Sheffield Emotional Well Being &
Mental Health Strategy for Children
& Young People
Consultation on Strategy
We would like to consult with you on the first draft of the Emotional Well Being and Mental Health
Strategy for Children and Young People in Sheffield. Following this consultation the Strategy will
be further developed to incorporate feedback and then the plans to deliver the Strategy will be
developed.
If you would like to be part of this consultation please complete the proforma below for any parts of
the plan you would like to make comments on. Please return to
Kate Laurance Strategy Manager
Children, Young People and Maternity Services
722 Prince of Wales Road
Darnall
Sheffield
S9 4EU
Kate.Laurance@sheffieldpct.nhs.uk
Comments to be returned by 18th of February 2011
Name (Optional)
Are you a parent or
carer, young person
or professional
Do you work for an
organisation in
Sheffield? If yes, which
organisation
Our Vision and Plans
Any comments?
Any changes?
Page 1
Context and
Background
Any comments?
Do you agree with the Context?
Any changes?
Priority One
Do you agree with the Priority?
Any changes or comments?
Priority Two
Do you agree with the Priority?
Any changes or comments?
Priority Three
Do you agree with the Priority?
Any changes or comments?
Priority Four
Do you agree with the Priority?
Any changes or comments?
Priority Five
Do you agree with the Priority?
Any changes or comments?
Priority Six
Do you agree with the Priority?
Any changes or comments?
The Needs
Assessment
Any comments?
Page 2
Document revision control
Version
Author/editor
Notes
Date
3
Kate Laurance
Giles Ratcliff e
Revised
follow ing
feedback from
partnership
group sources
Januar y 2011
Please provide feedback in writing to kate.laurance@sheffieldpct.nhs.uk
Page 3
Contents
1.
Our Vision and Plans
3
2.
Context and Background
5
3.
Our Priorities
8
4.
Our Implementation
12
5.
Conclusions
12
Appendix A
13
Appendix B
14
Page 4
Sheffield Emotional Well Being & Mental Health Strategy for
Children & Young People
This Strategy has been developed through the Emotional Wellbeing and Mental Health
Partnership Group which supports the delivery of the Children and Young People’s plan for
Sheffield.
What do we want for Children in Sheffield?
We want to improve emotional health and wellbeing for all children and young people in
Sheffield.
Emotionally healthy children are able to grow and learn through their good or bad feelings
and experiences, make friends, enjoy their own company and play and have fun.
In Sheffield we believe we can improve the emotional wellbeing of children and Young
people and maximise the use of available resources to provide better outcomes.
We shall involve key stakeholders to ensure we deliver this strategy as part of the priority
area within the Children’s Plan to improve Emotional and physical well-being of Children
within Sheffield.
In Sheffield we will:






Involve children and young people, parents and carers in the planning and
commissioning of local services
Help Children learn the skills they’ll need to stay emotionally healthy by developing
their resilience, by ensuring positive emotional health is supported and developed
through specific learning environments setting such as schools, colleges and youth
settings
Develop information and an easy to understand network of support locally for
children, young people and families
Raise the awareness and capability in local universal services to enable parents
and local professionals to provide the best possible support. Ensuring step down
care is available for children and young people discharged from specialist services
Target early intervention through supporting maternal mental health, positive
parenting and ensuring emotional wellbeing of infants through the first 5 years
Develop new innovative solutions and multi agency models of care for children and
young people with complex needs in highly specialised placements
How will we achieve this?
A number of different organisations plan and buy services which can help improve the
emotional health of children and young people in Sheffield. These include NHS Sheffield,
different parts of Sheffield City Council, schools, colleges and charities. This process is
known as planning and commissioning.
These different organisations have agreed which of the services above they will be
responsible for commissioning, and will do this as and when funding becomes available.
Page 5
The economic situation means that there is not going to be a lot of new money around to
fund new services, so we will try to improve the way we do things to use the money we do
have more effectively.
Commissioners will ask the organisations they are buying services from to prove and
report on what real difference they have made to children’s lives, rather than just how
many children they have seen. This will apply to services for children and young people
that are provided by the City Council and Health Service as well as to those provided by
charities.
Commissioners will also work together more, by sharing intelligence on the local
population relating to need, pooling resources, planning together, and creating more joined
up services.
People who work with children and young people are bringing together their local
knowledge of needs, and we will be moving towards commissioning relevant services to
meet those needs at the local level, as well as commissioning city wide services.
How will we know whether the strategy is working?
All the commissioners of services and key stakeholders will come together to monitor the
implementation of the strategy through the Emotional Well Being & Mental Health Strategic
Partnership Group.
A group of children, young people and parents will tell the Partnership Board their issues
with how things are working to inform future planning.
We will measure the outcomes of the strategy on two levels:


Individual commissioners will review the outcomes for children reported by service
providers – to monitor if they are improving the emotional health of children and
young people
The whole group will think about weather we are improving children’s emotional
health and wellbeing overall, by looking at the relevant information about quality of
life and service measures that we already collect, e.g. those about emotional health
and wellbeing, bullying, substance misuse, educational attainment, numbers who
have Behavioural, Emotional or Social Difficulties
Page 6
1. Context and background
There are approximately 125,000 children living in Sheffield and, based on national
average prevalence rates, it is expected that there are approximately 11,000 will have a
recognisable mental health disorder 1. These mental health disorders are typically
associated with educational failure, family disruption, disability, offending and anti-social
behaviour.
In summary:

Sheffield has the 4th largest population of any urban area in England, with a 0-19
population of 125,000 2

Within the 0-19 age bracket, there will be a predicted 11.5% rise between 2009 and
2031 2 and therefore, mental health problems in this age group are likely to rise in
similar proportions

Within Sheffield, there are 7,000 children between the age of 5 and 16 years and
2,500 16 and 17 year olds who may be suffering from a clinically recognised mental
health disorder3

6,300 pre-school children have a mental health difficulty of some kind

That around 7% of pre-school children have a severe mental health problem (2,205
in Sheffield) 3

An estimated 4,697 Children with Learning Difficulties/Disabilities may have a
mental health problem of some kind in Sheffield 3

