A Joint Hampshire Strategy for Emotional Wellbeing and Mental Health (Children and Young People)

A strategy prepared on behalf of Hampshire’s Children’s Trust

2014 – 2017

Make it worthwhile

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Contents

Forward 3

What do we mean by Emotional Wellbeing and Mental Health? 4

What does good emotional wellbeing and mental health mean to children in Hampshire? 5

Our Vision and Priorities 6

Underlying Principles 7

Why do we need a strategy for emotional wellbeing and mental health? 8

Your Views 10

Children and Young People’s Priorities 11

Parent/carer views 11

Professional and other stakeholders’ views 12

National Context 13

Local Context 14

Local needs assessment 16

Future projections of need 18

Protective and Risk Factors for Emotional Wellbeing and Mental Health 18

Emotional Wellbeing and Mental Health Services in Hampshire 21

Specialist Child and Adolescent Mental Health Services (CAMHS) 22

Our Priorities 24

How will we deliver the strategy? 27

Forward

Children and young people with good mental health do better. They are happier in their families; they learn better and do better at school; they are able to enjoy friendships and new experiences. They are more likely to grow up to enjoy healthy and fulfilling lives and to make a positive contribution to society and to have good mental health as an adult.

Intervening early and positively makes a real difference at every stage of the life course. We know that giving children and their families the right type of support in their earliest years can help to avoid many of the costly and damaging social problems in society. We are investing now to save later.

Through the oversight of Hampshire’s Children’s Trust and the successful delivery of the Hampshire Children and Young People’s Plan over the last eight years a wide range of organisations have successfully come together to improve a wide range of outcomes for children.

However, there is increasing evidence that the society we live in is not always good for the mental health of our children. This strategy which complements and sits alongside the Children and Young People’s Plan is our response to the increasing challenges faced by our children.

Over the past few months we have been privileged to be able to listen to the views of children and young people and their families and to the professionals who work with them. Their priorities are the basis of this strategy and have helped us to set out clearly the changes that we need to make to improve the mental health of Hampshire’s children.

We believe that the emotional wellbeing and mental health of children and young people is not the exclusive business of experts but everyone’s business, especially when it comes to promoting good mental health and preventing ill health. Raising awareness of the importance of good mental health for children is a key part of our strategy.

We will work to develop the capacity of our children to be resilient and to maintain their wellbeing. We know that children grow best in families and supporting families is an important part of the strategy.

The continued reduction in resources means that we need to work together even more closely to be as efficient as possible. It isn’t always about commissioning or developing new services, but how we can reform and maximise the use of the whole range of resources that we already have.

Thank you for working with us to improve emotional wellbeing and mental health for all Hampshire’s children and to ‘Make it Worthwhile’.

John Coughlan

on behalf of the Hampshire Children’s Trust

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What do we mean by Emotional Wellbeing and Mental Health?

What does good emotional wellbeing and mental health mean to children in Hampshire?

Many things affect children and young people’s emotional wellbeing and mental health and so it is unsurprising that there are many definitions.

Children and young people in Hampshire have told us that good emotional wellbeing and mental health means ‘feeling safe and secure’, ‘being satisfied with life’ and ‘feeling worthwhile’.

Mental health has been defined as: “A state of wellbeing in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.”1

Emotional wellbeing has been defined as: “A positive state of mind and body, feeling safe and able to cope,

with a sense of connection with people, communities and the wider environment.” It is increasingly used alongside mental health, and is often favoured by schools and others whose main contribution is around prevention and health promotion.2

These descriptions are useful, because they highlight the fact that emotional wellbeing and mental health are not about feeling happy all the time.

To help the reader throughout the strategy we have used the terms ‘mental health’ to mean emotional wellbeing and mental health and ‘children’ to mean children and young people.

1 World Health Organization. 2004. Promoting Mental Health: Concepts; emerging evidence; practice. Geneva: WHO.2 As set out in two diagnostic manuals: - World Health Organization. 2007. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines. Geneva: WHO. - American Psychiatric Association. 2000. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Arlington: APA.

