Falling off the cliff: young people in a mental health

service

Dr Uju Ugochukwu (Consultant Psychiatrist, EI & Youth)

Dr Sarah Maxwell (Consultant Psychiatrist, CAMHS & Youth)

Norfolk and Suffolk NHS Foundation Trust

Background and what we did

• Development of youth mental health service• Quantitative mapping project

– Description of the characteristics of 14 – 25 year olds within the service

– Description of mental health services available to young people in Norfolk

• Data from Trust Informatics Department

Findings

• September 2010 to August 2011• Total number of referrals for CAMHS

and AMHS = 7,476• Number of individual patients = 5,196• 2,280 referrals were either, re-referrals

or individuals passed between teams

All referrals by age and gender Sept 2010 to August 2011

Proportion of referrals accepted

Conclusion and Recommendations

• Teenage boys are not referred– behavioural presentations– seen in other services e.g. youth offending teams

• Reduced contact for 18 to 20 year olds – engagement– not meeting criteria– Stigma

• Many young people are either being re-referred or moved from service to service hence repeated assessments– New service needs to track care pathways to avoid repeated

assessments

Conclusion and Recommendations

• Lots of data which needs system around it to make it useful to clinicians

• Services working with young people need to be clear about what they offer and work collaboratively to avoid duplication

How to get ideas heard: influencing change in the NHS

Dr Sarah Maxwell (Consultant Psychiatrist, CAMHS & Youth)

Norfolk and Suffolk NHS Foundation Trust

Dr Uju Ugochukwu (Consultant Psychiatrist, Early Intervention & Youth) Norfolk and Suffolk NHS Foundation Trust

What we did• Background

• Qualitative project– Interviewed 9 key individuals involved in the

development of a new service including those with clinical, academic and management backgrounds

– Identified themes and developed a set of questions– Recorded and transcribed each interview– Looked for common themes using colour codes– Timeline

Findings

Four key areas • Organisational context

• Team/champion skills• Individual skills

• Political astuteness

• Keep the goal insight

Organisational Context• Taking advantage of what was happening in the

organisation and using that to take own ideas forward

“the Trust was looking at its vision and we very clearly felt that a … service should be part of it”

“services uneven across the piste …”

• New senior executive

A champion (team of champions)“It has been a really good example to other areas of how it works very well, working collaboratively and I think other areas have looked at that and thought … it doesn't’t have to be a them and us arrangement”

•Complementary skills•Can do attitude•Enthusiasm•Determination

“You need a kernel of individuals … who are enthusiastic and who have access to some clout”

“Organisations need developers and controllers to change and innovate”

“alongside the developers there has to be managers with different styles of management, just like alongside innovative clinicians there has to be people who will actually do the work”

Political Astuteness• “…I think the timings were really quite fortuitous really,

and we were riding our luck.”

• “…not only were they full of ideas … but they were able and know how to make the organisation tick”

• “..they’ve got a political understanding which is quite important too.”

• “ ... came and visited … and thought it was a very good thing … this is the way forward, this is a great thing and being convinced by the data”

Keep the goal in sight

• Ability to be flexible whilst keeping the goal in sight

www.slideshare.net

Challenges

• Enormous quantity of data• How to present in a concise & meaningful manner

• Doing qualitative research!

• Writing it up into something meaningful

• Confidentiality • Each meeting generated new ideas to follow up and so

more to do!• Juggling work, CLAHRC and home life

Other things that we've done

• Setting up YMH service in Great Yarmouth and Waveney

• Involvement of young people• Partnership with other statutory and non-

statutory agencies– Case discussion groups

• Presentation to different groups• Future research

Acknowledgements

• Professor Ian Goodyer• Dr Belinda Lennox• Dr Cecily Morrison • Dr Eivor Oborn• Valerie Gage, Kevin Brown, (NSFT Informatics dept)• CLAHRC including ALS• Study participants