Prevention of Self-Harm and Suicidal Ideation Conference

26th March 2015

David Loyd-HearnCommissioning Manager Children and Young People

Emotional Health and Wellbeing

Emma Grinham Young Person Chair of the Mental Health Anti

Stigma Programme

Welcome

Prevention of Self-Harm and Suicidal Ideation Conference

• Setting the Scene • Self Harm and serious Case Reviews – lessons learnt • Acute self harm • Break • Northamptonshire Community & Toolkit• The real story in school • TaMHS – Mental Health in Schools - setting up an

Emotional Health and Wellbeing Team • Action planning• Closing summary

Setting the Scene

Self-Harm = Symptoms

Self-harm across the spectrum

Why is Emotional Well Being and Mental Health for Children important?

Emotional wellbeing underpins being successful at school, making and keeping friendships and making the most of life.

Approximately 50% of lifetime mental illness starts before the age of 14 and it is estimated that potentially half these problems are preventable.

Self Harm can sometimes be a coping mechanism or fashion, but it can also lead to significant harm and occasionally suicide. It is not the act that matters, but the intent.

Around 1 in 10 children and young people may have a mental health problem at any one time. Referrals have increased by 27% in Northamptonshire over the last 3 years with 6.5% of all children getting support

Self-harming admissions are higher in Northamptonshire than the national average. Research suggests self-harming behaviours are average.

In adulthood half of all women, and a quarter of men will be affected by depression at some stage in their life.

Recent Northamptonshire Public Health assessment suggests local wider costs £1347 million due to mental illness

When it comes to children and young people, 1 in 10 children self-harm, with suicide accounting for 20% of deaths in young people between the ages of 15-24.

Key Findings from CYP Survey (775 Responses)

Unmet needs continue to feature which do not fit in defined Specialist CAMHS criteria e.g. challenging behaviour, self harm as a coping mechanism. We are working together to resolve.

73% of a significant sample of young people have body image concerns, this increases to 90% of the sample of CAMHS users. Young people suggest this is sometimes a cause for self-harm.

Behaviour Issues account for 52% of paediatric referrals and a significant number of CAMHS referrals. If untreated, sometimes these cases may lead to self-harm.

Anxiety and Depression is the number 1reason for referral (and can lead to

eating issues or self harm as a coping mechanism). Young People increasingly find self harm is an acceptable coping Mechanism.

We are a national outlier for self harm due to the adherence of NICE guidance, though we are about average in presentation numbers by NHS estimates.

There is a significant lack of knowledge of services, what is available and how to access. If in doubt, visit www.asknormen.co.uk

What is self-harm?• Self-mutilation

• Self-destructive behaviours (compulsively pursued acts that causes self-harm e.g. head banging)

• Self-harm without suicidal intent

• Attempted suicide

• Minority who self-harm attend A&E departments or specialist services

• Most are supported in the community

• Most young people who self-harm do not continue with this into their 20’s

How many young people self-harm?• Rarer in pre-teens (but locally this is growing)

• 10% of adolescents in the UK self-harm• At 14yrs; 25% Females & 14% Males experience suicidal ideation

• Only 2-3% present to medical services

• Huge number remain unknown (behaviour self harm has been anecdotally estimated at 50%)

Self Harm is not the issue, it is the cause and intent that matter most. Less than 4% of self harmers go on to have enduring mental health needs.

National and Local Statistics• 72% of people who seek help for depression are female

• 75% of people who take their own lives are men.

• National rates of self-reported self-harm are 7% for 11-16 year olds but several times higher in those with:

• emotional disorder (28%)• conduct disorder (21%) • ADHD (18%).

• Applying national rates to Northamptonshire would mean that 2940 11-16 year olds would report self-harm. Our actual figure is lower, though in schools anecdotal evidence suggests the rates could be as many as 50%.

