WSP2 Effective services for people in mental health crisis

Crisis care for Children and Young
Dr Peter Hindley and Dr Louise Theodosiou
Royal College of Psychiatrists
Significant increase in presentations at
Emergency Departments ≈ x3 over past 5
Increase in young people reporting self-harm
and suicidal thoughts to Childline 41% 20122013
Young people who commit suicide often have
contact with services prior to committing
suicide (LAAC Joint Planning Group 2006)
The Canary in the Mine
Increasing rates of self-harm are the canary in
the mine
Local Authorities under severe pressure
Difficult decisions re funding leading to loss of
universal and targetted services
Growing inequality and loss of opportunity for
young people
Social media
Not all crises involve self-harm
Severe behavioural disturbance with
breakdown of care
Children with neurodevelopmental disorders
and challenging behaviour
Intoxication with drugs/alcohol
Severe physical illness with delirium
The picture in Manchester 16–17 CMHT
Anecdotal trends demonstrate an increase in
rates of emergency presentations and young
people presenting later in their illness journey
Referrals from Tier 1 have reduced, referrals
from GPs have increased
Referral rates of males are significantly lower
than females.
Crisis Care Concordat and Children and
Young People
Less than 40% of CAMH services have rapid
access through crisis pathways (CAMHS
Benchmarking 2013)
958 children and young people held under
S136 2012-2013 >100 in Police cells (Howard
League 2014)
37/52 mental health trusts do not have
specialised places of safety for CYP (Howard
League 2014)
Crisis Care Concordat and Children and
Young people
 Develop effective crisis care pathways for all children
and young people
 Develop network of CYP places of safety for safe
management of children and young people detained
under S136
 Promote work between Police/social care/mental
health/child health for appropriate use of S136 with
 Develop Standards for S136 and CYP
How to prevent crises or intervene
 Early intervention and resilience building services to
prevent crises – more cost effective
 Increased awareness in all services about signs of
impending crisis – catch crises early
 Better linkage between physical health- mental
health- social care – Police- youth offending at point
of crisis
 Reduce inequality and improve opportunity
 Enhance communication at transition points
between school and college, child and adult services
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