Liverpool’s CAMHS Partnership
Lisa Nolan
Programme Delivery Manager
(Children and Maternity)
Liverpool CCG
Lisa.nolan@liverpoolccg.nhs.uk
Liverpool’s CAMHS Partnership
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Needs led
Family centred
Multi-agency – range of providers
Provides continuum of care with targeted support
Engaging, Involving and inclusive
Jointly commissioned
Strong
How did we get here?
The journey
In-patient
provision
Pre-2003
Alder hey
community
mental health
teams
2+1
service,
Alder hey
Providers:
Commissioners:
Outcomes:
Alder hey
Foundation
Trust –
Community
Mental health
teams
Regional
units
Liverpool
Health
Authority
Not monitored
or reported
Regional In-patient Units:
2003-2006
SLD team
CAMHS tier 3
community teams,
Working Together
HAVEN
CABI
YPAS counselling
Tier 2
BEST
YPAS Support Service
‘Mad, Bad or Misunderstood’,
AS Pathway
Providers:
Commissioners:
Outcomes:
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Alder Hey
(many teams)
VCS:
YPAS
Regional
units
Liverpool PCT
Liverpool City
Council
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Dev. of choice
Less stigmatising
provision
New ways of
working
More community
based provision
Joint and
partnership
working
Emerging
performance
monitoring
process
Policy driven
Regional Home Based
Treatment
Regional In-patient Units:
2007-2010
SLD team
YOS mental health
provision
CAMHS
16-18 team
Working Together
CAMHS tier 3
community teams,
CABI
CAMHS
LAC
YPAS counselling
AS Pathway
HAVEN
BEST
Tier 2
YPAS Support Service
TAMHS, MYA
ADHD Foundation
Participation team,
MYA
Banardos Young Carers &
‘Keeping the Family in Mind’
Training and MH Promotion: ‘Mad, Bad or Misunderstood’,
Healthy schools Partnership, Mental health promotion
Providers:
Commissioners:
Outcomes:
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Alder Hey
(many teams)
VCS:
YPAS, PSS,
Barnardos,
MYA
Regional
units and
HBT
Liverpool PCT
Liverpool City
Council
Social Care
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Dev. of choice
Less stigmatising
provision
New ways of
working
More community
based provision
Joint and
partnership
working participation
Thinking family
Improved
performance
monitoring
process
Policy driven
Comprehensive CAMHS Pathways 2010-2013
C&YP
&
Families
Training:
Public
Mental
Health
Self-care,
Website
Mental
Health
promotion
Provider:
voluntary
CAMHS
and c&yp
Universal
services
Tier 4
Dewi Jones
Unit
(0-14)
MBM
Inside Out,
Master class
Mental health
first aid
Specific training
Consultation
& support:
Telephone,
individual,
group
Alder Hey
Single
Point of
Access
Triage
(multiagency)
Provider:
Voluntary CAMHS
Statutory CAMHS
(Primary Mental
Health Service,
Specialist CAMHS)
Tier 4
YPC
(14-18),
CHEDS
Tier 4
OAT
(Independ
ent Sector)
Voluntary
Sector CAMHS
(YPAS, ADHDF, PSS,
Banardos YC)
AHCFT 0-16
years
Out of Hours
Psychiatry
Mersey Care 16
plus
care aims methodology
Other services
(signposted)
Providers:
Alder Hey
(2 teams with
SPA)
VCS:
YPAS, PSS,
Barnardos,
MYA
Regional
units and
HBT
Commissioners:
 Liverpool
PCT/CCG
• Liverpool
City
Council
• Schools
• Social Care
Outcomes:
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Dev. of choice • Single point of
Less
access
stigmatising  Multi-agency
provision
triage and
New ways of
working
working
 More accessible
More
information
community
 Consultation
based provision and training
Joint and
accessible to
partnership
frontline
working provision
participation
Thinking family
Robust
performance
monitoring
process
Liverpool’s CAMHS Partnership
Performance Monitoring:
• Activity – CAMHS returns/National data
set/national benchmarking
• Outcomes – CAMHS returns/ CORC
• Quality – CAMHS Returns/ Contract visits
Liverpool’s CAMHS Partnership
So What??
