BOND – WORKING WITH THE
WHOLE SYSTEM
Elaine Willis, Kevin Ford, FPM
10th September 2013
London
BOND (Better Outcomes, New Delivery) is a two
year project funded by Department for Education
that aims to increase the capacity of voluntary and
community organisations to provide early
intervention mental health support services for
children and young people.
THE CONTEXT FOR BOND
The Government’s Mental Health Strategy emphasises the crucial
importance of early intervention in tackling emerging emotional and mental
health problems for children and young people.
Intervening early has been shown to achieve improved outcomes for
children, families and wider society such as increased learning and
educational attainment, better physical health, improved long term mental
health and reduced health and social care costs.
Voluntary and community organisations have an important role to play in
providing effective, high quality early intervention services as they are
local, flexible, trusted, informal and friendly.
Why early intervention in CYP’s mental health?
50% adults with lifetime mental health problems experience
symptoms before 14 years of age.
75% adults with lifetime mental health problems experience
symptoms before their mid 20s.
Fewer than 50% were treated appropriately at the time.
(Taken from Mental Health Strategy 2011 DH)
Why intervene early in CYP’s mental health?
• Some people are more at risk due to individual, family and
social factors – knowing this can help target resources
• Early intervention can be protective (protecting those with
risk factors against developing problems later on) or it can
be remedial or therapeutic (improving the situation for those
in the early stages of problems)
• There are instances where early intervention acts as a
screening for those who will need more sustained or
intensive interventions later.
What is normal?
• Around 1 in 12 young people self harm (Mental Health
Foundation, 2006) and around 25,000 are admitted to hospital
every year due to the severity of their injuries (Fox & Hawton,
2004) with a 68% increase in the last 10 years
• 1 in 10 children experience problems severe and enduring
enough to meet the criteria for a disorder (ONS 2004)
• In an average classroom:
•
•
•
•
10 young people will have witnessed their parents separate
8 will have experienced physical violence, sexual abuse or neglect
1 will have experienced death of a parent
7 will have been bullied (Faulkner, 2011)
Mental health services for cyp in England are
organised in a four tier system
Tier 1 - provides treatment for less severe mental health conditions,
such as mild depression, while also offering an assessment service
for children and young people who would benefit from referral to
more specialist services.
Tier 2 - provides assessment and interventions for children and young
people with more severe or complex health care needs, such as
severe depression.
Tier 3 - provides services for children and young people with severe,
complex and persistent mental health conditions, such as obsessive
compulsive disorder (OCD), bipolar disorder, and schizophrenia
Tier 4 - provides specialist services for children and young people with
the most serious problems
Levels of competition in CYP mental health provider market
Numerous providers + commissioners
Large + small organisations
More VCS
Less clinical governance
Smaller contracts
Frequent tendering
Some variety of providers
More frequent tendering +
increasing competition (usually
LAs, NHS)
Infrequent competition amongst
larger MH provider trusts
Limited contestability
Tier 4:
Inpatient Care
Tier 3:
Clinical/ medical
care (diagnosis/
medication)
Tier 3/2 interface:
Primary MH
services
LAC, YOS, other
targeted CAMHS
Tier 2/1 interface:
‘Generic’
School + community
based e.g. counselling +
IAG services
Related services e.g.
drop-in, youth support,
family support
Where does the VCS fit in?
Mediation
D.V.
Activity
based
Mental
health
expertise
Young
Carers
Access
Drop
in
School
Counselling
1
Mental Health
Services
Service ‘tiers’
4
BOND’S AREAS OF WORK
• Publications & resources
• Pilot programme
• National Strand Master classes
• Commissioning support programme
• Sustainability – collaborative models
• ACE-V
• Workforce Development
• Work with schools as commissioners
Schools….
Greater autonomy, devolved funding….
• How are they shaping up as
‘commissioners’?
• What helps and hinders?
What schools do
Additional assessments
Counselling
Family support
X-School
Inc. support
roles
Internal ‘case’
management
Buy in
expert
capacity
Build
internal
capacity
Knowledge and
Expertise/training
Activities
Other services
e.g. CAMHS,
H&SC, VCS
Work
with or refer
to external
services External
processes
e.g. CAF
School concerns - ‘Hooks’
• Increasing MH needs (more accurately described as
emotional and social difficulties that manifest in
behaviour issues)
• Dissatisfaction with stat services/thresholds
• A very few pupils taking up a lot of staff time
• Impact of parenting and difficulty in engaging or
knowing how to work with parents effectively
• Closing the gap; behaviour and attendance –
underlying problems
Schools as commissioners - challenges
• Language of ‘mental health’
• Lack of understanding of link between MH and
academic attainment
• Knowing which schools are interested
• No one ‘model’ of intervention or what good looks
like
• Lack of systematic info on needs e.g. young carers,
bereavement, family problems
• Schools may lack confidence, knowledge and skills
to commission; not see it as their role; not know
what is out there
Persuaded by
•
•
•
•
•
•
•
What other schools are doing
References from schools/trusted colleagues
Speed of response to problem
Price and added value
Flexibility and integration in school
Examples of good practice & cases
Experience of results! E.g. improved behaviour
What schools want help with;
• Examples of good practice/ideas
• To be able to find services which can work in
schools – particularly for individuals
• Efficiency through joint commissioning (although
many still dependent on LA to facilitate this)
• Big interest in HOW schools can work with
emotional difficulties effectively - ‘sub statutory
services threshold pupils’
• How to build in effective processes, systems,
approaches to school inc. roles, staff skills, etc
What do schools do now for ‘support’?
• No school reported using any national guidance
• Schools did not see themselves as commissioners
• Structures within schools did not allow for a
commissioning approach – silo approaches and lack
of budget overview in relation to vulnerable pupils
• Special schools often buy in professionals and
integrate in to school workforce – much to learn
from re BESD
• Little linkage between research evidence and
practice – more evolved in response to
Impact of BOND – lasting change
• New relationships between commissioners and
providers – different and better understanding of each
others’ roles and requirements
• New ways of working together – more collaboration
and dialogue
• Some new (or safeguarded) money to VCS: £225,000
additional investment in Tees Valley from LA, CCGs &
NHS Tees; new money to VCS in Cumbria and
Cambridgeshire
• Greater involvement of schools; raised awareness in
schools of commissioning questions
Impact of BOND – lasting change
• Leadership development for school commissioners Commissioning for emotional and mental health’ for
Head teachers and Early Years leads, in collaboration
with National College for teaching and Leadership
• Active role of CVS and CVAs in developing the roles of
VCS as providers – e.g. Middlesbrough Voluntary
Development Agency (CVS) supporting development of
a VCSO consortium to provide universal, flexible,
responsive early intervention services
Supporting development: CYP, VCS providers &
Commissioners
What is the role of the CVS or infrastructure body?
 Bring people together within interest areas eg young people or
mental health and across interest areas
 Help develop market readiness – build the capacity of vcs to
respond to the needs in schools and of commissioning
 Work with commissioners to show how vcs can be engaged
 Break down the `us’ and `them’ – promote open dialogue
 Support consortium to develop and respond
 Be proactive with key vcs organisations to develop local
strategies and approaches
GETTING IN TOUCH
Website: www.youngminds.org.uk/bond
Email: bond@youngminds.org.uk
Telephone: 020 7089 5050