This document summarizes a presentation on extending early intervention services to additional mental health conditions beyond psychosis. It discusses how early intervention aims to improve outcomes by promptly starting effective treatments and providing intensive support. The network's priorities are outlined, which include identifying conditions early in adolescence/early adulthood where early intervention may be effective. Obsessive compulsive disorder is provided as an example condition that meets the priorities, as evidence demonstrates it often has onset in young people, can become severe and enduring without treatment, and responses well to early interventions. The case is also made for early intervention in anorexia nervosa based on evidence that outcomes are better when treatment is provided within the first three years.

1. Improving Access to Mental
Health Services by 2020
31st March 2015
@Time4Recovery #EI2020

2. House Keeping
Fire Exits
Bathrooms
Pictures & Video
Twitter & Social Media
@Time4Recovery #EI2020

3. Welcome & Opening Remarks
Gary Ford CBE
Chief Executive, Oxford AHSN
31st March 2015

4. AHSN core purpose – health and wealth
• Licensed by NHS England for 5 years to deliver four objectives:
• Focus on the needs of patients and local populations: support and work in partnership
with commissioners and public health bodies to identify and address unmet health and social
care needs, whilst promoting health equality and best practice.
• Speed up adoption of innovation into practice to improve clinical outcomes and patient
experience - support the identification and more rapid uptake and spread of research
evidence and innovation at pace and scale to improve patient care and local population
health.
• Build a culture of partnership and collaboration: promote inclusivity, partnership and
collaboration to consider and address local, regional and national priorities.
• Create wealth through co-development, testing, evaluation and early adoption and spread of
new products and services.
#ei2020

5. What and where are we?
Oxford AHSN – 1 of 15 in England
3.3M population
Annual NHS spend circa £5bn
NHS employees 65,000
12 Clinical Commissioning Groups
4 Local Enterprise Partnerships
12 Councils
Major international companies
300 Life Sciences businesses
Complex landscape with many providers and agencies
#ei2020

6. Our healthcare, academic and LEP partners
11. South Central Ambulance Service FT 11
#ei2020

7. Early Intervention in Mental
Health Network – a year in
Belinda Lennox

8. PSYCHOSIS:
Costs £11.8 billion
per year
(Schizophrenia Commission ‘The
Abandoned Illness’ 2012)
#ei2020

9. the most positive development in mental health
services since the beginning of community care.
...no where else have we seen the constant high
standards, recovery ethos, co-production and
multi-disciplinary team working.
“
“
”
”
Schizophrenia Commission, 2012
#ei2020

10. Source: A Lost Generation, Rethink 2014 #ei2020

11. Source: A Lost Generation, Rethink 2014 #ei2020

12. Oxford AHSN Early Intervention in
mental health theme will:
• 1. Reduce variation in care in early psychosis
across the AHSN and improve outcomes
• 2. Increase research activity in early psychosis
– in causes, treatments and service delivery
• 3. Extend early intervention across other
conditions
#ei2020

13. • What proportion of young people with a first
episode of psychosis in the Thames Valley
currently have access to an Early Intervention in
Psychosis service?
#ei2020

14. Proportion of young people with
psychosis in Thames Valley under EIP
service = 20%
#ei2020

15. #ei2020
Given that 6% of all young people are not in
employment education or training, to the nearest 10%,
what % of young people with psychosis do you think are
NEET in Thames Valley?

16. Not in Education, Employment Training with psychosis: 70%
19%
24%
12%
26%
22%
15% 18%
27%
18%
14%
23%
27% 28%
9%
6%
7%
9%
10%
8%
7%
7%
9%
10%
14%
15%
9%
72% 70%
81%
64%
68%
77% 76%
66%
72%
76%
63%
58%
64%
100%
NHS
Wokingham
CCG
138
NHS
Windsor,
Ascot and
Maidenhead
CCG
148
NHS South
Reading
CCG
194
NHS Slough
CCG
272
NHS
Oxfordshire
CCG
747
NHS North
& West
Reading
CCG
150
NHS
Newbury
and District
CCG
123
NHS Milton
Keynes CCG
357
NHS
Chiltern
CCG
387
NHS
Bracknell
and Ascot
CCG
213
NHS
Bedfordshire
CCG
448
NHS
Aylesbury
Vale CCG
210
Oxford
AHSN
3,532
Employed
Students in full-/part-time education
NEET (Not in Education, Employment or Training)
Source: Oxford AHSN user data contained in HES and MHMDS datasets licensed from HSCIC, 2014 #ei2020