Northamptonshire A&E Admission Rates for Self Harm

Locality

Inpatient Admissions of 0-19's in

2009-10

Inpatient Admissions of 0-19's in

2010-11

Inpatient Admissions of 0-19's in

2011-12

Inpatient Admissions of 0-19's in

2012-13

Western Northampton 51 60 64 55

Kettering 35 51 40 49

East/Southern Northampton 30 48 55 40

Central Northampton 44 43 55 28

East Northants 15 19 20 26

Daventry North 28 30 23 23

Corby 29 28 24 25

Wellingborough 15 21 14 20

Daventry South 14 17 18 17

Oundle & Wansford 1 0 1 4

Not coded 19 15 23 12

Total 281 332 337 299

Hospital Admissions (Approx)East Midlands 2010

• Under 10 yrs Low figures

• 10-14 yrs 350

• 15-19 yrs 1500

• 20-24 yrs 1300

• 25-29 yrs 1000

• 30-34 yrs 800

• 30-39 yrs 1100

• 40-44 yrs 1200

• 45-49 yrs 700

• 50-54 yrs 550

• 55-59 yrs 300

• 60-64 yrs 170

• 65-85+ yrs figures reduce

Under 18’s Hospital Admissions by PCTEast Midlands 2010

• Derbyshire 210 12.4

• Derby City 104 17.4

• Nottinghamshire 164 9.2

• Nottingham City 118 17.3

• Northamptonshire 220 12.8 Per 10,000 area population • Leicestershire 199 12.2

• Leicester City 91 11.2

• Lincolnshire 155 9.8

• East Midlands Total 1261 12.0

What are we doing about self-harm? Short Term

• The conference highlights the new self- harm toolkits for Northamptonshire on www.asknormen.co.uk

• Web resources for young people by young people available on http://www.talkoutloud.info/how-do-you-feel/self-harm.aspx

• We have redefined the acute self harm and suicidal ideation pathway

• We are actively working with Northampton and Kettering Locality Forums to embed action plans with excellent examples of best practice at schools such as Northampton Academy & Kettering Buccleuch Academy.

• Auditing Urgent Care Admissions

• Developing questionnaires for acute self-harmers

What are we doing to reduce self-harm? Long Term

• The 2014-17 Children and Young People Emotional Wellbeing and Mental Health Strategy looks at improving emotional resilience

• The Partnership are working to improve outcomes relating to challenging sexualised behaviours, drug and alcohol misuse, parental mental health and interpersonal violence

• Initiatives to improve family relationships, resilience and coping strategieso Five to Thriveo Targeted Mental Health in Schools (TaMHS)o Talk Out Loud Anti Stigma Programmeo Working with School Nursing as a part of the National Call to Action

• Support of adults with mental health concerns or harmful behaviours

• Developing the Children’s Community Health Services

Priorities for the 2013-17 Emotional Wellbeing and Mental

Health Strategy• The promotion of positive emotional wellbeing and early intervention

• Improved integration in targeted and specialist services including a single point of access

• Better support for children and young people who are chronically or acutely unwell

• Strengthened thresholds and pathways for behavioural and neurological developmental issues

• Focus on key groups of vulnerable children and young people to prevent poor emotional wellbeing outcomes and ensure there are appropriate interventions when they require additional support

Northamptonshire Children and Young People Community Health

Transformation Programme

When to make Referrals

Integrated Children & Young People’sSpecialist Health Service

CYP Referral Management Centre

Single Specialism

UrgentReferrals

IntegratedSpecialist Pathway

IntegratedAssessment &

Treatment

Non-UrgentReferrals

Transitions

Short Breaks

CAMHS In Patients

Countywide offer

delivered in Localities

Physiotherapy CAMHSCommunity

Children’sDietetics

CommunityPaediatrics

LookedAfter

Children

OccupationalTherapy

Speech &

LanguageTherapy

ADHD & ASD

ADHD & ASD

Children’sSpecialist Nursing

Children’sSpecialist Nursing

Dealing with Child and Young People presentations within local settings

• Doing Well – expected that universal services engage – e.g. the Talk Out Loud Anti Stigma programme/TaMHS work in schools to promote mindfulness

• Doing alright or with a single issue. Targeted Services to cover –(largely NCC services) – Self Harm as a behaviour may fit into this. School Nursing or Health Visitors may be appropriate

Where professionals are uncertain, it may be worth contacting the CAF Co-ordinator and attending complex case meetings

• SOME NOTICEABLE PROBLEMS – in more than one area. Variable functioning with sporadic difficulties or symptoms in several but not all social areas. Disturbance would be apparent to those who encounter the child in a dysfunctional setting or time but not to those who see the child in other settings. Targeted Plus services to cover e.g. Counselling services or some services by NCC

If the presentation is largely effecting children within school settings, it may be worth using the pupil premium to commission any support such as family support or education psychology services.

