adult Transition 18-25 service was being developed with adult mental health colleagues. The service would focus on those young adults who did not meet the threshold for adult mental health support.

·      Mental Health Support Teams in schools was a nationally led initiative.

·      The Children and Young People Intensive Support Team was supported those with special educational needs and disabilities (SEND).

·      The tier four delayed discharge programme supported those with eating disorders and supported keeping young people at home or working with them in an acute setting.

·      The Barnardo’s Keyworkers Pilot would support young people who could not be discharged due to ongoing social circumstances with Barnardo’s acting as a conduit to address the social needs of those young people.

·      There was now a Single Point of Access lead.

·      Patients now had the choice of remote or face to face support, however patients with complex mental health needs and eating disorders were seen face to face..

·      Work was underway to embed the I Thrive Model, supporting young people to thrive and move away from the medical model, offering them a helping hand in everyday language.

·      A number of services were being reviewed to ensure that they were fit for purpose.

·      The waiting times varied depending on need and remained challenging. There had continued to be an increase in both the number of children and young people accessing the service and an increase in the severity of the cases.

Waiting times were noted as:

·      Sandwell CAMHS Single Point Access, first appointment:

o   Pre-pandemic 11 weeks

o   During pandemic 5 weeks

o   January 2022 11 weeks

o   Current position 5.8 weeks (Jan 2023)

·      Sandwell CAMHS Core, second appointment:

o   Pre-pandemic 14 weeks

o   During pandemic 22 weeks

o   January 2022 18 weeks

o   Current position 31 weeks (Jan 2023)

·      Sandwell CAMHS Outpatients, first appointment:

o   Pre-pandemic 6 weeks

o   During pandemic 12 weeks

o   January 2022 10 weeks

o   Current position 15 weeks (Dec 2022)

·      Sandwell CAMHS Outpatients, second appointment:

o   Pre-pandemic 9 weeks

o   During pandemic 21 weeks

o   January 2022 13 weeks

o   Current position 41.5 weeks (Dec 2022)

The Board noted that while referrals at the early stages of lockdown had decreased and remained below pre-pandemic levels, from March 2021 referrals to CAMHS had increased significantly and continued to do so, with children and young people presenting with more complex needs. Areas of particular focus for practitioners were highlighted as:

·      Severe anxiety

·      Anxiety with school refusal

·      parental concerns around if their child had a disorder on the autistic spectrum continuum

·      parental concern around the loss of the richness of information that they share with referring professionals.

There was a number of challenges that continued to impact the service:

·      Increasing demand in young people having their challenges understood through the lens of mental ill health as the first approach, while there remained a range of factors that could be contributing to the young person’s distress.

·      Ensuring there was an understanding of the availability of other wellbeing/support services across Sandwell.

·      Continued recruitment challenges across the whole system and conversations were taking place with central government to find a national solution.

Following comments and questions from members of the Board,

the following responses were made, and issues highlighted:-

·      There was a proactive move towards a whole system approach to ensure that the support offered matched what was required.

·       A dashboard was being developed as a means of creating a single point of contact or directory for services.

·      The Early Help service was well developed and actively worked to support children and young people.

·      Reports were being sent to each locality on waiting times and a monthly basis, along with reports to the Thrive Board.

·      Digital poverty was an ongoing concern and work continued to support those young people who did not have digital access to services.

·      Provision for children and young people from the LGBTQ community was at a regional level.

·      CAMHS continued to work with the SHAPE Board to understand young people’s concerns.