17. Early Intervention achieves better outcomes for those with
psychosis across Thames Valley
23% 18%
11%
37%
41% 48%
33%
36%
15% 7%
10%
15%
18%
19%
7%
100%
Other
mental
health,
16-35
5,722
10%
Psychosis,
Other Age
Groups
7,068
4%
34%
Psychosis,
Other
teams,
16-35
2,747
8%
Psychosis,
Early
Intervention,
16-35
785
7%
Employed
Unemployed and seeking work
Students in full-/part-time education
Long-term sick/disabled, on benefits
Unknown/Retired
Source: Oxford AHSN user data contained in HES and MHMDS datasets licensed from HSCIC, 2014 #ei2020

18. #ei2020
What is the average length of stay in hospital for a young person with
psychosis?

19. Average length stay = 8 weeks.
40
-31%
Average
inpatient stay
/person/year
(days), 16-
35yrs
57
947
38%
+24%
Proportion
of users
that get
admitted,
2 years,
16-35yrs
31%
Seen only by other teams
Seen by Early Intervention teams in 2010-13
1.5 -10%
Average
admissions
per person per
year, 16-35yrs
1.6
Savings per 16-35 year old person per year
@£300/bed day is £5,100
Source: Oxford AHSN user data contained
in HES and MHMDS datasets licensed from
HSCIC, 2014
16-35 yrs
only
#ei2020

20. How are we making a difference?
#ei2020
Lets hear it from our quality champions..
Make your pledge today

21. Early Intervention in Mental Health:
Extending Early Intervention
Mark Allsopp
Joint Network Lead

22. Early Intervention in Psychosis
intervention n.
Interference so as to modify a process or situation.
• early identification - teenage and early adult
• facilitating access and engagement with services
• reducing stigma
• promptly starting effective treatment
• improving compliance by education and minimising side -effects
• providing intensive psychological and social supports to promote recovery
and prevent relapse

23. Prevention
Primary prevention
Methods to avoid occurrence of disease either through eliminating disease agents or increasing resistance
to disease. Examples include immunization against disease, maintaining a healthy diet and exercise
regimen, and avoiding smoking.
Secondary prevention
Methods to detect and address an existing disease prior to the appearance of symptoms.[1] Examples
include treatment of hypertension (cardiovascular disease), cancer screenings, identification of prodromal
or at risk mental states in Psychosis
Tertiary prevention
Methods to reduce negative impact of symptomatic disease, such as disability or death, through
rehabilitation and treatment. Examples include surgical procedures that halt the spread or progression of
disease, medication compliance and relapse prevention in EIP

24. Early
adjective, earlier, earliest.
1. occurring in the first part of a period of time, a course of action, a series
of events, etc.:
assertive intervention early in the course of a first episode psychosis
2. occurring before the usual or appointed time:
early identification and engagement in EIP service
3. appearing or maturing before most others of its type:
the early presentation of psychosis in a 14 year old.

25. Our Network Priorities
Our focus is :
• on young people in adolescence and early adult life.
• on identifying Mental Health conditions arising in that period of the lifespan early
• on facilitating access to and engagement with services in innovative ways
We will prioritise:
• those conditions with with high continuity and with significant risk of becoming severe and enduring if not addressed early.
• those conditions where there is evidence of, or potential for, effective early interventions
• those conditions where there is evidence of low uptake of interventions.
• and/or evidence of impact of symptoms on social and occupational functioning in adult life and /or cost of health care

26. Find innovative ways to help young people with mental health conditions improve
access and engagement with services, obtain the right intervention at the right time,
and continuity of care
When relevant transfer elements of the early intervention in psychosis model to
other mental health conditions
Explore ways in which existing early intervention in psychosis services might be
extended in scope and time
Through Our Extending Early Intervention Steering Group we want to:

27. Collate the evidence and experiences available nationally and internationally for
services which provide services for 16-25 year olds, and services which provide
alternatives to inpatient admission for young people
Scope the mental health conditions which arise in adolescence and young
adulthood to explore research evidence for the effectiveness of early
intervention strategies
Explore evidence and experience of best practice in transition and joint working
between CAMHs and AMHs to see what can be applied in EIP services locally
Through Our Extending Early Intervention Steering Group we have started to:

29. Alternatives to inpatient mental health care for children and
young people
Sasha Shepperd1, Helen Doll1, Simon Gowers2, Anthony James3, Mina Fazel3, Ray
Fitzpatrick1, and Jon Pollock4
Authors’ conclusions—
The quality of the evidence base currently provides very little guidance
for the development of services.
If randomised controlled trials are not feasible then consideration should
be given to alternative study designs, such as prospective systems of
audit conducted across several centres, as this has the potential to
improve the current level of evidence.
These studies should include baseline measurement at admission along
with demographic data,and outcomes measured using a few
standardised robust instruments.

30. Network of Networks 1
Strategic Clinical Network for Adult Mental Health :
Crisis Care Concordat
Physical Health Monitoring
Strategic Clinical Network for Children and Maternity:
Improved access in community CAMHS
Transition between CAMHS and AMH
Early identification of puerperal psychosis

31. Network of Networks 2
Oxford Academic Health Science Best Practice Networks
Anxiety and Depression ( IAPT):
Social Anxiety
Severe Mood Disorders
IAPT for Teenagers
Dementia:
Identification early in presentation
Services for Younger Adults

32. An Example : Obsessive Compulsive Disorder
Recent Public Health Data of community based samples has improved but confirmed results of
clinical samples from 1980 onwards
Obsessive-Compulsive Disorder: Prevalence, Comorbidity, Impact, and Help-Seeking in the British
National Psychiatric Morbidity Survey of 2000.
Torres et al Am. J. Psychiatry 2006
“Our data suggest that obsessive-compulsive disorder does not fit conveniently into the fashionable
relabelling of neurosis as “common mental disorder” and psychosis as “severe mental illness.”
Obsessive-compulsive disorder is a neurosis that is both rare and severe and should be prioritised
accordingly.”
The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey
Replication ( US 2001 -2003)
Ruscio et al Molecular Psychiatry 2010

33. An Example : Obsessive Compulsive Disorder
Onset in Young People:
Peak incidence between 16 and 19 years with > 90% before 30
12 month prevalence 1.2% , lifetime prevalence 2.3%
Females 1.4%, Males 0.9% . Those with very early onset mainly males
High Continuity
Most run a relapsing and remitting course
Those who develop OCD spend a mean of 8.9 years with the disorder
Prevalence reduces in later adult life

34. An Example : Obsessive Compulsive Disorder
Evidence of Effective Interventions
Trials of SSRI anti-depressants effective in adolescent and adult populations
CBT trials demonstrated effective in adolescent and adult populations
NICE guidance 2005
Each PCT, mental healthcare trust and children's trust that provides mental health services should have
access to a specialist obsessive-compulsive disorder (OCD)/body dysmorphic disorder (BDD)
multidisciplinary team offering age-appropriate care. This team would perform the following functions:
increase the skills of mental health professionals in the assessment and evidence-based treatment of
people with OCD or BDD, provide high-quality advice, understand family and developmental needs, and,
when appropriate, conduct expert assessment and specialist cognitive-behavioural and pharmacological
treatment.

35. An Example : Obsessive Compulsive Disorder
Low uptake of interventions
Significant delay in seeking help : embarrassment , stigma.
57% British sample not in contact with services
US sample higher, but only if co-morbidity. If no Co-morbidity only 14% receiving help
Evidence of impact on social function
Severe or moderate impairment a) Home management 71%, b) work 51% c) relationships 57% d) social
life 53% e) any domain 79%
OR for work or social impairment vs Neuroses 2.8 . 50% living alone. 50% unemployed. 86% earning
under £300 per week
25% reported life-time suicidal acts OR vs Neuroses 2.0

36. An Example : Obsessive Compulsive Disorder
So OCD meets our Priorities and much evidence
already exists.
But is not the only example - where do we put
our energies?
Take for example eating disorders ………

