Pathways to care in the absence of a local specialist Forensic Service, what we do in

York.

By Bekki Whisker

As a lone YOT/CAMHS representative, working with high risk clients without clear referral

pathways

B aged 15, Arrested for serious sexual offences, Learning difficulties, Full care order directly following arrest. Over a 4 month period he receives 7

different assessments as a result of the pathways leading from the family court system, criminal justice processes and CAMHS assessment.

P aged 15, long history of CAMHS involvement familial sexual abuse and domestic

violence. high risk behaviour within the home, -

fire setting, substance misuse, fascination with weapons, sexualised behaviour, animal cruelty, TWOC, physically aggression.

Lack of consensus regarding risk assessment and risk management, from an internal and multi-agency perspective.

F is 16, Well known to CS, YOT and CAMHS. Assessed High risk offender for some

time. Long term neglect and parental

substance misuse, Huge difficulty with engagement with all

services. Receives a custodial sentence. Within weeks he is sectioned, admitted

to a secure hospital and medicated with anti-psychotic medication.

A aged 14, Arrested for serious sexual offences Court bail for an extended period, Self-harm concern. Absence of mental illness, no suicidal

intent, very little evidence of self-harm – CAMHS discharge.

2 months later the Court outcome is that he is unfit to plead and he receives a Hospital Order.

Z – 17 serial fire setter ?LD CAMHS and CS advice to refer direct to

fcamhs due to lack of specialist risk assessment skills – forensic report makes recommendations for the Local Authority and CAMHS

Lack of local specialist forensic CAMHS and legal expertise

Poor co-ordination of services, a lack of partnership working, no one wants to take ownership of these cases

Limited success in terms of Court diversion

No support/supervision for those staff working as lone practitioners with these high risk clients

No forum to monitor the progress of cases/potential cases- they just get lost in the system, an offence is then often the trigger to action/assessment

We are a small city, we know our client group and we know our staff

Adult forensic mental health services wanted to help us

CAMHS, YOT and Childrens’ Services representatives had registered an interest in forensic cases

The Yot health Worker had developed a good understanding of the needs of this client group and had built some good relationships across the relevant agencies

There were enough interested and motivated individuals to make a multi-agency panel

YOT Service Manager (Chair) YOT CAMHS representative YOT admin CAMHS Psychiatrist CAMH Service Manager CAMHS Psychologist Head of Services Resources (Children’s

Services) Adult Forensic Mental Health Practitioner CAMHS Commissioner – (provided with minutes)

Where are the cases coming from?

Assessed as posing a high risk of harm to others (YOT ROSH or similar)

Stuck cases Those at risk of custody Other forums have not been successful

in addressing the emotional and mental health issues

26 cases discussed 3 females 23 males 2 cases raised by Children’s Services 4 cases raised by CAMHS 20 cases raised by YOT

Clarity to risk assessments A consistent multi-agency response to risk

management Early identification and intervention Better outcomes for high risk clients An enhanced experience for clients in

transition to adult services Identification of local skills, experience and

knowledge An opportunity for professional challenge An opportunity to explore diversion

pathways for individuals

Expertise A service – the panel is a forum we don’t

provide therapeutic input, consultation, written reports etc

Service Level Agreements and funding Time – we meet monthly therefore we are

not as responsive as some cases require Court diversion schemes (we have had some

success but they are minimal and messy) Clear pathways and therapeutic provision to

those young people who sexually harm Specialist fcamhs assessments which are

locally relevant to the service provision

The panel ‘felt right’ but this publication confirmed what we had identified and developed in York was not a local ‘whim’:

Community Forensic Child and Adolescent Mental Health Services (FCAMHS): a map of current national provision and a proposed service model for the future. Final Report for the Department of Health . January 2013

Are locally relevant, similar issues identified Evidence the need for Specialist Services

and expertise Highlight the unmet needs (but enables us

to recognise the progress we have made in York)

Identify that we are targeting the correct clients for discussion

Identifies need for minimum standards for community FCAMH service provision and a standard commissioning framework to provide a level of consistency

Thank you, if you have any queries regarding the panel please contact:

Angela Crossland, YOT Service Manager:Angela.crossland@york.gov.ukTel: 01904 554565