Better Outcomes, New Delivery
Collaborative Partnerships in Wandsworth
A case study in developing community
based mental health services for
children and young people.
Philip Prior – Head of Schools and Community Psychology Service, LB
Wandsworth
March 2012
Some information about Wandsworth
Around 52,000 C+YP aged between 0-19
Indices of Multiple Deprivation – ‘middle’ ranking London borough.
High contrast with extremes of relative affluence and poverty
Three areas of high volume / multiple incidence (including mental health) need:
Battersea, Tooting and Roehampton
Circa 80 ‘maintained’ schools and a developing academy and free school sector
Child Well-being Index - Wandsworth
Source: NHSW Public Health 2010 – from CWI 2009
What we (have always) wanted to do:
Improve mental health and psychological well being across Wandsworth
Focus energy and resources on vulnerable groups.
Create synergies with existing services and providers
Reduce reliance on / overburdening specialist services (e.g. Tier 3 CAMHS)
Principles of mutuality, collaboration and partnership
Easier access to consultation and interventions for children ,young people and
families.
Embed services and build capacity in schools and community based settings
Where we were in 2002:
Fragmented preventative and community based services
Widespread schools dissatisfaction with access to specialist mental health
Educational Psychologists managing large Statutory Assessment workload –
restricted capacity for interventions
Local Authority playing limited role in developing comprehensive CAMHS
Resources tied up in ad hoc projects and ‘posts’
Lack of shared strategic vision across education, health and social services
What happened next:
In 2003, a small group of school heads and the PEP convened to discuss how Place
to Be might help provide mental health services directly to schools in the borough
P2B appeal lay in making services available in non clinical settings (i.e. schools) –
place to be, to talk, to think (and latterly a place for parents)
P2B Steering Group established - presentations held in local schools and visits
arranged for heads to see a school in an established P2B hub (Southwark)
Securing match 50:50 funding (against schools contribution) locally proved a major
obstacle to ‘take off’.
Significant local scepticism about the potential role of a voluntary sector partner
Steering group waxed and waned for 3 years, but a core continued to champion
P2B despite challenges and set backs
Squaring the circle – and some luck:
Securing an educational departmental under spend, and contribution from the PCT
finally enabled the Wandsworth P2B hub to start up in 2006 in 5 schools (including
one special school)
Local support enlisted – council members, senior LA officers, borough police, PCT
and other schools – successful ‘Seeing is Believing events held
Funding arrangements remained ad hoc until 2011 – most significant, consistent
support from Wandsworth. Intermittent support from PCT, GoL, Met Police and
some corporate sponsorship – but often a ‘white knuckle ride’ securing funding
Since 2008 other VCS providers began taking on local contracts e.g. Catch 22,
Family Action and Contact a Family
Wandsworth P2B hub grew to 11 primary schools (nearly 20% of total) – by 2012
Where we are today:
Funding through LA ‘secured’ through CAMHS budget (EIG) – but PCT funding
remains elusive. Schools now contribute closer to 66% of the cost
P2B now incorporated into the Targeted Mental Health in Schools (TaMHS)
network, led by the Schools and Community Psychology Service (ex EPS)
Service provided by P2B now recognised as high quality and well managed,
supported by excellent data analysis / outcome measures. These are absolutely
critical in terms of future stakeholder support and buy-in
P2B piloting new models of delivery to appeal to a more diverse range of schools
Other providers beginning to emerge e.g. Kids Company
Head of SCPS has oversight of the council CAMHS budget and is one of the LA
Children’s services CAMHS Commissioners
Where were by 2010 (simplified)
Wandsworth
Schools and Community Psychology Service
Tier 2 CAMHS lead service
Tier 3 CAMHS
Wandsworth
Place 2 Be Hub
TAMHS
Marlborough Family Groups
mental health first aid
P2B parent worker
Sure Start /
Integrated Children’s Centres
PMHWs and EPs
School / cluster commissioned
Kids Co, Nightingale Therapy service,
BLSS, Shine,
school counsellors etc
Where we hope to be in 2012-13
Schools and Community
Psychology Service
Tier 2 CAMHS lead service
Core Psychological Services
Traded Services
Nurture Group
Network
Wandsworth
Place 2 Be Hub
GP group practice
pilot
TAMHS / Tier 2
Mental Health Consultancy
Tier 3 CAMHS
Sure Start /
Integrated Children’s Centres
PMHWs and EPs
Emotional
Literacy
Support
Assistants
Marlborough
Family Groups
CBT /
Psychologica
l therapy
services
Other school / cluster commissioned
mental and psychological health
services / VCS providers
The future: Opportunities and Challenges
1) Funding – LA budgets under constant pressure / ‘haircuts’. Complex
procurement procedures and contracting arrangements. New commissioning
players – schools / academies, GP consortia. Demise of the PCT
2) Expansion of the VCS sector – Increasing number of providers entering arena –
increased competition between VCSs for ‘market share’
3) Reduction and realignment in public sector – Role increasingly restricted to
commissioning and contract management. Council services becoming mutuals /
social enterprises and competing directly with VCSs
4) Other conundrums – Rapid development of academies and free schools, wider
impact of health service reforms, uncertainty over future role of local
government, impact of new government led initiatives e.g. IAPT
5) Constants – the needs of ‘unsponsored children’, vulnerable groups remain
6) ??? – can our TaMHS project (and P2B) change, adapt, survive and thrive?
Better Outcomes, New Delivery
Collaborative Partnerships in Wandsworth
A case study in developing community
based mental health services for
children and young people.
Philip Prior – Head of Schools and Community Psychology Service, LB
Wandsworth
March 2012