37. The case for early intervention in anorexia nervosa: theoretical
exploration of maintaining factors
Janet Treasure and Gerald Russell
Summary:
Here we revisit and reinterpret the original study in which the so-called ‘Maudsley (London)
model’ of family therapy was compared with individual therapy for anorexia nervosa.
Family therapy was more effective in adolescents with a short duration of illness. However,
this is only part of the story. A later study describing the 5-year outcome contains important
information. Those adolescents randomised to
family therapy achieved a better outcome 5 years later.
Moreover, the group with an onset in adolescence but who had been ill for over 3 years had a
poor response to both family and individual therapy, suggesting that unless effective
treatment is given within the first 3 years of illness onset, the
outcome is poor. We examine other evidence supporting this conclusion and consider the
developmental and neurobiological factors that can account for this.
The British Journal of Psychiatry (2011)
199, 5–7. doi: 10.1192/bjp.bp.110.087585

38. Guidance to support the introduction of access and waiting time
standards for mental health services in 2015/16 :
Eating disorders
The Autumn Statement 2014 outlined the provision of additional funding of £30million recurrently for 5 years to be invested in
a central NHS England programme to improve access for children and young people to specialist evidence-based community
CAMHS eating disorder services.
Part of this programme funding will be used to develop an access and waiting time standard.
The aims of the programme are to:
Deliver swift access to evidence based community treatment for children and young people with eating disorders;
Reduce demand for specialist inpatient beds;
Reduce relapse;
Reduce transfers to adult services and mitigate the problems of transition for young people with eating disorders when they
turn 18 through the development of care pathways for children and young people up to the age of 25;
Ensure a consistent evidence-based outcomes- focussed model of care;
Through ring-fenced investment in specialist eating disorder services, build capacity within general CAMHS so that a greater
number of children and young people with other mental health problems, such as self harm, can access

39. More than 1.6 million people in the UK are estimated to be directly affected by eating disorders (ED). Anorexia nervosa has the highest
mortality amongst psychiatric disorders. The CAMHS Tier 4 review (May 2014) noted that ED was the largest category of sub-specialist beds.
NICE (2004) recommends:
That most people with anorexia nervosa should be managed on an outpatient basis with psychological treatment provided by a service that is
competent in giving that treatment and assessing the physical risk of people with eating disorders.
Family interventions that directly address the eating disorder should be offered to children and adolescents with anorexia nervosa.
Research shows that areas with specialist community CAMHS Eating Disorder services:
Better identify ED in primary care;
Have lower rates of admissions with non-specialist CAMHS admitting more than 2.5 times as many people;
Demonstrate significantly lower relapse rates (5-10%) for children and young people who have responded well to outpatient family therapy
than those following inpatient care and there is some evidence that long-term admissions may have a negative impact on outcomes.
Are more Cost-effective over 2year follow up

40. Eating Disorders
NHS England has commissioned the National Collaborating Centre for Mental Health to set up an Eating
Disorders Expert Reference Group (ERG), which will meet in early 2015.
This is separate from the review NICE is undertaking to the ED guidelines published in 2004, although
information and learning will be shared.
The ERG will develop:
A service model for providers and commissioners;
The access and waiting time standard that will be put in place from 2016; and
A specification for any necessary amendments to the CAMHS Minimum Dataset.
There will be support to train existing and new staff in the appropriate model of care and to assure
progress, including supporting clinical network development.

41. Help clinicians and managers in the Thames Valley area map existing services,
improve early identification and access, and plan for the integration of the new
service model in their locality
Use and share research evidence , local experience and innovation to help
evolve high quality cost effective eating disorders services for young people up
to the age of 25 years
Develop means to benchmark provision and reduce unwarranted variation in
outcome in the Thames Valley area
Through an Early Intervention in Eating Disorders Best Practice Group we could
begin to:

42. Use technology, innovation and young people’ s involvement to improve access and
engagement with services. Explore whether 16-25 services, or alternatives to
admission services are beneficial.
Use existing evidence to transfer when applicable elements of the early
intervention model to other conditions such as OCD, Eating Disorders, Severe
mood disorders and emerging Personality Disorder
Explore ways in which CAMHs and existing early intervention services can work
together to ensure all young people obtain the right intervention at the right
time, are not excluded from evidence based interventions where they exist and
have good continuity of care
In Summary :
Through Our Extending Early Intervention Steering Group we want to:

43. Change from within
Zoe Emms
Kathleen Millar
Lyndsay Gittins
Tsitsi Milo

44. • Reduce variation in care for young people with psychosis across the
AHSN
• Improve outcomes for young people with psychosis
Objective 1: Reduce Variation in Care
#ei2020

45. 23% 18%
11%
37%
41% 48%
33%
36%
15% 7%
10%
15%
18%
19%
7%
100%
Other
mental
health,
16-35
5,722
10%
Psychosis,
Other Age
Groups
7,068
4%
34%
Psychosis,
Other
teams,
16-35
2,747
8%
Psychosis,
Early
Intervention,
16-35
785
7%
Latest across 2 years 2011-12 and 2012-13; Not all service users have Employment status recorded; 16-35 cohort identified by age in 2010-11
Employed
Unemployed and seeking work
Students in full-/part-time education
Long-term sick/disabled, on benefits
Unknown/Retired
Source: Oxford AHSN user data contained in HES and MHMDS datasets
licensed from HSCIC, 2014
Comparison of Education, Employment Status
#ei2020

46. • Reduce variation in care for young people with psychosis across the
AHSN
• Improve outcomes for young people with psychosis
Objective 2: Common Assessment
#ei2020

47. • Increase research activity and recruitment to research amongst young
people experiencing a first episode of psychosis
Objective 3: Increase Research Participants
Measure Target Timing
Research champions identified in EIP teams 4 QC & 2 RAs
recruited
August
2014
Number of research studies and current activity identified Number of
participants
per study
October
2014
Database of research ready participants in EIP Develop secure
database
July 2015
Accruals to Portfolio research studies 50% increase
ref: 2013
April 2016
Number of research studies active in EIP Increase ref:
2013
April 2015#ei2020

48. #ei2020

49. Addictions
Anxiety
BiPolar
Depression
Developmental
disorders
Eating disorders
Learning
Disabilities
Personality
disorders
Physical
Psychosis
Self harm
Service evaluations
Social
Other
Mental Health Studies by Disorder Nationally
#ei2020

50. • Improved transition between child and adult mental health teams
• Extend early intervention for young people with other conditions
Objective 4: Extend EI Model to Other Conditions
#ei2020

51. Mind the Gap
AMHS
18-65 years
Primary Care and General Practitioners
EIP*
14-35 years
*For psychosis only
CAMHS
0-18 years
#ei2020

52. Resilience Development
in Schools
Whole school approach to
mental health and wellbeing
– ethos, curriculum, positive
behaviour, anti-bullying,
pastoral care…
Resilience Development in
Communities
Strong network of youth
services, voluntary and
community organisations,
confident and skilled to support
and intervene early
Responding to Distress
Frontline staff in many
agencies should be helped to
develop confidence and
supported to intervene and
help children and young
people in situations of
distress, including self harm
and risk of suicide
Guiding Through the
Service Maze
Children, families & young
people have range of
support options for early
intervention and need to be
helped to find their way to
appropriate help quickly
Peer help & Social Media
Those who share their
problems enjoy better mental
health - build opportunities for
young people to provide peer
support, and to use social
media for wellbeing
One Good Adult
Importance of dependable
adult to support and
protect mental health of
child and young person –
e.g. strengthen parenting,
mentoring, guidance,
befriending initiatives
Systematic Review: Improving Continuity of Care
#ei2020

53. Thank you
Any Questions?

54. School-based mental health services
Looking to the future
Mina Fazel
NIHR Post-Doctoral Research Fellow,
Department of Psychiatry, University of Oxford
Consultant in Child and Adolescent Psychiatry
Children’s Psychological Medicine, Oxford University Hospitals

55. • Mental health of school-aged children
• School-based mental health
– What is it?
– TaMHS project
• Oxfordshire PCAMHS InReach service
– What has happened so far
– Advantages and challenges of working in school
– Future
Overview

56. Chief Medical Officer
“There is a great need for earlier treatment
for children and young people with mental
health problems. Half of adult mental
illness starts before the age of 15 and 75%
by the age of 18. Unless young people get
help, they risk a life of problems including
unemployment, substance misuse, crime
and antisocial behaviour. Under-investment
in mental health services, particularly for
young people, simply does not make sense
economically”
CMO Annual Report, 9th September 2014