The prevalence of mental disorder in 5-15 year olds from social housing is 17%,
compared with only 6% for 5-15 year olds from owner occupied housing reflecting
the social gradient of mental health 4. In Sheffield, 17% of 5-15 year olds living in
social housing equates to 2,430 children and young people
3
1.2 Sheffield’s CAMHS Strategy set out the direction of travel for the development and
improvement of Child and Adolescent Mental Health Services between 2007 and
2009 following the evaluation of the strategy and feedback from key stakeholders the
focus for planners, commissioners and providers needed to change. The focus on the
wider emotional health and wellbeing needs of children and young people needed
greater consideration as did making the mental health of children and young people
everybody’s business. In May 2010 the CAMHS Strategy group was disbanded and
the new Emotional Wellbeing and Mental Health Partnership Group was formed and
tasked with the development of a new Strategy.
1.3 The final report of the National CAMHS Review 2008 (Children and Young People in
Mind) identified 7 key areas, which they recommend all future strategies should take
into account. They are:
1.4 Leadership: Recommendations are made for strengthening leadership at local,
regional and national levels. The key recommendation for a Sheffield Strategy is:
1.4.1 The legislation on Children’s Trusts should be strengthened so that each trust
is required to set out in its Children and Young People’s Plan how it will ensure
Page 7
the delivery of a full range of children’s services for mental health and
psychological well-being across the full spectrum of need in its area.
1.5 What children, young people and families want: Feedback from children, young
people and their families and carers indicate the key areas for improvement are:
1.5.1 A need for greater awareness in schools, colleges, children’s centres and GP
practices; better promotion of services and issues being dealt with more
sensitively
1.5.2 Trust – being able to see the same person regularly and build a mutually
trusting relationship
1.5.3 Accessibility: A single point of entry, with easily accessible locations, open at
times to suit the patient and with information available in a range of formats
1.5.4 Communication; being spoken to in a non-clinical, non-technical way and
being listened to more closely
1.5.6 Involvement: Being given an opportunity to discuss what services are available
and being valued for the experience that children and young people bring
1.5.7 Support when it’s needed: Services available when the first need arises, not
when it reaches crisis point; services that stay in touch after treatment has
ended
1.5.8 Holistic approach; services that treat the whole person; which treat you as an
individual and which take into account your physical, as well as your mental
health
1.6 Promotion, prevention and early intervention: There are two key
recommendations:
1.6.1 Promote a positive understanding of mental health and psychological
wellbeing to improve everyone’s understanding; ensure everyone knows
where to go to get advice, help and support
1.6.2 Improve the access that children young people and families have to mental
health and psychological wellbeing support
1.7 Specialist help for children, young people and families: Children and young
people who need more specialised help, and their parents and carers, should have:
1.7.1 A high quality and purposeful assessment which informs a clear plan of action,
and which includes, at the appropriate time, arrangements for support when
more specialised input is no longer needed
1.7.2 A lead person to be their main point of contact, making sure that other sources
of help play their part in coordinating that support
1.7.3 Clearly signposted routes to specialist help and timely access to this
1.7.4 Clear information about what to do if things don’t go to plan
1.8 Services working together: Multi-agency working is seen as the ideal delivery
model but there is an acceptance that much more could be done:
1.8.1 Introduce a ‘shared and common language’ so that each team feels a part of
the same ‘family’ of care, to improve consistency and to promote greater
cooperation and coordination
1.8.2 Remove or reduce separate line management and administrative
arrangements
1.8.3 Work with pooled budgets so that there are no arguments about posts being
‘outside of our remit’
1.8.4 Recognise and plan for the fact that multi-agency working takes time,
particularly when many professions have different working patterns
Page 8
1.9 A needs-led system: Local areas need a comprehensive understanding of the
mental health needs of ALL of their children and young people in order to underpin a
sense of common purpose across all children’s services. Particular consideration
should be give to: Awareness of funding streams to maximise funding for services
(pooled budgets); further development and use of the CAF; Transitional services from
children and young people to adult services and a local commissioning framework
that provides clarity about who is commissioning what so that:
1.9.1 Weaknesses can be identified and improved
1.9.2 The effectiveness and impact of commissioning can be evaluated
1.10 Developing and supporting people who work with children: All bodies
responsible for initial training should provide basic training in child development and
mental health and psychological wellbeing. This should be in place within two years.
The children’s workforce development strategy should set out minimum standards in
relation to key knowledge of mental health and psychological wellbeing to cover both
initial training and continuous professional development.
2.
The Strategy is also be informed by Promoting the Emotional Health of Children and
Young People, Guidance for Children’s Trust Partnerships, including how to deliver
NI 50 – January 2010.
2.1 This document views emotional health as being synonymous with ‘psychological
wellbeing’ which is the term used in the CAMHS Review and previously in Standard 9
of the National Service Framework for Children, Young People and Maternity
Services. It also provides a useful Framework in terms of risk and protective factors
(see Fig 1 below).
Page 9
2.2 The guidance focuses on 4 areas of service delivery:




Supporting parents and carers
Supporting friendships, peer relationships and personal development
Promoting emotional health in childcare and learning environments
Information, advice and support when needed
3. Our Priorities
In February 2010 a workshop was facilitated with members of the Sheffield 0-19
Partnership Board to raise awareness of some of the emerging issues facing Children and
Young People Emotional Wellbeing and Mental Health; following this workshop the
Emotional Wellbeing and Mental Health Partnership Group gave further consideration to
the feedback from members of the 0-19 Partnership alongside a more detailed needs
assessment.
Six Key Strategic Priorities were identified with a suggestion that these could form the
basis of our new Strategy.
Our Priorities
Priority One
Involve children and young people in the planning and
commissioning of local services
Needs
The NHS White paper outlines the need for shared decision
making to become the norm.
Evidence from the NHS Patient Charter stipulates the need to
involve patients in the shaping of local NHS services.
Patient and public involvement is also a key component in World
Class Commissioning Competencies
The National CAMHS review highlights the need to consult with
children and young people in the developing a needs lead system
Maintain and involve the local Care Experience Council in all
planning and service development
Key Action
Integrate the voice of children and young people into the
Emotional Wellbeing and Mental Health Partnership Group by
reflecting them within the terms of reference
Ensure that service specifications and contracts monitor patient
experience and patient feedback is used to inform planning.
Outcome/Change A needs lead local service that reflects patient choice
Young people friendly services
Page 10
Priority Two
Help Children learn the skills they’ll need to stay emotionally
healthy by developing their resilience. This should be promoted
through development of positive emotional health within learning
environments setting such as schools, colleges and youth settings
Needs
The evaluation of the Primary Mental Health Service and the
Targeted Mental Health into schools evidence based the need to
provide early intervention and prevention.
The Every Child Matters Survey outlines the case for change and
local needs. The healthy schools audit identifies the local needs
within educational and learning environments
Key Action
VM and KA to comment and develop action
Outcome/Change Clear city wide objective on how to develop resilience in children
and young people
Reduction in the need for specialist treatment and interventions
Priority Three
Develop information and an easy to understand network of
support locally for children, young people and families
Needs
The interim evaluation of the primary mental health services and
the tier 3 CAMHS review highlighted a lack of clarity of referral and
access routes to CAMHS.
Key Action
Develop a single point of access to community services
Development of a guide to local mental health services
Development of self help manuals and accessible guides to
support common mental health problems
Outcome/Change Earlier access to appropriate services
Reduction in inappropriate referrals
Increase skill mix within universal services
Page 11
Priority Four
Raise the awareness and capability in local universal services to
enable parents and local professionals to provide the best
possible support. Ensuring step down care is available from
children discharged from specialist services
Needs
There is no clear consistent pathway to step down care following
specialist intervention
Sheffield has a high spend on specialist services and low
investment in early intervention and prevention services for mental
health.
Key Action
Develop skills and capacity in universal services
Develop a range of self help manuals to support parents and
professionals in the management of mental health.
Develop a range of training and consultation sessions on a rolling
programme citywide.
Develop a clear local universal pathway with Multi agency support
teams for step down care.
Outcome/Change Clear pathway for step down care
responsibilities of universal providers
specialist
roles
and
Priority Five
Target early intervention through maternal mental health positive
parenting and ensuring emotional wellbeing of infants through the
first 5 years
Needs
The Healthy Child Programme outlines the importance of
development of attachment and positive parenting in early years.
There has been an increase in demand for specialist maternal
mental health services over the past 3 years.
There has been an increase in complexity, behaviour disorders
and attachment disorder evidence over recent years within
Sheffield
Key Action
Development of Multi agency working within teams to identify and
support children and parents at risk
Development of positive
development programmes
Page 12
parent
programmes
and
child
Implementation of the maternal mental health pathway as part of
the specialist maternity care services
Outcome/Change Decrease in maternal mental health
Decrease in numbers of families entering care systems.
Priority Six
Develop new innovative solutions and multi agency models of
care for children and young people with complex needs in high
cost placements
Needs
There are a number of children and young people placed in out of
area placements due to complexity
There is concern about the monitoring quality and cost of out of
area placements for children and young people from Sheffield.
Key Action
Undertake a joint needs assessment of out of area placements
Develop local services to meet identified need
Develop joint ways of assessment and monitoring of individual
placements
Continue to monitor and develop Specialist tier 4 services in line
with emerging need.
Develop new integrated commissioning models to consider person
centred flexible packages of care and support to be developed
Outcome/Change Bring children in out of area placement back to there local
community
Provide care closer to come
Page 13
4. Our Implementation Plan
To be developed
5. Conclusions
To be developed
Page 14
APPENDIX A
0-19+ Partnership Board
Workshop Session held on Thursday 25th February 2010 on
CAMHS and the Emotional Well Being of Young People
Outcomes:
Members were able to:
1. Gain a better collective understanding of the issues impacting on emotional wellbeing
and mental health of children in the city
2. Develop a better understanding of the services and provision in place to support their
emotional wellbeing and mental health needs
3. Explore issues and challenges facing the Children’s Trust partnership
4. Develop a collective view of the way forward and the future development of strategic
plans
They supported the need for a new strategy that would:
1.
2.
3.
4.
Be broader in scope than specialist commissioned provision
Include partners whose work contributed to resilience and provision
To engage partners who might otherwise think it had “nothing to do with me”
That would provide a coherent framework for other developments, for example social
and emotional aspects of learning (SEAL) and targeted mental health in schools
Members worked in ‘themed groups’ and identified the following as being areas of
particular significance, which needed be taken into account in our strategy:
1. Broad and wide ranging consultation was needed in the development of the strategy
and must include children, young people, their families and carers, schools,
Connexions, YOS, and the police as well as CAMH professionals
2. The strategy should link to the length of the Children and Young People’s Plan and
extend existing strategies to 2011 whilst now starting an evaluation / consultation
process. It should also link into the 0 -5 Strategy
3. Examples of good practice (MAPS, Right Here, Forensic etc) should be cited.
4. Major ‘themes’ should be identified at an early stage (Bullying, separation, attachment,
family breakdown)
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APPENDIX B
Emotional Health and Wellbeing Needs of Children and Young
People in Sheffield and Overview of Current Services
Version 2.1
Section
Page
1
Introduction
18
2
Scope
18
3
The needs of young people in Sheffield
18
18
3.1
3.2
3.3
3.4
4
Services in Sheffield
4.1
4.2
4.3
4.4
4.5
5
Self Reported Emotional Health & Wellbeing
3.1.1 TellUS4 Survey
3.1.2 ECM Consultation 2009
3.1.3 Soul & Fame
Estimated Emotional Wellbeing & Mental Health Needs
3.2.1 Estimated Mental Health of 16/17 year olds
Vulnerable Groups
3.3.1 Learning Difficulties & Disabilities
3.3.2 BME
3.3.3 Children with continuing/end of life care needs
3.3.4 Youth Offending
3.3.5 LAC
3.3.6 Substance Misuse
3.3.7 Socio-economically disadvantaged
Parental Well-being
Tier 1
Tier 2
4.2.1 Primary Mental Health Service
4.2.2 Targeted Mental Health in Schools
4.2.3 Interchange Y-Talk Counselling & Therapy
4.2.4 Right Here Project
4.2.5 Independent Visiting Service
4.2.6 Mental Health Worker: Leaving Care Team
4.2.7 Early Onset in Psychosis Service
Tier 3
4.3.1 Tier 3 Activity Levels
4.3.2 BME Access
4.3.3 Presenting Problem
4.3.4 Multi-systemic Therapy Project
Tier 4
Adult Mental Health Services
Investment by Tier
19
21
26
26
27
27
30
34
35
36
Page 16
6
National CAMHS Benchmarking
36
6.1
6.2
6.3
6.4
36
37
38
38
Access Rates
Expenditure by Area
Staff ratios
Tier 4 Bed Days
Appendix 1:
Appendix 2:
Appendix 3:
Four Tier Model of CAMHS
Service Costs Per Annum
References
Page 17
39
40
42
A summary of the Emotional Well Being & Mental Health Needs
of Children and Young People in Sheffield and Overview of
Current Services
1. Introduction
This paper summarises recent emotional health and wellbeing needs assessments for
children and young people in Sheffield. This data is presented with the relevant National
Indicators for emotional health and local surveys of children and young people’s emotional
wellbeing. Together this data presents a picture of the current levels of need in Sheffield.
The current range of commissioned services are briefly outlined including activity levels
where available and presented with associated levels of investment and where applicable
end dates where current funding streams are expected to come to an end. The services
costs are then presented by tier against the levels of need to show the relationship
between need and investment.
2. Scope
The services included within this report are from across all 4 Tiers of emotional wellbeing
and mental health services in Sheffield (See appendix 1 for Tier model) The services
include those that are jointly or separately commissioned by NHS Sheffield and CYPS of
Sheffield City Council. In addition some significant voluntary sector projects have been
included.
However, this report does not include all voluntary sector organisations that may contribute
to the wider emotional health and wellbeing agenda, and this gap in mapping of services
should be noted. Particular examples include provision that primarily is concerned with
children with learning difficulties and disabilities but that also provides mental health
support to families such as autism and ADHD support groups often jointly delivered
between CAMHS and voluntary groups such as Family Action; and parenting support
programmes.
Some children enter transition to some adult mental health services at 14 (Early Onset in
Psychosis service) or 16 for some Tier 3 teams. Brief activity and cost data is included to
show the current level of adult mental health service access by under 19’s.
The Educational Psychology Service is also omitted from this report.
3. The needs of young people in Sheffield
3.1 Self reported Emotional Well Being & Mental Health
There are several locally implemented surveys of children and young people that give
good insight into the current levels of need relating to emotional health and wellbeing
3.1.1 TellUS4 Survey
The TellUS4 survey provides the data for National Indicator 50 (NI50) – the ‘Emotional
health of children 2009-10’.
Page 18
Sheffield scores 56.5% compared with Yorkshire and Humber average of 57.3% and the
National score of 56.0%. The indicator is a combined score of four questions to give a
percentage of children with good relationships. Although better than national average
Sheffield is lower than many neighbouring cities and still suggest that just under half of
children and young people do not have good relationships which are essential for good
emotional health.
3.1.2 ECM Consultation 2009
The Every Child Matters annual survey of Sheffield schools provides some useful data to
give a picture of the mental health of children in Sheffield.
Bullying
41% of Y2 children and 39% of Y5 children have been bullied in the last year. 28% of Y7
and 22% of Y10 have been bullied in the last year.
Across all ages the majority of bullying takes place at school or college.
It is worth noting that the figures for bullying for 2009 are much lower than the 2008
figures, where 50.4% of Y2 children and 46.9% of Y5 children, 53% of Y7 and 43% of Y10
had been bullied in the last year.
Feelings of happiness
8% of Y5 say that they feel sad or unhappy everyday, rising to 10.5% of Y5’s with FSM
and 12% with SEN.
3% of Y7 say that they feel sad or unhappy everyday, rising to 6.8% of Y7’s with FSM and
6.8% with SEN.
7% of Y10 feel sad or depressed regularly, rising to 11.1% of Y10’s with FSM and 12.2%
with SEN.
9% of Post 16’s feel sad or depressed regularly.
3.1.3 Soul & Fame
A 2010 Peer Research survey and report about the views of Young People with Learning
Difficulties and Disabilities in Sheffield in relation to the Every Child Matters Outcomes.
The sample of 500 young people from the Sheffield Disability Index to receive a
questionnaire.
87% of the returned sample said that they have been bullied, with 67% indicating this is
likely to occur at school.
3.2 Estimated Emotional Wellbeing & Mental Health needs
There are approximately 125,000 children living in Sheffield and, based on national
average prevalence rates, it is expected that there are approximately 11,000 will have a
recognisable mental health disorder 1. These mental health disorders are typically
Page 19
associated with educational failure, family disruption, disability, offending and anti-social
behaviour.
In summary:

