Published on March 11, 2014
‘Raising the bar: What needs to be done to improve mental health outcomes for children and young people?’ Sarah Brennan Chief Executive
– A capacity to enter into, and sustain, mutually satisfying and sustaining personal relationships – Continuing progression of psychological development – An ability to play and to learn so that attainments are appropriate for age and intellectual level – A developing moral sense of right and wrong – A degree of psychological distress and maladaptive behaviour within normal limits for the child’s age and context What is Mental Health?
• Children and Young People’s Health Outcomes Strategy • Mental Health Strategy & Implementation Framework • CYP IAPT • PbR Development • Health and Social Care Bill • SEN and Disability Green Paper • Education Act 2011 • OFSTED 2012 framework for school inspection • CMO Report • NHS Mandate • Closing the Gap • Tier 4 Review • Crisis Care Concordat CYP Mental Health: Policy Context
At any one time around 1.3 million children will have a diagnosable mental health disorder. Although effective treatments are available only 25% of those who need such treatment receive it.
The British Medical Association report, Growing Up in The UK, highlighted that the highest number of children ever recorded in the UK were referred to local authority care, mainly for abuse and neglect. Given NICE guidance states around 60% of looked after children have some level of emotional or mental health problem what is being done to tackle this issue?
Recent headlines, Old problems
Recent headlines, Old problems
Investment in mental health services 2009/10 (1) Total NHS Budget of £104,000,000,000 of which £11,260,000,000 Total mental health budget £10,490,000,000 Adult mental health services £770,000,000 Child & Adolescent mental health services • 7% total budget spent on CAMHS • (1) From: Programme Budgeting estimated Eng. Gross expenditure for all progammes DH 2009/10.
Which Agency Commissions What?
Simple local overview
Developing context continues…. • Efficiency savings impact: – Dramatic affect on tier 2 services nationally – YM FOI found 34 of 51 local authorities reduced CAMHS budgets since 2010. Some altogether – LA v Health funding varies widely – Pushing thresholds towards crisis end – Specialist CAMHS reporting overwhelmed (tiers 3&4)
• Two thirds of JSNAs do not have a section that specifically addresses children and young people’s mental health needs • One third of JSNAs did not include an estimated or actual level of need for children and young people’s mental health services in their area • Estimated need based on: hospital admissions data; rates of referral to CAMHS and calculation by mapping national levels of children and young people’s mental health disorders onto local population size • The most commonly used data for generating an estimate of prevalence of need was from the study of children and young people’s mental health conducted by Green et al at the Office for National Statistics in 2004. • This study was undertaken almost ten years ago and prior to the recession and other significant social and cultural changes which are likely to have had an impact on children and young people’s mental health Commissioning – developing JSNA’s – what info do they use?
Children & young people with mental health or emotional needs Who pays? NHS pays NHS pays Tier 2 Services Tier 3 Specialist CAMHS Tier 4 Inpatient Care T H R E S H O L D T H R E S H O L D CAMHS Care Pathways U n i v e r s a l S e r v i c e s UniversalServices
The mental health spectrum Flourishing Moderate mental health Languishing Mental disorder From: Huppert Ch.12 in Huppert et al. (Eds) The Science of Well-being Number of symptoms or risk factors
The effect of shifting the mean of the mental health spectrum Flourishing Moderate mental health Languishing Mental disorder From: Huppert Ch.12 in Huppert et al. (Eds) The Science of Well-being Number of symptoms or risk factors
50% adults with lifetime mental health problems experience symptoms before 14 years of age. 75% adults with lifetime mental health problems experience symptoms before their mid 20s. Less than 50% were treated appropriately at the time. (Taken from Mental Health Strategy 2011 DH) Why early intervention in Children and Young People’s mental health?
What works – resilience (A. Hart & D. Blincow) • Help with the ‘basics’: housing, play, safety, transport • Sense of belonging: at least one constant, stable relationship; help to make sense of the world; provide good times and positive experiences • Help with learning: mentors; getting organised; life skills; highlight achievements; raise aspiration through planning • Coping: problem solving; calming down; fostering interests; understanding boundaries; laugh; be brave; rose tinted glasses; sense of self – instil hope; build empathy & responsibility; foster talent
Making the most of limited resources: • Develop responses for critical times in cyp development and onset of mental health problems with greatest gains. • Systemic approach and whole system funding, bring cyp commissioning together with social care and education • Ensure the local JSNA appropriately assesses cyp resilience and mental health needs and high risk groups • Influence and nurture key local champions • Invest in successful interventions reducing high cost end services (tier 4 services, long term adult care) • Early intervention works (Outcomes from Early Intervention in Psychosis, Urgent Help team Sussex)
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Sarah Brennan, YoungMinds Chief Executive. Sarah Brennan became chief executive of YoungMinds on 12 May 2008.
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