Children in Hampshire have told us that good mental health means:

It doesn’t mean:

feeling worthwhile

feeling safe and secure

being satisfied with life

The diagram below was produced by children who attended the Youth Conference in May 2014, when they were asked to talk about emotionally healthy schools.

never crying or being angry laughing a lot

being outgoing and chatty

Emotional

No abuse

Sports facilities

Social spaces

Music

Peers

Training

Drama

Creative Arts

Visitors

Professionals

Art

Support group

Spiritual room/space Children

& Adults

Previous experiences

EmotionallyHealthy School

Underlying Principles

This strategy has been developed in partnership with children and young people, parents/carers, representatives from health, education, social care, the voluntary sector, schools and early years settings. These are the principles that have been agreed and that underpin the strategy:

l take a life-course approach; this means considering a child’s journey from before birth into adulthood

l focus on promoting mental health as well as ensuring we have high quality treatment services

l the views of children should inform the development of the strategy and of services

l make sure that we meet the needs of vulnerable groups of children and their families

l make sure that the work we do will help to reduce health inequalities; this means reducing the preventable and unfair differences in health experienced by different groups of people in our community

l improve access to services; this means removing barriers and making it easier for everyone who needs a service to access one

l ensure that all the interventions and services we provide, either directly or through commissioned services, are based on the best available evidence and are high quality, safe and good value for money

l ensure that everyone works together to improve mental health of children in Hampshire; this means people in different organisations and sectors working together

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Our Vision and Priorities

We want all children in Hampshire to enjoy good emotional wellbeing and mental health.

We will build on the work that is already going on across Hampshire, coordinated through the Children and Young People’s Plan, to promote good mental health in children and build their resilience, especially for those who are at higher risk of developing mental health problems. Where children and their families need support in relation to mental health, we believe this should be focused on delivering long lasting improvements in mental health. We recognise that this is not the responsibility of any one organisation and that families are fundamentally important in the development of good mental health for their children.

We want all children in Hampshire to enjoy good emotional wellbeing and mental health

Ensure all children, young

people and families have

access to timely, evidenced based,

high quality specialist mental health support,

when it is needed.

Improve information and advice available

for children, young people, families and professionals with regard to emotional

wellbeing and mental health.

Earlier recognition and intervention for mental health problems in

children.

Emotional Wellbeing and Mental Health in Hampshire is Everyone’s

Business.

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Mental health is influenced by many factors and is strongly associated with the wider environment in which children live. Some groups of children such as looked after children, children from black and other ethnic minority groups, lesbian, gay, bisexual or transgender (LGBT) young people, young offenders, young carers, refugees or asylum seekers, children from gypsy and traveller communities, children from service families are more likely to experience poorer mental health than others.

It is vital that we identify and support these children as we know that effective early intervention can help prevent the development of ill health and disability in adult life8.

Delivering the priorities set out in this strategy will help us to do this.

3‘Fair Society, Healthy Lives’ (The Marmot Review).4Foresight report 2008 5Chief Medical Officer report 2012 6Young Minds

7Mental health and behaviour in schools – departmental advice for school staff. Department for Education. June 2014 8Early Intervention: The Next Steps, Graham Allen MP (2011)9Chief Medical Officer’s (CMO) Annual Report 2012: Our Children Deserve Better: Prevention Pays

The Cost of Poor Mental HealthIn addition to the human and social costs, poor mental health has an economic cost. The costs of emotional, conduct and hyperkinetic disorders among children aged 5–15 years in the UK are estimated to be £1.58 billion every year.9

The most recent UNICEF study [2013] placed the UK at number 16 out of 29 of the world’s richest countries in a league table of child wellbeing.

Children who are resilient – they can ‘bounce back’ and recover quickly from difficulties - are able to adapt and thrive even if they experience significant risks or trauma in their lives and they are more likely to have good mental and physical health.

Good mental health is associated with positive life outcomes and is essential for

children to ‘develop their potential, work productively and creatively, build strong and positive relationships with others, and contribute to their community’.4

‘What happens during the(se) early years (starting in the womb) has lifelong effects on many aspects of health and well-being – from obesity, heart disease and mental health, to educational achievement and economic status.’3

Why do we need a strategy for emotional wellbeing and mental health?

‘Health is the basis for a good quality of life and

mental health is of overriding importance in this’

Article 24 of the United Nations convention on the Rights of the Child.

‘Three-quarters of adult mental disorders are in evidence by the age of 21, but three quarters of

children and young people with these disorders are not detected or treated.’5

Most children grow up mentally healthy, but surveys suggest that more children and young people have problems with their mental health today than 30 years ago6. This is probably because of changes in the way we live now and how that affects the experience of growing up. It is estimated that at any one time one in ten children aged between 5 and 16 years in England has a clinically diagnosable mental health problem and one in seven has less severe problems7.

There is no evidence that mental health problems in children are becoming less common. In its 2014 report ‘Health for the World’s Adolescents’ the World Health Organisation highlights mental health in adolescents as an emerging public health priority. It describes how ‘effective interventions during adolescence protect public health investments in early child development’ and that ‘adolescence offers an opportunity to rectify problems that have arisen during the first decade’.