Sheffield has the 4th largest population of any urban area in England, with a 0-19
population of 125,000 2

Within the 0-19 age bracket, there will be a predicted 11.5% rise between 2009 and
2031 2 and therefore, mental health problems in this age group are likely to rise in
similar proportions

Within Sheffield, there are 7,000 children between the age of 5 and 16 years and
2,500 16 and 17 year olds who may be suffering from a clinically recognised mental
health disorder3

6,300 pre-school children have a mental health difficulty of some kind 3:

That around 7% of pre-school children have a severe mental health problem (2,205
in Sheffield) 3

An estimated 4,697 Children with Learning Difficulties/Disabilities may have a
mental health problem of some kind in Sheffield 3

The prevalence of mental disorder in 5-15 year olds from social housing is 17%,
compared with only 6% for 5-15 year olds from owner occupied housing reflecting
the social gradient of mental health 4. In Sheffield, 17% of 5-15 year olds living in
social housing equates to 2,430 children and young people
The total numbers of children (aged 5-16) in Sheffield with specific disorders can be seen
below 5, 6, 7. Many of these children will have multiple mental health difficulties. Although
there are gender differences between the disorder classifications, the overall picture of
mental ill-health is balanced between the genders.
Table 1: Total Number of Children (5-16) with Specific Disorders in Sheffield
Disorder
Number
Conduct Disorders (5.3%)
3,760
Emotional Disorders (4.3%)
3,050
ADHD (2.27%)
1,610
Less Common Disorders (1.3%)
Total (10% of population)
922
7,094
Note: Total is not a cumulative figure, but reflects co-morbidity
Page 20
3.2.1 Estimated Mental Health of 16/17 year olds
2,532 16-17 year olds in Sheffield may suffer from some form of psychological problem 8.
1,684 young people may experience a generalised anxiety disorder; that approximately
215 16-17 year olds suffer from a depressive disorder; and that approximately 25 16-17
year olds suffer from psychosis 9. However the actual number of local 16/17 year olds
suffering from psychosis at any one time is likely to be significantly lower that this because
the average age for first onset psychosis is 22 years. Estimated local figures for female
anorexia and bulimia based on 2% and 3% rates respectively, suggest 124 16/17 yr olds
suffering from anorexia and 186 suffering from bulimia 3.
3.3 Vulnerable Groups
A range of vulnerable groups of children and young people are at an increased risk of
developing mental health problems. These include: learning difficulties/disabilities (LDD)
including physical disabilities; BME groups; children with life-limiting and chronic
conditions; young offenders; looked after children; substance misusers; the socioeconomically disadvantaged; and other groups such as the homeless; asylum seekers;
and those Not in Education, Employment or Training (NEET).
3.3.1
Learning Difficulties and Disabilities
An estimated 4,697 Children with LDD needs may have a mental health problem in
Sheffield (based on ONS 4 estimates of 44% of SEN & School Action Plus having
additional mental health needs).
Table 2: Estimated Numbers of Children with Both a Learning Disability & Mental
Health Problem
Age
5-16
Estimated Numbers of
Children with a Learning
Disability & Mental Health
Problems
3,949
17-19
748
Total
4,697
Population projections within the LDD Comprehensive Needs Assessment for Sheffield 10
indicate a growth in the total children with LDD population in Sheffield which averages at
about 5.1% per annum over the period 2009-2012 compared with a national average of
3.1%. The following groups are the fastest growing LDD needs in Sheffield with national
comparators:
Page 21
Table 3: Fastest growing categories of LDD need in Sheffield
Category
Local Growth
Rate
National
Growth Rate
Autistic Spectrum
Disorders (ASD)
16.8%
6.5%
Speech Language
and Communication
Needs (SLCN)
13.5%
10.5%
Behavioural
Emotional and Social
Difficulties *
1.8%
5.2%
Severe Learning
Difficulties (SLD)
9.5%
-2%
* BESD is NOT a fastest growing area of need and is present for comparison
Some estimates suggest that over 80% of children with autism will meet the full diagnostic
criteria of at least one anxiety disorder 11.
The projection also suggests the percentage of children with LDD from BME communities
will increase from 21.5% to 25.5% between 2009 and 2012 10.
3.3.2
BME
Understanding the prevalence of mental illness among different ethnic groups is
recognised as being both controversial and complex however the following are accepted
differential rates of mental health problems in young people across broadly defined ethnic
groups 12:




Black children 12%
White children 10%
Pakistani and Bangladeshi children 8%
Indian children 4%
As Sheffield’s BME populations grow it is anticipated that the proportion of children with
mental health needs in Sheffield from BME groups will also rise, reflecting the above rates.
3.3.3
Children with continuing and end of life care needs
Children with a long-lasting physical illness are twice as likely to suffer from emotional
problems or disturbed behaviour. This is especially true of physical illnesses that involve
the brain, such as epilepsy and cerebral palsy 13. There are an estimated 3,472 children
under the age of 18 in Sheffield with chronic and life-limiting conditions (based on hospital
Page 22
admissions 2008-2009) who are at increased risk of developing mental health problems,
self-harm, eating disorders and suicide.
3.3.4
Youth Offending
Rates of mental ill-health are much higher amongst juvenile offenders. The table below
shows the expected prevalence within Sheffield. 53% of YOS caseload may have conduct
disorders according to national estimates 14.
Table 4: Estimated prevalence within the YOS caseload
Conduct disorders (53%)
Hyperkinetic disorders
(19%)
Substance abuse (24%
Depression (14%)
Psychotic symptoms (4%)
Number of
Cases
1,154
414
522
305
87
Note: Total number of cases greater than total number of Children in Sheffield YOS, as some young
people may have more than one disorder.
3.3.5
LAC
As with other vulnerable groups, rates of mental ill-health a substantially higher amongst
Looked After Children. ONS (2003) 3 found that 37% of Looked After Children had
clinically significant conduct disorders (218 in Sheffield), 12% had emotional disorders (71
in Sheffield), and 7% were diagnosed as hyperactive (41 in Sheffield).
Data collated from LAC Health Plans in Sheffield (2008-2009) suggested that 96 of the
590 children and young people reported problems or a need in relation to their mental
health/emotional well-being (16.3%).
NI58 the Emotional Health of looked After Children uses the Strengths & Difficulties
Questionnaire (SDQ) sample of looked after children (aged 4 – 16 years) on an annual
basis. The SDQ is not self-completed – but is completed by the carer. Difficulty scores (010) in 5 areas are compiled with a Total Difficulties score (0-40) being calculated form 4 of
these. In addition there is an impact score (0-10) that indicates chronicity, distress, social
impairment, and burden to others. Scores are put into rating categories of Average;
Borderline; High; Very High.
Data is now available for 2008-09 and 2009-10 nationally (All Children) and in Sheffield
(Looked After Children) allowing comparisons and some trend analysis.
Page 23
Chart 1: Overall Distribution of SDQ Scores for Sheffield 2008-09 & 2009-10
Against National Normative
Sheffield City Council, CYPS, 2010.
Chart 1 Shows the Sheffield SDQ scores over the two years for LAC against the national
normative (Average of 10,000 children from general population). The chart shows that
Sheffield’s LAC scores are more evenly distributed across the range of scores than the
national average for all children, with a lower proportion of ‘average’ scores and a greater
proportion of borderline, high and very high scores. This would indicate that the average
emotional wellbeing and mental health for Sheffield LAC is much lower that of the ‘average
child’ in Britain.
Whilst this position is not ideal, it is perhaps unsurprising to see that the emotional
wellbeing of Sheffield LAC is significantly worse than that of the ‘average child’ in Britain.
Chart 2 shows the Sheffield scores in more detail and breaks it down by Score Area to
highlight the areas of greatest concern. It also provides a Total Difficulties Score which
can be compared with the National NI58 Dataset to see how Sheffield is performing in
relation to Yorkshire and the Humber, and the National Average for LAC.
Page 24
Chart 2: Sheffield Scores Areas, 2008-09 & 2009-10
2008-09
2009-10
Average
Average Rating
Average
Average Rating
Emotional Symptoms Score
3.0
Average
2.9
Average
Conduct Problems Score
3.8
Borderline
3.5
Borderline
Hyperactivity Score
5.6
Average
5.3
Average
Peer Problems Score
3.4
Borderline
3.3
Borderline
Pro-Social Score
6.4
Average
6.1
Average
Total Impact Score
2.5
High
3.1
Very High
Total Difficulties Score
15.8
Borderline
15.1
Borderline
Sheffield City Council, CYPS, 2010.
Between 2008-09 and 2009-10 there has been a slight reduction in Total scores indicating
an increase in the overall emotional wellbeing of Sheffield LAC. However the Total Impact
Score has risen from High category to Very High over the same period which suggests a
higher impact on daily lives.
The Sheffield score for 2008-09 (15.8) is significantly higher than both national and
Yorkshire & Humber scores in the same year of 13.9 and 14.9 respectively 17.
Further data is available locally breaking down the scores by age, gender, placement type
and stability of placement. However, interpretation of this data is difficult and should be
used with caution. For example, those LAC with good long term placement stability have
lower SDQ sores (15.3) than those who fail the NI 63 placement stability criteria (16.5).
However, the data cannot show whether this is due to the impact of placement stability on
emotional wellbeing, or conversely whether LAC with greater needs and difficulties and
more likely to have placement breakdown.
The same interpretation difficulties are present for placement type. LAC in independent
living (11.3) and foster care 14.7) have much lower scores than those in homes and
hostels (17.4) or residential schools (17.1). This may be reflection of quality of placement
type and its environment impacting on emotional wellbeing. However, it may simply show
that the most challenging LAC with poor emotional wellbeing struggle to find foster carers
and are unsuitable for independent living, and therefore are placed in homes and
residential school settings.
3.3.6 Substance Misuse
During 2008/09 of 158 children or young people in treatment at Sheffield’s Young People’s
Drug Project 17% were referred for assessment for mental health problems (at Tier 3)
equating to 27 young people.
Page 25
3.3.7 Socio-economically Disadvantaged
It is recognised that socio-economic disadvantage is among the key risks in child and
adolescent mental health. The 2000 15 and 2003 4 ONS reports highlighted the link
between a family’s employment, economic situation and the prevalence of mental health
problems in children. The prevalence of mental disorder in 5-15 year olds from social
housing is 17%, compared with only 6% for 5-15 year olds from owner occupied housing.
In Sheffield, 17% of 5-15 year olds living in social housing equates to 2,430 children and
young people 4.
3.4 Parental Well Being
A range of issues relating to parental well-being impact on the emotional health and wellbeing of children and young people. Examples include poor family relationships, domestic
violence, having a parent suffering from mental ill health, or parental substance misuse.
Post natal depression is a common example of adult mental ill-health. Current prevalence
estimates suggest that post natal depression occurs in between 10-15% of new mothers in
the UK. Using current delivery data for Sheffield this equates to between 600 and 900
Sheffield women every year.
Children in families experiencing domestic abuse are more susceptible to mental ill health.
There are on average 6000 domestic violence incidents every year in Sheffield attended
by South Yorkshire Police.
4. Services in Sheffield
The Table below shows some existing inconsistencies in relation the age range of mental
health services for children & young people in Sheffield.
Table 5: SCC & NHS Sheffield Commissioned Services by Age range & Tier
Service
TaMHS
PMHS
MAPS
Community CAHMS
Forensic
Youth Offending
Tier
Dual Diagnosis
Substance Misuse
Becton & Shirle Hill
Page 26
2
2
3
3
3
3
Age
Range
5 to 13
0 to 18
0 to 18
0 to 16
0 to 18
0 to 18
3 0 to 16
3 0 to 18
4 0 to 18
4.1 Tier 1
Social and Emotional Aspects of Learning (SEAL – Curriculum & Whole School Approach
to emotional well-being and small group work)
 97% of Primary Schools engaged in SEAL through SCC (130)
 100% of secondary schools implementing elements of Secondary SEAL with 4
Lead Secondary Schools implementing the programme (27 secondary).
Nurture Groups
 23 Schools Actively running
 Further 4 schools trained but not running at this time
National Healthy School Programme
 100% of schools recruited to programme (173)
 83% (144) schools at Health Schools Status (of which Emotional Health and wellbeing is a core component)
 40 schools working towards Enhanced Healthy School Status, some of whom will
priorities EH& WB as school priority.
 Initial discussions around healthy FE & HE.
Healthy Early Years Scheme (SEAD)
 Started April 2010
 27 Providers signed up
 Est. 40 providers by end of July 2010
4.2 Tier 2
4.2.1 Primary Mental Health Service (PMHS)
This is a two year tendered service ending March 2011. The aim of the service is to
strengthen and support the provision of child and adolescent mental health and emotional
well-being services at the universal level and provide support to families, children and
young people.
This is achieved by:





Promoting the mental & emotional well-being of children, young people and families
in the community
Enabling schools, health and other universal services to support children and young
people’s development through the building of capacity and capability
Enhancing the capacity and capability of complementary services aimed at or
contributing to the promotion of mental & emotional well-being
Enabling early identification and prevention of the development of mental health
problems in children & young people within universal services
Enhancing accessibility and equity for children and families, especially those who
would not ordinarily have opportunity to seek help from statutory and non-statutory
agencies
Page 27
25% of the service is direct support to children young people and families.
Table 6: PMHS Activity Sept 09 – March 2010
Family and
Professional Individual
Consultations Consultations Training
Total
104
73
345
522
The activity levels (above) are not truly reflective of service activity as the service was only
fully operational from January 2010 and due to MAST integration issues some data is
missing.
4.2.2 Targeted Mental Health in Schools (TaMHS)
Targeted Mental Health in Schools (TaMHS) in Sheffield is a two year (2009-2011) DCSF
programme aimed at supporting the development of innovative models of therapeutic and
holistic mental health support in schools for children and young people aged 5 to 13 at risk
of, and/or experiencing, mental health problems; and their families. Within Sheffield
TaMHS is running in two families of Schools.
Table 7: TaMHS 2010-2011 Activity as of June 2010
Group Work
(Children)
Numbers of
Clients
4.2.3
68
Individual
Case Work
(Children)
Drop-Ins
Child
Parent
Total
24
11
7
110
Interchange Y-Talk Counselling & Therapy Services
Sheffield YMCA Emotional Well-Being Services (non-statutory funding) offer counselling in
schools and community settings and referral for therapeutic services. These services are
also offered through Sheffield Futures/Connexions via Star House. Although the majority
of work is at Tier 2 there is some work including art therapy and CBT that crosses into Tier
3. High numbers of referrals are children and young people from BME backgrounds.
Page 28
Chart 3: Interchange School Counselling Service Locations
Interchange School Counselling Service Locations (2008-2009)
3.5
3
Number of Schools
3
2.5
2
2
2
1.5
1
1
0.5
0
Primary Schools
Secondary Schools
Pupil Referral units
6th Form Colleges
Table 8: Estimated Annual Interchange Client Activity Levels
Primary
Schools
Number of
Individual
counselling /
therapy clients
Secondary
School, PRU
& College
Star House Other
20
53
140
Total
11
224
Estimated levels are actual activity levels for schools 08-09 and Star House activity 09-10
combined.
These figures are expected to increase to around 350 in the current year.
4.2.4 Right Here Project (2009-2013) (YMCA)
Working with 16-25 yr olds in NE Sheffield this third sector funded project builds resilience
and the ability of young people to recognise and maintain their own mental health through
a variety of schemes including professional training and capacity building; direct work;
peer support; meaningful participation and consultation in service design and delivery;
parent support and improved pathways; communication and promotion. 20110-2011 is the
first full year of service delivery. Predicted 1-2-1 delivery to 70 young people.
4.2.5 Independent visiting service
1.0 WTE Independent Visitors Coordinator & 20 Independent Visitors. Matched with child
– mentor and befriending service from and an adult role model to have regular contact with
a matched child or siblings to support development. Outcomes not available at the time of
writing.
Page 29
4.2.6
Mental Health Worker: Leaving Care Team
A mental health worker is employed at No 92 (Leaving Care Team). This is currently
funded through CAMHS Grant (SCC). Outcomes not available at the time of writing.
4.2.7
Early Onset in Psychosis Service
Service for 14-35 year olds (as defined by the national model). Delivered by Sheffield
Health & Social Care NHS FT. Joint working protocol in place for children under 16 years.
In Practice this often results in14-16 year olds remaining with CAMHS as the case holder
and lead treatment agency with additional support from their General Practitioner, and do
not therefore formally enter Adult Mental Health Services.
4.3 Tier 3
Across Sheffield, there are 3 generic community CAMHS teams (Beighton, Flockton and
Centenary), and four city wide specialist Tier 3 CAMHS teams (Youth Offending, Dual
Diagnosis, MAPS for looked after children, and Forensic) which are targeted to children
from specific vulnerable groups. These seven teams are provided by Sheffield Children’s
Hospital NHS Foundation Trust. In addition a Substance Misuse Team is provided by CRI.
Mental health conditions considered appropriate for referral to Tier 3 include:












Depressive disorders
Anxiety disorders
Hyperkinetic disorders
Developmental disorders
Psychotic disorders
Eating disorders
Conduct disorders
Obsessive compulsive disorders
Post traumatic syndromes
Somatic syndromes
Severe behavioural problems
Significant issues relating to attachment
The recent NHS Sheffield commissioned review of Tier 3 CAMHS in Sheffield produced the
following recommendations 16:

Improve the access to preventative and early intervention services as part of
community CAMHS to reduce increase in the complexity of cases. A new Tier 2
service is currently being commissioned on 2 year basis initially;

Continue to improve access to services and reduce the numbers waiting; a common
issue raised by stakeholders. There is a need to look carefully at the impact of
CAPA, and in particular, the increased number of referrals and risk of internal waits.
Continued improvements in equity of access for hard to reach families and the coordination of resources between services could best be handled through the
development of a single point of access for generic community CAMHS services;
Page 30

The Dual Diagnosis service provides a positive and effective service. Therefore,
there is a strong case for change that identifies the need for additional resources in
the future to increase timely access to this service, particularly given the complexity
of the cases and the extended duration of treatment and care;

Ensure that through the development and commissioning of new services, that
pathways are clearly identified and protocols for transfer and discharge are
developed, embedded, mobilised and monitored. Commissioners will need to
ensure that there is no duplication of service provision between the community Tier
3 teams and the Tier 2 and Tier 4 services and that resources match demand.
Commissioners need to consider the future options for the development and
sustainability of Tier 2 CAMHS;

Commissioners need to be clear about expectations of caseload and the
appropriate length of time that service users should continue to be an open case
within each of the services. These expectations should form part of the service
specifications for each service area, and performance against these indicators
should be monitored;

Proposals for all children requiring ongoing intensive intervention (beyond the initial
assessment and treatment) by the specialist Forensic, MAPS and Dual Diagnosis
teams should be referred and reviewed through a central panel. In Sheffield, this
would be the Resource Allocation Panel, a multi-agency group who consider the full
care plan for a child or young person, and review progress against this;

Commissioners need to monitor and assess skill-mix, and to define the skills and
competencies required to meet the outcomes required for the local population;

Develop a commissioning framework under which services will be commissioned.
This framework should focus on quality and outcomes and be explicit about the
scope of services and its core offer. Options for joint commissioning by health and
social care should be considered through, for example, pooled budgeting
arrangements, a single contracting process and a single procurement;

Embed the performance monitoring framework and continue to include additional
measures, in particular, service user experience and outcomes, which for some
services are already been collated;

The responsible commissioner arrangements for CAMHS for looked after children
placed out of county and forensic services for out of area placements in Aldine
House must be incorporated within the service specifications to ensure clarity
across all parties; and

