Children and young people’s mental health:

Gloucestershire’s Future in Mind Local Transformation

Plan for children and young people’s mental health

and wellbeing

Presentation to Health & Wellbeing Board 21st July 2015

Simon Bilous, Joint Commissioner, Children’s Health & Maternity

Purpose

Update on what is needed to be done and by when

Setting the local context

Discussion of what we know about priorities & gaps

Developing a Gloucestershire ‘vision for 2020’

Demographics

Approx 138,000 0-18s

Age range estimates:

0-4: 34,066

5-10: 38,715

11-15: 34,721

16-19: 29,560

Current trends suggest that Gloucestershire’s 0-19

year old population will increase by almost 10,000

people or 7.2% to about 146,700 in 2021

Needs & issues (1)

National:

ONS 2004: 10% CYP

50% (by 14) & 75% (by 18) adult MH need start in

adolescence

Local:

Online Pupil Survey (OPS) – see next slides

Needs & issues (2) : Online Pupil Survey

General positive & improving ‘health’ story eg

secondary pupils:

Drink alcohol - 79% never or only once or twice

Smoke – 94%

Drugs – 96%

Feeling ‘happy’:

75-80% in year 4; 60-65% in year 10

Feel good about things like school / college, results,

sport

Bullying has declined

Needs & issues (3) : Online Pupil Survey

Cyber bullying

Self-harm

4.5% regularly

In line with national figures

80% girls

50% didn’t tell anyone

© Foster & Brown Research 2014

OPS 2014 bullying

% of pupils who felt their school deals extremely or quite well with bullying

69%

42%

71%

48%

71%

51%

74%

50%54%

Primary Secondary

2006 2008 2010 2012 2014

18 20

14

25

19

14

21

16

14

6

21

18

13

8

15 14

11

7

0

5

10

15

20

25

30

Year 6 Year 8 Year 10 Year 12

% bullied sometimes, quite often or most days

% bullied 2006 % bullied 2008 % bullied 2010 % bullied 2012 % bullied 2014

OPS 2014 self harm

2014 Self harm reporting by secondary age pupils

•84.2% have never self harmed

•8.2% have self harmed once or twice

•3.1% have sometimes self harmed (e.g. monthly)

•4.5% have self harmed more regularly (weekly or daily)

Needs & issues (4) Risk Factors

Poverty

Family breakdown

Children in Care / adoption

Parental mental illness, substance misuse, offending

Domestic abuse / violence

Severe adversity (eg abuse / neglect)

Young offenders

Disability / complex or long-term health needs

Young carers

Needs & issues (5): Demand for services

Activity for CYPS: 2012 - 2014

2012/13 2013/14 Difference

Referrals

3,351 3,769 + 12.5%

Discharges

2,912 3,685 + 26.5%

Caseloads

1,689 1,918 + 13.5%

Contacts

20,078 26,116 + 29%

Needs & issues (6)

Self-harm

around 2-3 fold increase in yp attending hospital

Overdose most common

Other types ‘held’ elsewhere

Gender: 80% female

Suicide: average 2-3 per year since 1994 (4 in 2012)

‘Near misses’:1/3 known to services

Peri-natal / maternal mental health

National & Regional ‘policy’ and context

NHS England CAMHS Tier 4 Review – July 2014

SW Strategic Clinical Network CAMHS review and

Commissioning document – October 2014

Parliamentary Health Select Committee Review –

2014

NHS – Mental Health ‘Parity of Esteem’ / NHS 5 Year

Forward View

National CAMHS Task Force – Government

response ‘Future in Mind’ – March 2015

Chancellor - Autumn and Budget Statements

National Mental Health Taskforce – all age

Future in Mind - what does it say?

Five key themes:

Promoting resilience, prevention & early intervention

Improving access to effective support – a system

without tiers

Care for the most vulnerable

Accountability & transparency

Developing the workforce

Future in Mind - ‘national’ priorities

Needs assessment

Engagement and involvement – children, young

people, parents, stakeholders

FIM (year 1)

Eating Disorders

IAPT

Peri-natal mental health

FIM & NHS Five Year Forward View

Liaison psychiatry

Crisis care

CAMHS – capacity; transitions; alternatives to inpatient

care; places of safety

Future in Mind - local issues (1)

Whole system

Primary Prevention / promotion / schools

Secondary prevention / early intervention & support

Information

Where to go for help & advice

Pathways and what to expect

For users, parents, professionals

Future in Mind - local issues (2)

Local ‘Offer’

Access & waiting times

Peri-natal / maternal mental health

Crisis support

Inpatient care / intensive community-based support

Safe places / places of safety

Workforce support and development

Future in Mind - opportunities

Mapping provision / service directory

Role of independent / voluntary sector

‘cultural’ commissioning

Role of parents

Training and whole workforce development

Supporting and influencing the ‘network’ and having

a ‘joined-up’ system

Future in Mind – local priorities & where we are Local: ‘sub-clinical’ & ‘clinical’

‘Sub-clinical’

Primary prevention – OPS; GHLL

Access to ‘counselling’ & support – secondary prevention –

BERS; review of counselling support

‘Clinical’

Eating disorders – plan in development

Liaison services – extending hours and ages

Crisis support – changing model, extending hours and ages

Peri-natal mental health – plan in development

CAMHS capacity / waiting times etc – investment in capacity

Alternatives to inpatient care – capacity pressures eased by

other changes

‘safe places / places of safety’ - foster carers

Future in Mind - what and by when?

Local Transformation Plan

Initial Guidance rec’d – more to come ‘in June’

Plan is gateway to resources

Assurance process, sign off & allocations for 2015/16 -

end September

Submission of Plan – end August / early September?

Working draft for refinement / local sign off – during

August?

Future in Mind - next steps

Plan is in development – led by CCG

Wide range of partners involved and engaged

Sign-off of the Plan will be comprehensive:

Guidance says: ‘We anticipate that Health & Wellbeing

Boards will want to be engaged to ensure coherence

with existing local priorities’

How does HWBB wish to be involved going forward?

Thankyou