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Children and young people’s mental health care system set for shake-up

PUBLISHED: 12:34 17 April 2018 | UPDATED: 12:34 17 April 2018

Picture: Time to change/Newscast Online

Picture: Time to change/Newscast Online

Time to change/Newscast Online

“The system is complicated, with no easy or clear way to get support.”

Mental Health. Pictured: Two women hold hands. Picture: Time to change/Newscast OnlineMental Health. Pictured: Two women hold hands. Picture: Time to change/Newscast Online

That was the assessment of mental health services for children and young people across the country, given last year by regulator the Care Quality Commission (CQC).

In Norfolk and Waveney, services - like elsewhere - came under strain as a 10 - 15pc increase in referrals was recorded year-on-year.

And mental health was clearly on the consciousness of the region’s young people as county-wide it ranked fourth in issues important to them.

In 2017/18 it was estimated there were 18,154 children aged under 18 with a mental health condition in the area.

Mental Health. Pictured: A woman is consoled by her friend - hands only visible. Picture: Time to change/Newscast OnlineMental Health. Pictured: A woman is consoled by her friend - hands only visible. Picture: Time to change/Newscast Online

Nearly 11,000 of those were referred to services, provided by a variety of organisations.

Despite this, the region’s mental health trust, Norfolk and Suffolk Foundation Trust (NSFT), which sees the most severe patients, was consistently seeing more than 98pc patients aged under 18 within the 12-week target. While the median waiting time for treatment at the trust was 14 days, in the 10 lowest waiting times nationally.

But unlike elsewhere NSFT was turning down more referrals than anywhere else in the country last year.

A report from the Education Policy Institute revealed more than a quarter of children referred to specialist mental health services in 2016/17 nationally were not accepted for treatment.

Mental Health. Pictured: A woman is consoled by her friend. Picture: Time to change/Newscast OnlineMental Health. Pictured: A woman is consoled by her friend. Picture: Time to change/Newscast Online

But this more than doubled at NSFT with 64.1pc of referrals being turned away - the highest proportion in the country.

Claire from Norwich, who did not wish to give her surname, was only too aware of this.

The mother-of-two said when her son Paul was just nine, he became suicidal when he realised his autism made him different to his peers.

A three-year waiting list for diagnosis forced the family to go private for the diagnosis. But Claire said: “We were faced with little help and understanding from teachers and were turned away from CAMHS because my son wasn’t ‘suicidal enough’.”

Now Paul, 11, receives help from CAMHS when he needs it, but Claire said there should be more resources put towards children and young people.

Rob Mack, locality manager for children, families and young people’s services in Norfolk and Waveney said the trust wanted to ensure all children needing support were able to access services as required and they had branched out into offering sessions at more flexible times to help with this.

He said: “If a young person has needs which can be better and more appropriately met by another service, we will refer them on, including to our own Wellbeing services which can support children and young people with lower levels of stress, anxiety and depression.”

Claire added every member of staff she had contact with was “brilliant”.

And a spokesman for NSFT welcomed Claire’s praise for staff once they were accepted. They said: “It is gratifying for our staff to learn the people we are here to serve are satisfied with the care we provide and to hear that we are making a positive difference.

“We also welcome calls for additional expenditure for mental health services, both locally and nationally, from service users and their families.”

For others, even when they were granted a referral they felt like they were let go too soon.

Adam, 18, a student from Norfolk was referred through to CAMHS when he tried to take his own life.

He said: “I was diagnosed with post-traumatic stress disorder, depression and anxiety. I had four sessions with a family therapist but then they discharged me because they thought we were coping.

“But I was still depressed and things hadn’t got any better.”

Finally, Adam was offered cognitive behavioural therapy, which he said did not help, and after a serious attempt on his life he was eventually admitted to hospital - but not after a week-long wait for a bed.

He spent seven weeks in hospital with access to 24-hour counselling, but when he went home sessions were only available once a week.

For Adam, this was not enough, and he was forced to turn to charity Childline for help instead.

He said: “If it wasn’t for Childline I might have been sectioned or I might not even be here today.”

Mr Mack, said: “We work with young people and their families to plan for and support discharge to ensure they leave our service only when it safe and clinically appropriate to do so.“

Why are young people experiencing mental ill health?

The demand for mental health services in general has increased in recent years, but some of the most intense pressure has been in CAMHS.

Research shows that children and young people today are more likely to be depressed than generations before them.

In young people born in 1990/01, a decade before the millennials, it was found that 12pc of girls and 5.5pc of boys were depressed, compared with 24pc of girls and 9pc of boys born in 2000/01.

And while it is not clear exactly why this is, those studying the increase have some ideas.

Children today face huge pressures, especially in adolescence. This is fuelled by pressure over exams, body image, a changing society, among other things.

Digital technology also has a part to play. Cyber-bullying has brought trauma you could previously shut the door on into bedrooms and living rooms.

And images perpetuated online can create an environment where young people feel inadequate.

A fractured landscape

There are a number of different providers who deliver CAMHS across Norfolk and Waveney, and those reviewing CAMHS have admitted services are not well integrated.

The most well-known is NSFT, but they are only commissioned to provide care for the more serious conditions.

This does not always mean inpatient units - although they do run those - but also support in the community and at other centres.

Charity Ormiston Families runs the Point 1 service for mild to moderate issues.

The Starfish Teams through Norfolk Community Health and Care look after community-based support for complex learning disabilities, and the same trust provides the ADHD nursing service.

However NSFT also provides ADHD services in Great Yarmouth, at the Silverwood centre.

Outside of NHS provision, a number of charities also provide help including Relate, the YMCA, or Young Minds.

A CAMHS overhaul?

Over the coming months and years, CAMHS is undergoing an complete overhaul.

Commissioners and the county council are changing the way services are provided to make them more joined up, and increase the number of young people they reach.

The ambition is to redesign the whole system to reach 65pc of all children and young people with a diagnosable mental health need.

It is also hoped gaps in service can be addressed, as well as tackling problems which come with having several providers.

Commissioners committed £1.9m a year up to 2020 to help with the change.

When plans were first announced Clive Rennie, from the mental health commissioning team, said: “Our plans are ambitious and it will be challenging to deliver everything we aspire to. But there is a commitment from all of us in health and our partner organisations to make some vital improvements for our young people.”

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