Emotional Wellbeing and Mental
Health of children and young
people in Medway
Medway vision for CAMHS…..
Improve children and young people’s access to,
experience of and outcomes from integrated and
comprehensive emotional wellbeing and mental
health support. Ensuring that those who are most
vulnerable to emotional wellbeing difficulties are
identified and supported as soon as possible.
Key features of comprehensive CAMHS
in Medway…..
• Involvement of children and young people
– in all aspects of commissioning and service delivery
including the use of ‘You’re Welcome’ standards.
• Strategic pathway planning for vulnerable groups
– including teenagers who self-harm, LAC, children and
young people with ADHD and/or ASD.
• Practice improvements
– that ensure that all emotional wellbeing services are delivered to an
evidence based model of what works well including NICE guidance and
the CAPA standards.
• Process improvements
– to streamline the referral, access and delivery of services including a
Single Point of Access
– to ensure that waiting lists are managed effectively
– that ensure transition between children’s and adult services is well
planned and supported by key processes.
Key features of comprehensive CAMHS
in Medway cont’d…..
• Performance management
– that effectively tracks the users experience of the service and outcomes
achieved using HoNOSCA or similar tool that measures clinical outcomes
and provides key management information to inform service
improvements and commissioning decisions.
• Communications
– to ensure that all referrers including children and young
people and families know where they can get support
with whatever level of emotional wellbeing need they
may have and understand the basic nature of the services
on offer in the area (including specialist support).
• Workforce development
– to ensure that all staff working with children and young people can
identify a child or young person who may need access to emotional
wellbeing support services and know how to access them as early as
possible.
Medway vision for CAMHS…..
Improve children and young people’s access to,
experience of and outcomes from integrated and
comprehensive emotional wellbeing and mental
health support. Ensuring that those who are most
vulnerable to emotional wellbeing difficulties are
identified and supported as soon as possible.
Developments so far…..
Mental health NSF which helped transform services
over past 10 years ended in 2009
In 2009 after consultation, previous Government
introduced cross Government mental health strategy
entitled ‘New Horizons’ with twin aims:
1) Improve quality and accessibility of services for people with
poor mental health
2) Improve mental health and well-being of the population
Continuing twin track approach in development of
current draft Cross Government mental health strategy
Impact of mental illness…..
No other health condition matches mental ill health in the
combined extent of prevalence, persistence and breadth of
impact
WHO (2008) figures for UK (total DALYs)
• Mental disorder
• Cardiovascular disease
• Cancer
22.6%
16.2%
15.9%
Mental health problems occupy one third of a GP’s time
(ODPM 2004)
Economics of Mental Illness…..
Interventions to prevent mental illness
and promote mental health
Key messages:
• In 2003, the wider annual cost of mental ill-health in England was £77 billion
while updated figures suggest this figure is now £105 billion
• Although future costs of mental illness will double in real terms over next the
next 20 years, some of this cost could be reduced by greater focus on wholepopulation mental health promotion and prevention, alongside early
diagnosis and intervention
• Since half of lifetime mental illness arises by the age of 14, prevention and
promotion interventions during childhood and adolescence are particularly
cost effective
• Early intervention programmes for children and adolescents:
– have the clearest evidence of cost benefit with economic returns of early
childhood interventions exceeding cost by an average ratio of six to one
– reduces health care and wider costs. There is good evidence for
intervening early with psychotic illnesses and depression. The economic
cost of not intervening is significant
Cost of Mental Illness
• Conduct disorder
– Cost of crime attributable to adults who had conduct problems in childhood is £60
billion a year in England and Wales (SCMH, 2009).
• Depression
– Total annual costs of depression in England is circa £24 billion a year (McCrone et
al, 2008).
• Anxiety
– Health service costs of anxiety disorders in 2007 were £1.2 billion. The addition of
lost employment brings the total costs to £8.9 billion (McCrone et al, 2008).
• Medically unexplained symptoms
– Annual NHS cost of MUS in England amount to £3.1 billion (2008/9) with a further
£5.2 billion in lost productivity and £9.3 billion reduced quality of life (Bermingham
et al, in press).