5 15 £1.58 billion

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Children and Young People’s PrioritiesWe asked children to tell us about their main priorities for services. They told us that they want people to:

l Communicate with them well

l Be inviting

l Have a sense of humour

l Be trustworthy and available

and they want to:

l Be involved in decisions that involve them

l Be treated as an individual

Your Views

We wanted the views of children and of people interested in the mental health of children to be at the centre of this strategy. We asked an independent charitable organisation to seek these views using questionnaires and by talking with groups of people.

The chart below shows who responded. We were very pleased that over half of the responses were from children and young people themselves.

We received 1,647

responses to the

questionnaires.

A

Children and young people

B

Parents and carers

C

Professionals

Overall children wanted to make sure that whatever we do we:

Make it WORTHWHILE

Parent/carer views

The most commonly reported difficulties were anxiety, depression, autism and self-harm. The majority of parents/carers told us that they would choose to seek support from their GP if their child was having mental health difficulties, with the next choice being their child’s school or college. Most parents/carers would choose to have support provided by a specialist mental health service, closely followed by voluntary sector organisations. Just over half of parents/carers who had experience of accessing emotional wellbeing and mental health services for the first time for their children felt that the service had improved their child’s emotional wellbeing. Where an additional service was accessed, this increased to two-thirds. Parents/carers felt that there were gaps in services for children suffering from ‘low-level’ mental health difficulties, including the need for more access to counselling services, support with attachment difficulties and transition. Parents/carers felt that their children generally had to wait too long to access services.

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Professional and other stakeholders’ views

Professionals had experience of referring to a wide

range of support agencies, about a third of which

were to the Specialist Child and Adolescent Mental

Health Service. There was a mixed response when

professionals were asked to comment upon how easy

it was to make a referral, with half saying it was easy

and half saying it was difficult. Some raised concerns

about the capacity of specialist services to meet

current demand. It was reported that it was easy to

refer into other emotional wellbeing services, although

professionals identified that there are some gaps in

the availability of appropriate services. Generally

professionals reported that services were in accessible

locations and had convenient appointment times.

They identified a need for better communication

and information for both professionals and families

about both specialist and non- specialist services.

They wanted more information about the best way to

support those children with mental health needs who

do not require a specialist mental health service, to

help ensure that their health does not get worse.

‘What do I think?’ SurveyEach year Hampshire County Council provides children in school with the

opportunity to say what they think about a variety of issues through the ‘What do I think?’ survey. The last survey was conducted in 2013 and over 16,000 responses

from children aged 5-14 were received.

The results of the survey have helped us to understand how supported those children who responded feel when they are in school if someone is being unkind to them or if they need to talk about their feelings.

Children told us that mostly they enjoy being at school. While most of the younger children always have an adult in school to talk to who will do something if someone is being

unkind only a third of older children thought that they had an adult who could do something. A third of children did not think that there

was anyone in their school that they could talk to about their feelings.

National Context

A number of national strategies and guidance documents have been considered when developing this strategy. A summary of each of these documents is provided in the needs analysis.

l Every Child Matters (2003)

l National CAMHS Review (2008)

l Promoting the health and wellbeing of looked after children, Department of Health (2009)

l Fair Society, Healthy Lives; The Marmot Review (2010)

l Healthy People, Healthy Lives: Our Strategy for Public Health in England (2010)

l Getting it right for children and young people – a review by Sir Ian Kennedy (2010)

l Confident Communities, Brighter Futures (2010)

l The Importance of Teaching, Department for Education (2010)

l No Health Without Mental Health; a cross-government mental health outcomes strategy for people of all ages (2011)

l Early Intervention: The Next Steps Graham Allen MP (2011)

l The Munro Review of Child Protection: Final Report, A child-centred system (2011)

l Children and Young People’s Health Outcomes Framework report (2012)

l Chief Medical Officer’s (CMO) Annual Report 2012: Our Children Deserve Better: Prevention Pays

l How healthy behaviour supports children’s wellbeing (2013) – Public Health England

l The Mandate: a mandate from the government to the NHS Commissioning Board: April 2013 to March 2015

l The Health Visitor Implementation Plan 2011-15 – ‘A Call to Action’

l Closing the Gap: Priorities for essential change in mental health (2014)

l From a Distance - Looked after children living away from home, Ofsted (2014)

l Health visiting and School Nurse Programme: Supporting implementation of the new service offer: Promoting emotional wellbeing and positive mental health of children and young people, Department of Health (2014)

l National Institute for Health and Care Excellence guidance

l Promoting the quality of life of looked-after children and young people’ 2010/ PH No 28

l Quality standard for the health and wellbeing of looked-after children and young people- QS31/ 2013

l Social and emotional wellbeing in primary education (PH 12)

l Social and emotional wellbeing in secondary education (PH 20)

l Social and emotional wellbeing – early years (PH 40)