When to make a referral to the Referral Management Centre for CAMHS/Paediatrics?

• Specialist Services (e.g. CAMHS) to cover - OBVIOUS PROBLEMS – moderate impairment in most areas or severe in one area - Moderate degree of interference in functioning in most social areas or severe impairment functioning in one area, such as might result from, e.g. suicidal preoccupations and ruminations, school refusal and other forms of anxiety, obsessive rituals, major conversion symptoms, frequent anxiety attacks, frequent episodes of aggressive or other antisocial behaviour with some preservation of meaningful social relationships.

• SERIOUS PROBLEMS – major impairment in several areas and unable to function in one area Major impairment in functioning in several areas and unable to function in one of these areas, i.e. disturbed at home, at school, with peers or in the society at large, e.g. persistent aggression without clear instigation; markedly withdrawn and isolated behaviour due to either mood or through disturbance, suicidal attempts with clear lethal intent. Such children are likely to require special schooling and/or hospitalisation or withdrawal from school (but this is not a sufficient criterion for inclusion in this category).

If uncertain, there is a CAMHS PROFESSIONAL CONSULTATION LINE Monday to Friday 9.30am—1.00pm Tel: 0300 1111 022

When issues are treated as urgent?• Highly Specialist Services (e.g. Crisis team/Inpatient) - SEVERE PROBLEMS - unable to function in

almost all situations - Unable to function in almost all areas, e.g. stays at home, in ward or in bed all day without taking part in social activities OR severe impairment in reality testing OR serious impairment in communication (e.g. sometimes incoherent or inappropriate).

• VERY SEVERELY IMPAIRED -considerable supervision is required for safety Needs considerable supervision to prevent hurting others or self, e.g. frequently violent, repeated suicide attempts OR to maintain personal hygiene! OR gross impairment in all forms of communication, e.g. severe abnormalities in verbal and gestural communication, marked social aloofness, stupor, etc.

• EXTREMELY IMPAIRED - constant supervision is required for safety Needs constant supervision (24-hour care) due to severely aggressive or self-destructive behaviour or gross impairment in reality testing, communication, cognition, affect or personal hygiene.Working as a self- harm team, consider peer support/supervision and confidentiality issues.

Websites and Links

Northampton Young Healthy Minds Gateway- www.asknormen.co.uk

CAMHS- http://www.nhft.nhs.uk/main.cfm?type=CONTENTCAMHS

Northampton Youth Forum- http://www.northampton.gov.uk/info/200124/forums/329/northampton_youth_forum

Northamptonshire Parent Forum Group-www.northantspfg.co.uk

Out There- http://www.thelowdownevents.info/new-youth-group-out-there/

Shooting Stars- http://www.northantspfg.co.uk/shooting-stars/

Talk Out Loud – www.talkoutloud.info

Young Minds- http://www.youngminds.org.uk/

Youth Space - www.youthspace.me

Northamptonshire CAMHS Review: http://www.neneccg.nhs.uk/cyp-services/

NORTHAMPTONSHIRE’S STRATEGY FOR THE EMOTIONAL WELLBEING AND MENTAL HEALTH OF CHILDREN AND YOUNG PEOPLE 2014 –2017 http://www.neneccg.nhs.uk/modules/downloads/download.php?file_name=1156

Websites and Links – Youth Counselling

• Youth Counselling across the county - http://www.servicesix.co.uk/

• Northampton - http://thelowdown.info/

• Daventry - http://www.time2talk.org.uk/

• Kettering and Corby - http://kyi.org.uk/

• Oundle - http://www.oundle.gov.uk/oundle-town-council-properties/courthouse/chat/

• Wellingborough - http://www.servicesix.co.uk/

• ADHD Support - http://www.autismconcern.net/index.php?option=com_content&view=article&id=195:new-adhd-a-as-dual-diagnosis-provision-in-northamptonshire

• Prevention of Self-Harm and Suicidal Ideation Toolkit http://www.asknormen.co.uk/self-harm-and-suicidal-ideation-conference-resources/

• And new for supporting training in 2015/2016 https://www.minded.org.uk/

Self Harm and serious Case Reviews – lessons learnt

Case Vignette

Maggie Beer