57. Children‘s mental health needs in the UK
40%
 Currently treated within NHS context
 Effective psychological interventions
exist
 Children with significant clinical needs not
effectively reached by mental health
providers
 High persistence of disturbance into adult
life
 School front-line workers (TAs, SENCOs)
already spending considerable time
supporting these children
 Vulnerable populations overrepresented
in this group
20%
4%
10%
60%
90%
Anxiety or
Depression
Conduct
Disorder
ADHD
Other (1%)
Children
untreated
*
Children with
psychiatric disorders
*

58. In a given classroom of
25 students….
1 in 5 will
experience
a mental
health
problem of
mild
impairment
1 in 10 will
experience
a mental
health
problem of
severe
impairment
Less than half of those who need it will get services

59. IS IT IMPORTANT TO IMPROVE
EARLY DETECTION OF MENTAL
HEALTH PROBLEMS IN YOUNG
PEOPLE WITHOUT PARALLEL
INCREASES IN SERVICE PROVISION?
Question 1

60. WHAT IS A MAIN REASON WHY
YOUNG PEOPLE WHO MIGHT NEED
SERVICES DO NOT ACCESS THEM?
Question 2

61. UK School-based mental health
• Targeted Mental Health in Schools (TaMHS)
(2008-2011)
– £60 million programme
– innovative, locally determined models
– early intervention for 5-13 year olds at risk
– Included 3000 schools in 151 Local education
authorities (LAs) who determined budget allocations
• Longitudinal study and RCT
– 137 primary and 37 secondary schools

62. TaMHS evaluation
• Findings:
– More positive links with mental health services associated with
greater reductions in behavioural problems in secondary school
– Parents reported schools as key point of first contact for mental
health advice for child
• Implications:
– Prioritise improved relationships and referral routes between
secondary schools and mental health services
– Ensure schools retain a role in referral
• Future policy implementation:
– Balance: prescriptiveness and flexibility
– Emphasis on integration of services in schools

63. American experience
• Established school mental health for >30 years
• Over 2000 school-based mental health services
• Growing evidence-base
• Visits for mental health needs second highest after
accidental injury
• 75% of children receiving mental health care receive it in
the school system
• Fewer DNA and drop-outs
• 12% American child psychiatrists spending time in schools

64. What are school-based mental health interventions?
Who gives the treatment?
To
whom?
Whole
school
Classroom
Pupils at
risk
Diagnosed
pupils
What
treat-
ment?
Cognitive
behavioural
therapy
Behavioural
intervention
Art therapy
Counselling
Medication
Family therapy
Important prevailing issues
Internal External
Consent? Confidentiality Evidence based
1
2 3
4
Peers Pastoral
support
staff
Teachers School
counsellors
School
nurse
School
psychologist
Charities Mental
health service
Whose responsibility?
£

65. Types of School Interventions
Treatment/Indicated:
Cognitive Behavioral Intervention for Trauma in Schools,
Coping Cat, Trauma Focused CBT, Interpersonal Therapy
for Adolescents (IPT-A)
Prevention/Selected:
Coping Power, FRIENDS for Youth/Teens, The Incredible
Years, Second Step, SEFEL and DECA Strategies and Tools,
Strengthening Families Coping Resources Workshops
Promotion/Universal:
Good Behavior Game, PATHS to PAX, Positive Behavior
Interventions and Support, Social and Emotional
Foundations of Early Learning (SEFEL), Olweus
Bullying Prevention, Toward No Tobacco Use

66. Oxford Opportunity

67. Oxfordshire Services
Mental health services
• Discontent about availability and access of mental health services
• Overwhelmed services
– 30% increase in referrals
Education
– 34 state funded secondary schools
• 7,000 children per school year
– Over 20 independent schools
– Mental health provision in schools
• School-dependent
– School counsellors
– Pastoral care system
– No strong links with local mental health services

68. School: Location quotations
 I don’t know maybe it would be more complicated or
something …. Maybe just to find it and maybe she doesn’t
know who you are, where you come from, … I don’t know
it’s just different. I think in the school is better
 Good to have it in school, if come to hospital it is scary, I
don’t know if I would go if it was in a hospital …no one likes
hospital

