The case for CAMHS services for 0-25 year olds

Dr Jonathan Prosser

Who am I?

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

SENDFrom 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.

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 education2009/10 .

What is so different about young people?

What is so different about mental health services for children?

Habits

Illnesses Temperaments

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

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

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

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

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)

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’?

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

CAMHSBecomesCHYPS