• Schizophrenia
– Total costs of schizophrenia were approximately £6.7 billion per year in England in
2004–05 (Mangalore & Knapp, 2007). Cost of treatment and care was £2 billion,
annual costs of welfare benefits were £570 million and the cost to families of
informal care and private expenditure amounted to £615 million. Costs of lost
productivity due to unemployment, absence from work and premature mortality
were £3.4 billion.
Cost of Mental Illness cont’d…..
• Suicide
– Average lifetime cost of each completed suicide for those of working age in England
as being £1.7m at 2009 prices (Knapp et al, in press). Since 4200 suicides occurred
in 2008, total annual cost is £7.1 billion.
• Alcohol misuse
– costs the health service £2.7 billion every year. Workplace cost of alcohol is over £4
billion while cost of alcohol related crime and disorder is £8–13 billion. Total cost
of alcohol misuse is estimated at £18–£25 billion a year which includes costs of
treating alcohol-related disorders and disease, crime and anti-social behaviour, loss
of productivity in the workplace and social support for people who misuse alcohol
and their families (DH, 2009).
• Smoking
– Annual direct cost of smoking to the NHS is £5.2 billion (Allender et al, 2009) with
smoking responsible for 440,900 hospital admissions in 2007/8 (NHS Information
Centre, 2009). Almost half of total tobacco consumption and smoking related
deaths are by those with mental disorder.
• Dementia
– Total annual UK costs of dementia are £17 billion (Knapp et al, 2007). Long-term
care for older people with cognitive impairment in England could rise from £5.4
billion to £16.7 billion between 2002 and 2031.
Conduct
disorder
Depression
NHS
Emotional
Wellbeing
Police
Anxiety
Medically
unexplained
symptoms
minority
Schools and
Academies
Youth Justice
Board
Schizophrenia
Suicide
Mental Health
Substance
misuse
Local
authority
Connexions
3rd Sector
Health benefits of mental wellbeing
• Improved resilience to broad range of adversity
• Reduced emotional and behavioural problems in
children and adolescent including persistence
(NICE, 2007; NICE, 2009; Parry-Langdon et al,
2008)
• Reduced physical illness
• Reduced health care utilisation
Benefits outside health
• Improved educational outcomes
• Reduced anti-social behaviour, crime and
violence
• Healthier lifestyle/ reduced risk
taking
• Reduced substance misuse
• Stronger social relationships
• Increased productivity at work, fewer missed
days off work
• Improved cognitive ability, more flexible thinking
What do we know locally?
Comprehensive CAMH Service Providers
Universal
2
3
Universal & Targeted
1
Targeted
1
Targeted & Specialist
4
Specialist
4
Universal, Targeted &
Specialist
CAMH service provision in age groups
14
12
10
8
Series1
6
4
2
0
0-11
0-18
11-18
4 out of 12 providers support children and young people whose
mental health prevents them from accessing the curriculum
Emotional wellbeing and mental health
Operational group’s work programme
1.
2.
3.
Collect service information on each service using a standard proforma.
Create database with information collated from all services.
Cluster services within the 3 tiered CAMH services; Universal, Targeted and
Specialist to better understand gaps in CAMH needs met.
4. Agree language to be used for presenting needs to provide consistency of
language and better understanding of level of severity served by each service.
5. Create pathways for specific vulnerable groups to better understand the
customer pathway and transition process between services e.g. teenagers
who self-harm, LAC, children and young people with ADHD and/or ASD.
6. Share/review criteria used by each service and redefine as necessary.
7. Produce geographic map of Medway and overlay with services provided.
8. Adopt and embed good practice guidelines as outlined by Choice &
Partnership Approach (CAPA).
9. Setup Triage Team to review and agree interim support to children and
families whilst on waiting list for assessment at Tier 3.
10. Close working with SPA/CAST on reviewing cases that are high level Tier 2
referrals in order to understand commissioning implications and to inform an
enhanced Tier 2 service.