69. Oxfordshire Opportunity
• Oxford Health NHS Foundation Trust
– Uniquely placed to develop school-based mental health services
• Newly commissioned school health nurse service for secondary
schools
• Mental health: PCAMHS and CAMHS
• Oxford University
• To develop and evaluate a new school-based mental health
service in Oxfordshire secondary schools by placing existing
Primary Child and Adolescent Mental Health Service
(PCAMHS) workers into each school for a fixed weekly
session

70. The Oxford PCAMHS InReach Service
Consult
with teachers
and other
key school
professionals
Specific
school
Group
interventions
Give
assemblies, talk
to parents
1:1
treatment
PCAMHS
worker
Half a day
each week

71. What might be the effect of this for
Oxford services?
• See young people earlier in services
• See more young people as many have difficulty accessing
services
• Engagement might improve with fewer non-attendances
• Help schools manage difficult and concerning problems on
– Individual cases
– Classroom problems
– Whole school difficulties
• Provide additional support to school staff

72. Roll-out plan
• Roll out slowly (ish)
– 3 schools May 2014
– 10 more January 2015
– more with each subsequent term
• Monitor PCAMHS worker activities
• So far:
– New service welcomed by school staff
– Schools holding considerable risk within their systems of care
– Learning how best to integrate
• Which students
• What happens to the students
• Parental involvement

73. DO YOU THINK CHILDREN BETWEEN
THE AGES OF 12 & 15 SHOULD
HAVE PARENTAL CONSENT TO
ACCESS MENTAL HEALTH SERVICES?

74. PCAMHS worker utilisation in schools
– Training
• Whole school assembly
• Teachers and pastoral care system
– Individual cases
• Can see for brief interventions
• Convenient
• Follow-up easier
– Interface with pastoral care system
• Offer supervision
• Non-threatening involvement

75. Challenges 1
• Ethical
– Consent
– Notes & confidentiality
• Screening
– Should we do this
– When and how
– Teacher nomination system?
• Pastoral care systems within schools
– How best to work in collaboration
– Threatened
• Space
• Private schools

76. Challenges 2- Future
• NHS service
– Subject to pressures of service delivery context
• Other models of care in the region
– Swindon
– Milton Keynes
– Local care options
• PCAMHS worker 1 session
• PCAMHS 2 sessions
• PCAMHS + training school nurse
• PCAMHS + training school staff
• PCAMHS + CAMHS/Child psychiatrist

77. IS IT ETHICAL TO DELIVER AND
CHANGE SERVICES WITHOUT
PROPERLY EVALUATING THEM?
Question 4

78. WHO HAS PRIMARY
RESPONSIBILITY TO FUND SERVICE
EVALUATION?
Question 5

79. WHO IS BEST PLACED TO CONDUCT
SERVICE EVALUATION?
Question 6

80. How to move forward
• Education and Health Integration challenges
• Services in schools democratises access to
services
– Opportunity for early intervention
– Access the most vulnerable
• Evaluation challenges for health services
– Electronic patient records

81. Personality Disorder: Evidence and
Innovation
Dr Rex Haigh
https://prezi.com/kmh3m1fb6_bg/personality-disorder-evidence-and-innovation/?utm_campaign=share&utm_medium=copy

82. Physical Health & Wellbeing Clinic
Early Intervention in Psychosis Service
Elwira Lubos
Nurse Researcher

83. Outline
1. Why? Ten minute pitch on why this is
important
2. How? What works well within and beyond
the clinic
3. So What? Actions for the future
#ei2020

84. ‘From how I am to how I act’
FUNCTIONINGHEALTHY WEIGHT
ACTIVE & FIT LIFESTYLE ENERGY
MENTAL & EMOTIONAL
BALANCED & NUTRITIOUS DIET
ABILITY TO EXERCISE

85. Why is this important?
1. Life expectancy gap of 15-20 years.
2. Only 35% of this population had adequate physical
health monitoring in the past 12 months (NAS, 2014)
3. Higher mortality related to cardio vascular events
(Crump et al, 2013; Laursen et al, 2012; Wysokinski et al, 2014).
4. Change in NICE guidelines for Schizophrenia (2014)
#ei2020

86. Health promotion
activity, physical health
assessments and
interventions need to
be integrated at every
level if the 15-20 year
mortality gap is to be
closed.
#ei2020