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Starting well So every child can thrive

Living well Empowering people to live healthier lives

Ageing well Supporting people to remain independent, have choice, control and timely access to high quality services

Healthier Communities

Helping communities to be strong and support those who may need extra help

Promoting maternal mental health

Ensure that the health visiting contract continues to include the responsibility to identify mothers at risk or in early stages of postnatal depression, and then offer appropriate support and treatment.

Promoting positive parenting

Enable access to evidence based parenting programmes for those at highest risk.

Ensuring access to mental health services

Enable access to effective services to diagnose and treat conduct disorders in childhood, especially amongst first time entrants to the youth justice system.

Ensure that child and adolescent mental health services meet the breadth of need of our young people and are readily accessible to them and are non-stigmatising.

Looked after children

Ensure there is adequate support for young people leaving care, particularly transition to adult services.

Local Context

Hampshire Children and Young People’s Plan 2012-2015 is the overarching strategy for children in Hampshire. It sets the direction and priorities for services for children, and families in the county. The plan has the following priorities and is underpinned by the United Nations Convention on the Rights of the Child:

The Hampshire Joint Strategic Needs Assessment (JSNA) Children and Young People’s chapter pulls together a wide range of information to describe the current and future health and wellbeing needs of Hampshire children and associated inequalities. The 2013 JSNA made some recommendations to improve mental health in children in the following areas:

l Addressing the incidence and reducing impact of poverty on the achievement and life chances of children and young people.

l Securing children and young people’s physical, spiritual, social, emotional and mental health, promoting healthy lifestyles and reducing inequalities.

l Providing opportunities to learn, within and beyond the school day, that raise children and young people’s aspirations, encourage excellence and enable them to enjoy and achieve beyond their expectations.

l Helping children and young people to be safe and feel safe.

l Promoting vocational, leisure and recreational activities that provide opportunities for children and young people to experience success and make a positive contribution.

The Hampshire Health and Wellbeing Strategy has been developed by Hampshire’s Health and Wellbeing Board and sets out four areas where the Board will focus to improve the health of people living in Hampshire:

This strategy supports the overall objectives of the Children and Young People’s Plan, the Health and Wellbeing Strategy and the recommendations of the Joint Strategic Needs Assessment. It complements other existing Hampshire strategies and work streams where the importance of mental health for children is recognised including: Hampshire Adult Mental Health Needs Assessment 2013, Domestic Violence Strategy, Autism Strategy for children, the Hampshire Local Offer and the Clinical Commissioning Groups’ strategic and operating plans.

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Among children with learning

disabilities 36%13 are likely to

have a mental health disorder.

They are much more likely

than others to live in poverty,

to have few friends and

to have associated long

term health problems such

as epilepsy and sensory

impairment. All these factors are positively associated with

mental health problems. We estimate that there are 1,560

children with learning difficulties in Hampshire who have a

mental health problem.14Young Carers become vulnerable and at increased risk of mental health problems when the level of care giving and responsibility to the person in need of care becomes excessive or inappropriate for that child. The number of young carers reported in Hampshire has doubled since the 2001 census, from 3,300 carers aged 0-24 years in 2001 to 7,604 in 2011. We know that many of these young people will need special support from services such as school nursing to help them maintain good mental health.

Local needs assessment

Although children in Hampshire generally enjoy good mental health we estimate that at any one time about 18,000 of those aged 5-16 will have a diagnosable mental health problem.

Adults in general have been shown to have low awareness of mental health in children. A UK survey12 found that almost four in ten adults did not know the signs and symptoms that they should look out for to assess children’s mental health. The same proportion of men surveyed believed that many children diagnosed with a mental illness were just showing bad behaviour. It is very likely that adults in Hampshire will show similar low awareness and that there is a need to improve understanding about mental health in children locally.

Rates of mental health problems increase as children become teenagers and are higher in boys compared to girls. The commonest disorders are conduct and emotional disorders (anxiety and depression). Conduct disorders are more common in boys while emotional disorders are more common in girls. We estimate that in Hampshire there are 10,700 children with conduct disorders, 6,950 with emotional disorders and 2,785 with hyperkinetic disorders.