Addressing the needs of 16-18 year olds through appropriate transitional services
and have clearly commissioned age ranges for services.
Page 31
4.3.1 Tier 3 Activity Levels
Table 9: Tier 3 service activity levels
2009/10
No. of
Cases
Centenary
Beighton
Flockton
Dual
Diagnosis
452
496
608
55
Forensic
68
MAPS
Substance
Misuse
YOT
127
2
93
Chart 4: Tier 3 Service Activity Levels
Tier 3 Service Activity Levels
700
608
600
496
Cases 09/10
500
452
400
300
200
127
100
55
93
68
2
0
Centenary Beighton
Flockton
Dual
Forensic
Diagnosis
MAPS
Substance
Misuse
YOT
Service Area
Numbers of contacts to be added
4.3.2 BME Access
Table 10: Sheffield Children's NSH Foundation Trust - Child & Adolescent Mental
Health Services Directorate Ethnic Origin of New Clients first seen between 01/04/10
and 30/09/10
Ethnic Group
Black African
Black, Caribbean
Black, Other
Mixed, Any Other
Mixed, White & Black African
Totals
7
1
1
3
4
Mixed, White & Asian
10
Mixed, White & Black Caribbean
15
Not collected/asked
72
Page 32
Other Asian
Other Ethnic Group
Pakistani
Patient Refused
White, British
White, Irish
White, Other
Indian
Chinese
Bangladeshi
0
3
7
2
354
2
5
0
0
0
Table 10 shows the Ethnic Origin of CAMHS patients during the first 6 months of 2010. At
first glance it shows that 73% of all patients are from a White British background. This
appears favourable with an estimated 23% of children and young people in Sheffield from
BME backgrounds.
However, 72 of the 486 patients did not have their ethnic origin collected or asked, and
including them in the data skews the results. When removed from the totals, 85.5% of
patients are from White British backgrounds, with less than 15% from BME.
4.3.3 Presenting Problems
Table 11: Presenting Problem at Referral April 09 to March 10 - NOT INCLUDING
TIER 4
Presenting Problem
Autistic Spectrum Problem
Conduct Problem
Deliberate Self Harm
Developmental Problem
Eating Problem
Emotional Problem
Habit Problem
Hyperkinetic Problem
Learning Disabilities
not recorded
Other
Psychotic Problem
Number
18
437
99
14
48
768
15
140
39
70
95
13
Percentage
(%)
1
24.8
5.6
0.8
2.7
43.7
0.9
8
2.2
4
5.4
0.7
4.3.4 Multi-Systemic Therapy Project
In addition to the above CAMHS tier 3 delivery, Sheffield (SCC and Sheffield Children’s
NHS FT jointly) successfully bid to deliver 1 of 12 national MST pilot projects. MST is
about delivering intensive support in homes, neighbourhoods, schools and communities. It
aims to keep children out of the care system by working alongside the main caregivers and
family support systems. The service is provided 24/7, with direct and telephone support to
families. The service is funded through a central grant that ends in 2011 with a local
extension to funding through to April 2012. Since 2008 the project has worked with 62
families. The project offers intensive support for extended periods of time, with an average
family engagement of about 20 weeks.
Page 33
4.4
Tier 4
The majority of referrals to Tier 4 are for in-patient or day patient treatment. Factors
leading to referral to Tier 4 are not only severity and complexity, but also lack of treatment
response, unusual clinical features, breakdown in therapeutic relationships, availability of
local treatment options, and patient choice. (Specialised Services National Definitions Set
(SSNDS) Version 3, 2010)
The Becton Centre including Becton School is a sub regional resource offering specialist
care for those young people needing Tier 4, Child and Adolescent Mental Health Services.
This new facility replaces the former Oakwood School but has increased capacity and
scope.
Shirle Hill Hospital Service is part of the Tier 4 Child and Adolescent Mental Health Service
and offers out-patient day provision including educational provision for children attending
the hospital and outreach assessment for schools.
Table 12: Numbers of patients (Children & Young People) requiring
Tier 4 services in 2009-10, per PCT
Size of
population
Barnsley
Bradford & Airedale
Calderdale
Doncaster
East Riding of Yorkshire
Hull
Kirklees
Leeds
N E Lincs
N Lincs
Nth Yorks & York
Rotherham
Sheffield
Wakefield
Grand Total
Number of CAMHS
Tier 4 patients
4
10
4
12
19
29
9
19
5
2
36
3
51
7
210
225900
501700
201800
291600
335000
258700
403900
770800
159600
155300
794500
253900
534300
322300
CAMHS
Patients
Per
100,000
Population
1.8
2.0
2.0
4.1
5.7
11.2
2.2
2.5
3.1
1.3
4.5
1.2
9.5
2.2
CAMHS Tier 4 in Yorkshire & Humber 2011-2014 – Service Strategy
Table 12 highlights the relatively high numbers of CAMHS Tier 4 patients from Sheffield
compared to our neighbouring areas, both in total and the rate per 100,000 population.
The difference appears stark, with only Hull having comparable levels of Tier 4 use.
However, these statistics should not be interpreted in isolation. Hull has a very different
commissioning model to the other areas (and Sheffield) and therefore their high service
use statistics can be explained by the different approach taken (No in-city Tier 4 provision).
This illustrates that each area commissions and defines its Tiers differently; with many
areas (including Leeds) including day patients within their Tier 3 services, rather than in
Tier 4 as in Sheffield. In addition, other areas have introduced a Tier 3 crisis management
Page 34
approach to keep patients in Tier 3 including additional investment in Tier 3 services to
enable this approach.
All of these caveats suggest that although Table 12 is of interest it is not a true like-for-like
comparison.
Chart 5: Regional admissions data by reason for admission (2009-10)
PCT
Reason for admission
Wakefield
TEWV
Sunderland
Sheffield
Rotherham
NY&Y
NE Lincs
N Lincs
N Derbyshire
Leeds
Kirklees
Hull
ERY
Donc
Calderdale
Barnsley
B&A/BDCT
Psychotic, Hyperkinetic,
Epilepsy, Catatonic and Bi-polar
Bullying, School refusal, anxiety
and chronic fatigue
Good support, CAMHs,
assessment, mental health
Angry outbursts, conduct,
ADHD, disruptive behaviour
Drug abuse,
Eating disorders
Aspberger, autism, ASD, PDD
Self harm, suicidal, depressed,
emotional problems
Habit, OCD
Sectioned
0
10
20
30
40
not given
CAMHS Tier 4 in Yorkshire & Humber 2011-2014 – Service Strategy
Chart 5 shows the reasons for admission to T4 services by area. There is some significant
variation between areas, although the reasons for admission for the majority of patients fall
into 3 broad categories. These are:



4.5
Eating Disorders
Psychosis, Hyperkinetic, Epilepsy, Bi-polar
Self-harm, suicidal, depressed, emotional
Adult Mental Health Services
Some activity relating to 14, 15, 16 and 17 year olds is not captured within the children’s
Tiers highlighted above (see table 5). Over a one year period (2007-2008) a total of 627
16/17 year olds were referred, or receiving a service from specialist mental health
services. The true number is likely to be lower than this – taking account of internal
referrals between teams and between different services. Sheffield Care Trust figures
show that 31.5% 16/17 year olds did not attend their outpatient appointment; and 9.7% did
not attend a non-outpatient event from across the service. This information – in addition to
20% 16/17 year old referrals choosing not to engage with sector team services, suggests
that this age group are struggling to access, or choosing not to access services
Page 35
2009/10 data from Sheffield’s adult mental health services shows that 9.2% of service
activity (1277 contacts) are with under 19’s, although this has reduced from 15.5% in
06/07.
5. Investment by Tier
Chart 6 below shows Sheffield’s current investment in children and young peoples mental
health services (tiers 2, 3, & 4). Currently Tier 2 (prevention and early intervention)
receives just over 10% of budget; Tier 3 approximately 65%; and Tier 4 just over 20%.
Chart 6: Relative Investment in Mental Health Services by Tier
2010-2011 Sheffield investment in mental health
services by Tier
100%
90%
2275162
80%
70%
60%
Percentage of
Investment
Tier 4
50%
Tier 3
6145529
40%
Tier 2
30%
20%
10%
1067048
0%
Current Investment per annum (£)
6.
National CAMHS Benchmarking
Published in October 2010 the NHS Benchmarking Network Report on CAMHS Services
documents current approaches to delivering CAMHS and produced structured
performance comparisons.
6.1
18
Access Rates
Chart 7 below 18 shows rate of access of secondary mental health care by area for
England. Although this rate is for all people of all ages it provides a useful picture of how
Sheffield compares nationally and locally.
Sheffield has an access rate of between 1000 to less than 1,750 per 100,000. This rate is
just below national average and noticeably lower than other South Yorkshire PCT’s.
Page 36
Chart 7: Numbers accessing NHS Secondary Mental Health Care in England by area
of GP Registration in 2007-2008 (Directly standardised rates per 100,000 population)
Barnsley
Doncaster
Sheffield
7
Recommendations
To note the scale of emotional health and well-being needs amongst children and young
Rotherham
people in Sheffield
and the current levels of mental health service provision across the
Tiers.
6.2
Expenditure by area
Analysis of CAMHS funding nationally 18 confirms the average revenue budgets for
2010/11 of around £1m per 100,000 weighted population. For Sheffield this would equate
to an approximate revenue budget of £5.7 million per annum for the city across.
Current actual Sheffield revenue budgets for CAMHS in 2010/11 are approximately £8
million per annum (excluding any additional Tier 1 & Tier 2 funding e.g. PMHS & TaMHS);
significantly higher than would be expected for our population. This high level of
expenditure could be a reflection of higher than normal levels of cases – however the
national benchmarking suggests this may not be the case, with Sheffield experiencing
lower than average access to secondary mental health services (although this
benchmarking includes adults). It may also reflect a higher than average number of
contacts with patients; based on national benchmarking 18 one would expect in the region
of 16,000 contacts per annum. Current total contact data for Sheffield to be
added It could also indicate a higher than average spend on Tier 4 services which tend
to be more costly than lower tier interventions.
Page 37
6.3. Staff Ratios
National benchmarking 18 shows that across all grades of Staff the average workforce is 15
WTE per 100,000 weighted population, with an equal split between administration,
nursing, psychology and other categories. For Sheffield this would equate to 85 staff
across the tiers. Sheffield data required
6.4. Tier 4 Bed Days
For Tier 4 CAMHS the average number of bed days per 100,000 population was 185 days
per annum 18. For Sheffield this equates to 10,545 days based on weighted population.
Sheffield data required
Additional data required:
Contact data across all CAMHS tiers
WTE staffing across all CAMHS tiers
Tier 4 bed days for Sheffield
Page 38
Appendix 1 - The Four Tier Model of CAMHS
Tier
Tier 1
A primary level
of care
Tier 2
A service provide
by professionals
relating to
workers in
primary care
Tier 3
A specialised
Service for more
Severe, complex
or
persistent
disorders
Tier 4
Essential tertiary
Level services
such
As day units,
highly
specialised outpatient teams
and inpatient units
Professionals providing
the service include
 GPs
 Health visitors
 School nurses
 Social workers
 Teachers
 Juvenile justice workers
 Voluntary services
 Social services
Function/Service
 Child and Adolescent Mental
Health workers
 Clinical child psychologists
 Paediatricians (especially
community)
 Educational psychologists
 Child and adolescent
psychiatrists
 Child and adolescent
Psychotherapists
 Community nurses/nurse
specialists
 Family Therapists
 Child and adolescent
psychiatrists
 Clinical child psychologists
 Nurses (community or
inpatient)
 Child psychotherapists
 Occupational therapists
 Speech and language
therapists
 Art, music and drama
therapists
 Family Therapists
CAMHS professionals should be
able to offer:
 Training and consultation to
other professionals ( who
might be in T1)
 Consultation to professionals
and families
 Outreach
 Assessment
Page 39
CAMHS at this level are
Provided by professionals
working in universal services
Who are in a position to:
 Identify mental health
 Problems earlier in their
development
 Offer general advice
 Pursue opportunities for
 mental health promotion and
prevention
Services offer:
 Assessment and treatment
 Assessment for referral to T 4
 Contributions to the services,
consultation and training at T1
and T2
 Child and adolescent inpatient
units
 Secure forensic units
 Eating disorder units
 Specialist teams (e.g. for
sexual abuse)
 Specialist teams for neuro –
psychiatric problems
Appendix 2 - Service Costs Per Annum (at 2010-11 levels)
Service
Tier
NHS Sheffield
Funding
Mental Health Inpatients including:
Shirle Hill Hospital
Oakwood (Becton)
Mental Health Patients: Child (day
attendees)
4
1,189,932
1,189,932
Funding End
date (if
applicable)
n/a
4
935,230
935,230
n/a
Mental Health Specialist Teams (Tier
3) including:
3
4,788,529
5,635,529
n/a
3&4
300,000
300,000
n/a
360,000
150,000
March 2011
July 2010; July
2011
220,000
Ends 2013.
429,700
Grant for SCC
funding ends
March 2011
165,000
DCSF Grant ends
March 2011
MAPS (LAC)
Community (Flockton,
Beighton, Centenary)
Forensic (youth offending)
Dual Diagnosis (LDD)
Youth Offending
Substance Misuse
Individual funding requests to NHS
Sheffield (for exceptional need and
out-of-city) (Yearly average)
Multi-systemic Therapy project
Interchange Y-Talk Counselling &
Therapy
3
2&3
Other Funding
847,000
360,000
150,000
Comic Relief; Children
in Need; One-off CYPS
Education awards
Right Here 16-25 Project
2
20,000
Primary Mental Health Service
2
125,000
Targeted Mental Health in Schools
(TAMHS)
2
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Sheffield City
Council
Funding
200,000
Paul Hamlyn
Foundation & Mental
Health Foundation
304,700
165,000
DCSF Grant
Total Funding
Mental Health Worker (Permanence &
Through Care Team)
2
37,348
37,348
Independent Visiting Service
Post Abuse Therapy Service
2
2
26,000
39,000
26,000
39,000
Totals
7,358,691
Page 41
1,614,048
515,000
9,487,739
Ends 31st July
2011
Appendix 3 – References
1.
ONS (2000) The Mental Health of Children and Adolescents in Great Britain.
London: The Stationery Office
2.
NHS Sheffield (2008) Sheffield population estimates & projections by Age &
Sex to 2031. Public Health Analysis Team, NHS Sheffield, 2008
3.
Reed, CA (2005) Sheffield Child & Adolescent Services Needs Assessment
4.
ONS (2003) Persistence, Onset, Risk Factors and Outcomes of Childhood
Mental Disorders. London: The Stationery Office
5.
DfES and DoH (2004a) The Mental Health and Psychological Well-being of
Children and Young People. London: DfES/DoH
6.
National Collaborating Centre for Mental Health (2009) Attention Deficit
Hyperactivity Disorder. Diagnosis and management of ADHD in children,
young people and adults. National Clinical Practice Guideline Number 72.
The British Psychological Society & The Royal College of Psychiatrists
7.
ONS (2003) The Mental Health of Young People Looked after by LA’s in
England, 2003. London: The Stationary Office
8.
British Medical Association (2003) Adolescent Health, London: BMA
Publications
9.
Singleton, N., Bumpstead, R., O'Brien, M., et al (2001) Psychiatric morbidity
among Adults living in private households, 2000, London: The Stationary
Office
10. Teamwork Management Services (2009) LDD Comprehensive Needs
Assessment for Sheffield. Teamwork Management Services
11. Research Autism (2009). ‘Mental health’.
http://www.researchautism.net/asditem.ikml?t=3&ra=50&infolevel=4&info=pre
valence 28/06/2009
12. Street C, Stapelcamp C, Taylor E, Malek M, & Kurtz Z (2005). Minority
Voices. Research into the access and acceptability of services for the mental
health of young people from black and minority ethnic groups. Young Minds.
13. RCPSYCH (2004) Chronic Physical Illness: the effects on mental health.
Factsheet 27. Royal College of Psychiatrists.
http://www.rcpsych.ac.uk/mentalhealthandgrowingup/27chronicphysicalillness
.aspx Accessed 23/11/09
14. ChiMat (2009). CAMHS 10-18 Population Projections – Sheffield CAMHS
Partnership. Child and Maternal Health Observatory.
Page 42
15. ONS (2000). The Mental Health of Children and Adolescents in Great Britain.
London: The Stationery Office
16. Teamwork Management Services (2009). NHS Sheffield Review of Tier 3
CAMHS in Sheffield. Final Report. Teamwork Management Services.
17. DCSF (2009) Children Looked After in England (including adoption and care
leavers) year ending 31 March 2009. SSDA903 SFR Return. DCSF.
18. NHS Benchmarking network (2010). Benchmarking CAMHS Services.
Benchmark Report. NHS Benchmarking Network.
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