Presentations from the NHS Health Education Wessex, Wessex AHSN Mental Health Summit

1. The case for CAMHS
services for 0-25 year olds
Dr Jonathan Prosser

2. Who am I?

3. CYP Mental Health: Policy Context
• Children and Young People’s Health Outcomes Strategy
• Mental Health Strategy & Implementation Framework
• CYP IAPT
• PbR Development
• Health and Social Care Bill
• SEND Changes –single plan
• Education Act 2011
• OFSTED 2012 framework for school inspection
• CMO Report
• NHS Mandate
• Closing the Gap
• Tier 4 Review
• Crisis Care Concordat

4. SEND
From September 2014 CCGs must:
• commission services jointly for children and young people (up to age 25)
with SEND, including those with Education Health and Care (EHC) plans
• work with the local authority to contribute to the Local Offer of services
available
• have mechanisms in place to ensure practitioners and clinicians will
support the integrated EHC needs assessment process, and
• agree Personal Budgets where they are provided for those with EHC plans
The reforms are focused on enabling children and young people to achieve
the best they can, with an emphasis on outcomes rather than processes.
CCGs and local authorities have considerable freedom in how they work
together to deliver integrated support that improves children and young
peoples’ outcomes.

5. CYP Mental Health: Political Context
• Total NHS Budget of £104,000,000,000
• 10% total NHS budget spent on mental health
• £11,260,000,000 spent on mental health
• £770,000,000 spent on CAMHS
• Which is 7% of MH budget
• And 0.7% of NHS budget
• Does not include figures on psychological
wellbeing spend in social care and education
2009/10 .

6. What is so different
about young people?

8. What is so different about mental
health services for children?

9. Habits
Illnesses
Temperaments

10. 5YFV – what does it say?
• 5YFV accepts we will have less money
to spend against increasing need
• 5YFV doesn’t mention children much
except obese ones but…
• 5YFV does talk a lot about prevention
• 5YFV certainly mentions new ways of
working, particularly integrated
(MCP) health and social care
provision

11. What are the problems?
• Tiny resources cf need and potential benefit
• Past silo mentality of CAMHS
• Historically narrow-ish focus
• Historical scheduled care, clinic based focus
• Offer from partners in social care, education
has been changing – 3rd sector stepping in
• Not clear who our lived experience users are
• Massive ‘hidden’ need

12. What are the answers?
• Wider psychological & systems wellbeing focus
• Redistribute, amalgamate and co-opt resources
for better overall benefit
• Re-think extended hours and 24/7 offer
• Integration of community children’s health
services as well as partners in social care,
education and third sector
• Courage to prevent on tight budgets
• New ways of working

13. What are the answers?
• Get money out of T4 private sector IP care
• Co-design and co-deliver services with our
populations – say what?
– Outcomes oriented planning at the outset
– Rationing (time or cash budget)
– Pathway navigation
– Increased range of choices
– Timing of delivery

14. Wishlist
• A step change in user engagement
• Parity of esteem (within children’s and mental health)
• Commissioning for outcomes or joined up care
• Patient held budgets (time or money)
• Single integrated patient held and co-produced health
and social care record, incorporating the twin functions
of recording the past, and planning for the future
• Tech that works and reliable data
• T4 bed money
• Different CPD paradigm (more on the job learning,
observation and apprenticeship)
• Adaptable and responsive workforce (NWW)

15. Workforce?
I’m possibly the wrong person to speak to
this but:
• Some trained workforce is essential!!
• Multidisciplinary workforce is essential
• Mainly there is a need for training to be
about future models of care and
assistance rather than models – wither the
‘evidence base’?

16. The case for CAMHS services
for 0-25 year olds?
• Developmental perspective remains
particularly pertinent in the YA group
• ‘Personality’ is still forming
• Long term outcome focus v relevant
for early presentations of severe and
enduring mental illness