• Reduction in specialist CAMHS referrals
by 21% form 11/12 to 12/13
• 90% of those accessing services
showing improvement in mental health
(CORC)
• 90% high satisfaction with services
(CORC)
• Increase year on year of universal staff
accessing training
Liverpool’s CAMHS Partnership
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All providers using CORC measures
VCS all quality assured
Built local workforce
Strong equalities agenda
Strong participation agenda
Focus on early identification and
prevention
Liverpool’s CAMHS Partnership
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Why VCS?
Less stigmatising
Less medical
More Flexible
Innovative and creative
Skills of workforce
Added value
Community based
Engaging and involving
Asset based
Liverpool’s CAMHS Partnership
Challenges:
• Professional hierarchy
• Funding
• Restructure
Liverpool’s CAMHS Partnership
WHAT NEXT?
Need:
• Approx. 100,000 c&yp
• Liverpool is 1 of the most deprived
cities in UK
• High proportion of LAC, young
cares, c&yp with disabilities, BME
communities and refugee and
asylum seekers
High risk factors therefore mental
health problems likely to be high
Tier
Number
1
12828 (15%)
2
5986
3
1582 (1.85%)
4
64
(7%)
(0.075%)
Main presenting problems:
- Emotional disorders, behavioural
and self harm
Adverse Childhood Experiences:
- physical, emotional, sexual abuse,
domestic violence, household
substance misuse, household mental
illness, parental separation and
divorce, parent in prison
Main referrers:
- Education, child health services,
GP
L4, L8 and L6 postcodes account for
27% of referrals
Future Challenges:
•Integrated commissioning – funding
•Integrated care – culture, personalities
•Changing NHS – relationship management
•Economic climate and social determinants
GAPS:
• Transition – CAMHS to AMHS and Tier 3-4 pathway
• Early years and maternal mental health
• Neuro-developmental problems (ASD and ADHD)
• Mental health promotion
• In balance in access – too many at specialist level
• In balance in funding and therefore delivery – more
focus on specialist than early intervention
• Integration at commissioning level
Future Opportunities:
• Integrated commissioning and care
• CCG and LCC priorities
• Liverpool’s children and young peoples/whole family
agenda
• Public health changes
• IAPT (Improved Access to Psychological therapies)
• Mental health promotion and FYI developments
(participation)
• Training menu
• Transition
• Research opportunities
• Neuro-developmental pathway
• Datasets
2014-2017 strategy:
Range – VCS,
independent and
statutorypartnership
Joint commissioners
PROVIDER
DECISION
MAKERS
CHILDREN,
YOUNG PEOPLE
& FAMILIES
UNCRC
Working Together to ensure mental health and emotional wellbeing is
‘Everybodies
Business’
Liverpool CAMHS
Outcomes Strategic
Map and Pathway
Improved mental health of
Children & Young People
[& their Families]
Improved Environments
so that Children,
Young People & families can
Thrive
Increased Identification
of C&YP with
early indicators of
distress and risks
Reduction in
Mild to Moderate
Distress
Reduction in the
development of Moderate
To Serve distress
Alder Hey - Specialist
CAMHS
MYA- MHP, training and
engagement
Alder Hey – Early intervention (PMHS) and LAC/CIN
Reduction in
life long distress
In-patient care – Dewi
Jones (alder hey) and
YPC (CWP) and
OATS
YPAS – therapeutic/counselling and support service
PSS – refugee and asylum seekers therapeutic support
ADHD Foundation
Barnardos YC and KFIM
Key:
Delivery- public mental health, early
intervention, targeted
Contracts – LCC
Funding- LCC/CCG/social care/schools
(pooled budget)
Performance managed – LCC
Delivery – specialist
Contracts– CCG
Funding- CCG
Performance managed – CCG
Delivery – In-Patient
(regional)
Contracts– Spec Comm
Funding- CCG top slice
Performance managed –
Spec Comm
Liverpool’s CAMHS Partnership
Outcomes:
• Improved mental health of children, young people and their
families
• Improved environments so that children, young people and
families can thrive
• Increased Identification of children and young people with
early indicators of distress and risk
• Reduction in mild to moderate distress
• Reduction in the development of moderate to severe distress
• Reduction in life long distress