Children and Young People’s Mental Health Herefordshire CAMHS Dr Clair ire Middle dle Lead Psychologist Hereford CAMHS
quiz 1. What percentage of young people in this country has a diagnosable mental health condition? 2. What percentage of adolescents experience a mental health problem in any given year? 3. What percentage of mental health problems are established by age 14? 4. What percentage of mental health problems are established by age 24?. 5. How many times more likely are children with behavioural disorders i) to be dependent on drugs ii) to die before the age of 30 iii) end up in prison.
What are we talking about? • 1 in 10 children in this country has a diagnosable mental health condition. • 20% of adolescents may experience a mental health problem in any given year. • 50% of mental health problems are established by age 14 and 75% by age 24. • The long-term effects can be crippling: children with behavioural disorders are 4 times more likely to be dependent on drugs, 6 times more likely to die before the age of 30, and 20 times more likely to end up in prison.
Local If one in ten children in this county has a diagnosable mental health condition, that’s 3,170 under 16 year olds If add the number of children and young people with poor emotional resilience, this is estimated to increase to 8,620 children and young people.
How do we understand children’s mental health Children mental health has to be understood in the context of systems they live in (Bronfenbrenner 1979)
Effects of context and environment • Children are powerless to change their context and environment. • The Adverse Childhood Experiences Research brings this into sharp relief
Adverse Childhood Experiences (ACEs)
Rethinking trauma • Trauma is not just those obvious and serious trauma • Trauma is subjected – based in the meaning and experience of the person • We know reactions to trauma are individual influenced by previous experiences, resilience and support available
Adverse Childhood Experiences (ACEs)
How do ACEs Affect Health? Through stress: Frequent or prolonged exposure to ACEs can create toxic stress which can damage the developing brain of a child and affect overall health.
We are the sum of what we have experienced Hitting out Seeking reassurance Controlling behaviours Sabotage Isolation Dependency Poor identity Unable to trust Shame formation Poor attention Low self esteem Loss Trauma Neglect Deprivation Inconsistency
Effects of toxic stress
Adverse Childhood Experiences (ACEs)
Strategy Future in Mind (2015) set out guidance for improvements in mental health services for children and young people Under the Children and Young People’s Partnership for the county, there is a Children and Young People’s Mental Health Partnership. P.S. In 2015/16, this plan was rated as in the top 20 (out of 121 plans) in England.
Outdated models of children’s mental health? • Heavily influenced by ‘adult mental health’ • Leads to a ‘within child’ model • Activity is measured by direct contacts • Administration is organised around a ‘named child’ • Evidence base organised around ‘disorders’ located within the individual (Nice Guidelines) • Medication entirely locates the problem within the child • Expectation to ‘fix’ the child is pervasive
With-in child model The Adverse Childhood Experiences Research seriously challenges this – as it clearly demonstrates that life experiences and physical and mental health are inextricably linked
‘Tier’ system
How do we understand children’s mental health in CAMHS? Psychological Formulation FAMILY COMMUNITY SCHOOL CHILD SOCIETY We formulate what may be contributing to the difficulties and try and intervene accordingly - but the pressure to work primarily with the individual child is everywhere.
One size doesn’t fit all? • Services are designed in such a way that they don’t meet the needs of all • The more severe the ACEs, the less appropriate traditional services are • Parent’s and children are can feel ‘blamed’ for ‘failure to engage’ • Mental Health professionals are measured on ‘outcomes’ and so feel like they are failing when children don’t ‘fit’ the service • Resources are put into turning away ‘inappropriate referrals’
Costs and use of resources
Giving children the right help, at the right time, in the right place • We rely on the information from referrers, families, schools to determine this • We seek to ensure that we accurately understand the difficulties to the best of our abilities • We want to avoid unhelpful, inaccurate diagnoses and focus on children’s strengths and resources
Consequences of abuse and neglect In severe cases of abuse and neglect ‘symptoms of disorder ’ and ‘signals of distress ’ are indistinguishable Romanian Orphanage Studies ( 1990’s)
Behaviour and ADHD Is it helpful to label a child with ADHD when their behaviour is in response to their environment, yet they present in the same way . Elspeth Webb (2014)
New models of children’s mental health Based on the evidence that brain development and environment are inextricably linked Starts from the view that signs of distress in children are signs that something is wrong in the environment NOT that something is wrong in the child.
Key Areas of transformation Improved crisis care right Improved transparency & accountability A better offer for the most place, right time, close to across whole system vulnerable children & young people home Improved public awareness, less Timely access to More evidenced-based More visible & accessible fear, stigma & discrimination clinically support outcomes focussed support treatments Professionals who work with Model built around the needs of Improved access for parents to CYP trained in child CYP, and move away from the tiers evidence-based programmes of development & MH model intervention & support Source: Future in Mind Overview by 2020 27
How are CAMHS raising to the challenge? • Give message that distress is not a sign of disorder but rather a signal to the world that all is not right somewhere in their world • Let the adults in their lives make changes before a decision is made whether the child would benefit from therapy • De-stigmatise mental health • Offer intervention where it seems helpful
How are we doing this? • Family/systemic based approach • More training offered by CAMHS to our partners • More consultation offered to adults caring for/supporting children • Development of specialist services addressing key mental health needs
Training: Being attachment aware Research shows that schools who are understanding of children’s emotional and attachment needs are able to: • Raise attainment • Make less use of exclusions • Lower the number of recorded behaviour incidents • Improve children’s life chances • Improve staff wellbeing and confidence (including in adult self- regulation)
Local Performance • Most CYP are seen • Waiting times: CAMHS within 4 weeks for an is contracted to see CYP assessment but can be in under 4 weeks from seen on the same day if referral to assessment; the referral is urgent. 18 weeks from referral • 75%+ of CYP receive to treatment. treatment within 10 weeks of referral.
Local Performance Hereford CAMHS ‘benchmarks’ performance against national services and near neighbours (in terms of geography and also those who deliver services in similar rural localities). Regionally and nationally, Hereford CAMHS performs highly regarding access and waiting times.
What’s new? Eating Disorders Team New monies have enabled us to develop an Eating Disorders Team . We have 1.6 WTE staff to: • Assess and treat CYP with Eating Disorders, • Support the wider CYP workforce to develop skills to feel confident in identifying eating disorders in CYP, how to refer to Hereford CAMHS and how to support CYP while they are receiving treatment. There are national targets attached to this – in urgent cases, CYP must receive treatment within 7 days of referral , and in routine cases, treatment must start within 28 days of referral .
What’s new? CAMHS Duty Team Our duty team can be contacted on 01432 842233 to discuss any concerns you have about a CYP’s mental health. They can provide general advice, signposting suggestions and information about making a referral. They can be contacted for urgent advice when you are concerned that a CYP may be at significant risk of harm to themselves or others related to mental ill health. They will advise you if they think you need to contact MASH. Where a person has suicidal ideas and/or a suicide plan, contact the CAMHS duty team on 01432 842233.
New posts: • Case consultation & supervision to social care teams, Youth Justice Team, Children’s Ward to support carers and professionals meet young people’s emotional and psychological needs • Improving access worker – offering specialist assessments and advice for young people where a clinic based model is unlikely to be helpful
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