87. So What?
• Drop-in service for EI clients within Oxfordshire.
• Physical health checks, include weight, BMI, blood pressure, waist
circumference, comprehensive bloods, life style screening, health
advice and signposting.
• Full cardiometabolic monitoring check.
• Side effect monitoring.
• Physical health history and family history of cardiovascular risks/
diseases and diabetes.
• From July till October 2014 - 20 service users attended the drop in.
#ei2020

88. Cardiometabolic Monitoring Results:
0 2 4 6 8 10 12 14
Life style risk factors
Current smoker
Blood pressure over 140/90
BMI over 25 kg/ m2
Cholesterol/ HDL ratio
Blood Glucose over 5 mmol/L
#ei2020

89. top motivators for sustaining behaviour change
Information
HEALTH BEHAVIOUR CHANGE MOTIVATORS
Aspiration Social Influence Incentives
.
.
.
.
Source: Health Barometer, 2014
&

90. Positive ways forward
• Self monitoring, e.g. weight and blood pressure.
• At the point of access provide condition and medication
specific information. Development of apps may be a
way forward.
• Incorporate physical health checks as part of routine
outcome measures.
• More designated staff time to facilitate staff training to
develop roles within the team (champions), and to offer
outreach service.
• Investment in portable ECG machine to assist people
unable to leave home.
#ei2020

91. Thank You
ANY QUESTIONS?
#ei2020

92. Raising Awareness of Early
Signs of Mental Health problems in
young people and supporting rapid
access and signposting to services
Gwen Bonner, Head of Adult Mental Health Services, Reading
Berkshire Healthcare NHS Foundation Trust

93. • Similar to other services nationally Early Intervention Services in
BHFT have been eroded to accommodate changes to care
pathways models of working
• Reduction in referrals into services
• Difficulties in the transition from young people to adult services
• Young people coming into services much later than they should be
• Current pathway excludes a number of young people that could
benefit from treatment interventions
Background .

94. • Five month time limited project
• Four nursing staff covering six geographical localities
across Berkshire
• Based within Adult Community Mental Health teams but
linking with CAMHS services
EIP project Berkshire .

95. • To increase awareness and understanding of early signs
of mental health problems in young people in the
communities where they are engaged
• To facilitate early signposting to appropriate services for
young people experiencing MH problems
• To facilitate early assessment and treatment for young
people who have early signs of psychosis
Aims .

96. • Improved understanding by other agencies – schools,
universities and colleges, GP’s, our own internal services
• Early referral into services for appropriate assessment
and treatment
• Increase in referrals into CAMHS for young people
presenting in a prodromal stage of psychosis
• Reduction in unscheduled hospital admissions in acute
and mental health sectors
Desired outcomes .

97. • Four project workers working across six localities
• Map out stakeholders to focus the education intervention
• Develop a training package to take out to a variety of stakeholders
• Review and increase use of technology
• Highlight early warning signs and where to access help and support
• Support early referral into services
• Evaluate impact of training on these stakeholders
• Work with existing teams to support timely access and treatment
The project .

98. • Baseline number of people receiving training package –
broken down by agency / organisation
• Evaluation of training impact – post session survey
• Increase in referrals in for young people for assessment
Key performance indicators .

99. • Evaluate project impact
• Awaiting outcome of substantial funding bid
• Integrate this approach into above
• Work with AHSN around informatics for future –
establish comprehensive national picture
Next steps .

100. Any questions?

101. Contact details:
gwen.bonner@berkshire.nhs.uk
Thanks for listening .

102. Daniel Maughan
Royal College of Psychiatrists Sustainability Fellow
Sustainable Psychiatry

103. Sustainable
health care
system
Over-burdened
health care system
Healthy
community
Chronically
unwell
patients

104. CENTRE for
SUSTAINABLE
HEALTHCARE
Social Sustainability
Recovery:
Hope
Agency
Opportunity
✔
✔
✔
BIOPSYCHOSOCIAL

105. £
P
R
I
N
C
I
P
MODELS
OF CARE
Prevention
Patient empowerment
Lean service design (reduce waste)
Preferential use of low carbon interventions

106. CENTRE for
SUSTAINABLE
HEALTHCARE
Thank you