Only a complete overhaul of children's mental health services would have a shot at stopping long waiting times and youngsters being 'bounced between' services.
That was the conclusion of a report into children and young people's (CYP) mental health services in Norfolk and Waveney.
The report said there had been suggestion that money which had been meant for children's mental health care had been held back to help organisations balance the books.
But Rebecca Hulme, chief nurse at Great Yarmouth and Waveney Clinical Commissioning Group (CCG) denied this was the case and said all £1.9m extra a year put aside for CYP services had been spent in the area.
The report, commissioned by the county council and NHS also found:
- Relationships between providers and those holding the purse strings were "very poor";
- Those on the frontline line had significant concerns about the closure of children's centres in Norfolk;
- And Norfolk County Council children's services department boss will now oversee CYP mental health services in the area.
The report, which was carried out by consultancy Rethink Partners - not to be confused with the mental health charity of a similar name - also found there was considerable tension between the vast number of players in the CYP system, and a "reluctance to surface and address difficult or contentious issues".
But Sara Tough, director of children's services at Norfolk County Council, said many of the issues highlighted had already been tackled and that bosses felt positive about the future vision.
She said: "Between the county council and the CCGs, we both felt we had done some good work around our local transformation plan for children's mental health, but it was not having the impact in terms of the preventative intervention we were hoping for, what we really wanted to do was be more creative."
Ms Tough said the idea was for the council and CCGs to work closer together, and already she had been heading up work on CYP services.
Ms Hulme added: "We had initially some really excellent services but they were not connecting well."
One of the biggest challenges for CYP services was money, and the report found there was "a clear perception that not all of the additional funds that were allocated for CYP mental health services were actually released, with some organisations holding funding back to offset wider financial pressures. There is a lack of transparency over this issue, causing considerable mistrust and some resentment across the system".
But Ms Hulme said this was not the case and that different commissioners had spent the money in different ways, while there had been confusion over whether this was extra money or not.
She said: "The funding that came through, that NHS funding, we had to find that in budgets."
She added: "The money is being spent, and I think there's been a lot of confusion."
Ms Tough also said problems identified in the report of organisations clashing had been fixed. She said: "I think we're already overcoming many of those issues simply by doing these pieces of work."
And she said by acknowledging organisations wanted to work together many of those walls were coming down.
But she stopped short of saying it was a merger, and added: "I think it would be different if we were talking about mergers."
Both Ms Tough and Ms Hulme said the criticism in the report did not come as a surprise, but both the county council and the NHS were keen for a new way forward.
Ms Tough's authority also came under scrutiny over the decision to close 38 of Norfolk's 53 children's centres, as the report revealed in several cases organisations had "significant concerns about the possible knock-on impact of the proposals on other services".
Ms Tough said: "We are really excited about this, there is a lot of motivation to work together. That feels like a really positive place."
How do the children feel?
One of the participants in a focus group, as part of the research, said: "You know when you're swinging on a chair? That moment where you're not sure if it's about to fall? That's how I feel, all day, every day."
The report found: "Children and young people in Norfolk and Waveney are overwhelmingly contemplating emotional and mental health issues in their daily lives.
They appear resilient on the face of it, but they have a perception that they need to 'deal' with issues themselves - in order to avoid burdening friends and family.
There is a dearth of opportunities for young people to discuss emotional wellbeing and to build resilience and skills and there is little knowledge on how to access support."
Meanwhile GPs reported being "exasperated" by the system, and staff delivering services "highly pressurised and in parts undervalued".
'This is not good enough'
Liz Wormald, a family support worker at Allsorts CIC in Lowestoft, said her experience of children and young people's mental health service drove her to start her own support groups.
Ms Wormald's 14-year-old daughter Holly struggled to get help to the extent that Ms Wormald and her husband had to take photographs of the self-harm wounds to try and get her into services. She said: "This is not good enough, we need to all work together, waiting times are horrendous."
She said that her daughter was able to hide her illness and would tell professionals she was okay, but that was not the case. However it led to her not getting the help she needed. She said: "Parents do need to take better responsibility and we need to stop CAMHS [children and adolescent mental health] bashing, but we also need the parent bashing to stop."
- For more information on Allsorts search Allsorts Support Lowestoft on Facebook.
What does the future hold?
The report said there was a "strong vision for the future [...] that breaks down traditional tiers, focuses on prevention and resilience and is driven by outcomes".
But at the moment this is not well understood, and there is not a clear way forward.
It was suggested that CYP mental health and children's services would work closer together, and the report writers suggested doing away with differentiating between services which provide less intensive support and more intensive support.
Ms Tough said: "I'm hoping children and parents will be able to say 'we don't experience lots of waiting times any more, we don't feel we are being pushed from one service to another service'."
Ms Hulme added: "We've all got that shared vision and outcomes. We will all be working towards the same end goal. I would hope the experience is a lot easier to access."
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