These estimates are based on a survey of child and adolescent mental health that took place 10 years ago. While this is the best evidence that we have it is far from ideal to inform the planning of services. Childhood has changed in the last ten years particularly with the dramatic broadening of the scope and increase in exposure of children to media in all its forms.

There are many benefits of media such as opportunities to stay connected with friends through social media, educational uses and e-health. However, increasingly it is recognised that there are potential negative impacts on children’s mental health including problem internet use, the sexualisation and exploitation of children and cyberbullying.

We know that socio economic disadvantage is a risk factor for poor mental health and expect that the highest areas of need for children’s mental health will

be in the most deprived areas of Hampshire. These are in Havant, Gosport and Rushmoor with pockets of deprivation in the New Forest, Eastleigh, Romsey, Andover and Basingstoke.

The current economic downturn can be expected to have an adverse effect on the mental health of some children and families. We do not know the extent of this health impact which will depend on the effectiveness of both national and local policies to safeguard and support the mental health of our population.

Some groups of children are more likely to experience mental health problems.

Self-harm is very common among young people and

is more common in girls than boys. Some children

find it helps them manage intense emotional pain if

they harm themselves, for example through cutting or

burning. They may not wish to take their own life. In

the UK rates of deliberate self-harm appear to be rising

among young people, especially amongst girls and are

higher than anywhere else in Europe. Self-harming

behaviour occurs in over 1 in 4 young people with an

emotional disorder, e.g. anxiety, depression or phobia,

and 1 in 5 young people with a conduct disorder.

In 2012/13, rates of hospital admissions in Hampshire for children admitted to hospital for self-harm were higher than the England average. We need to look more closely at these findings to understand the reasons and the actions we need to take.

Hospital admissions for children with mental health conditions in Hampshire are falling but have been consistently above the England rate and those of similar local authorities since 2012. Work is continuing to understand if these higher rates are due to a higher rate of mental illness, or are a reflection of the way our local services are designed.

36%

2001

3,300

7,604

2011

Young Offenders have at least three times the rate of mental health problems compared to the general population, although this is probably an underestimate and local data shows that almost half of young people in contact with the Hampshire YOT were known to mental health services. The most common disorders are similar to those in the general population - conduct, emotional and attention deficit disorders. They are 18 times more likely to attempt suicide.

5,649

Children of Armed Forces Personnel – Hampshire has a

greater range of armed Forces than any other county

in the UK. In 2012 there were 5,649 children of service

personnel on the Hampshire school roll. Evidence suggests

that the impact of parental deployment and constant

mobility on the family dynamic can lead to increased

mental health problems in some children.

Looked after children are at five to six times increased risk of developing mental health problems than their peers and at four to five times greater risk of self-harm. Hampshire has a rising trend in the numbers of reported looked after children from 1,015 in 2008 to 1,130 in 2013, mirroring the trend across England. We estimate that 500 of these children will have a mental disorder, the majority of which will be conduct disorders.

YEARS

CA

RERS

12 The Lancet, Mental health and wellbeing in children and adolescents Volume 383, Issue 9924, Page 1183, 5 April 2014 13 Emerson, E. and Hatton, C. (2004) Estimating current need/demand for supports for adults with learning disabilities in England. Institute for Health Research, Lancaster University, Lancaster

14 Public Health England Learning Disabilities Profile 2013

1,015 1,1302008 2013

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Future projections of need

By 2020 we predict that there will be 9,640 more children living in Hampshire. The recent rise in births, continuous housing development and inward migration are all contributing to the increase. This is likely to continue and we should consider these projections as ‘lower end of the range’ estimates.

The indications are that we will continue to see an increase in the number of children with mental health conditions in Hampshire due to the following factors:

l it is unlikely that mental health problems will become less common. This means that we can expect an increase in the number of children with mental health needs simply from the population increase

l evidence suggests that mental health conditions in children in Hampshire, in common with the rest of England, are underdiagnosed. The increased national and local focus on children’s mental health and the drive for parity with physical health may lead to more children being identified with mental health problems. At the same time there will be increased opportunities for prevention and early intervention which could reduce some of the need for specialist mental health interventions

l trend data suggest that we will continue to see an increase in the number of vulnerable children in Hampshire who are at significantly increased risk of mental health disorders, for example looked after children and children with learning disabilities

l the long term impact of lifestyle behaviours which increase the risk of poor mental health such as obesity, physical inactivity and substance misuse is more difficult to predict. While we have had some success in influencing risky behaviours in children it is unlikely that we will see a dramatic reduction over the next few years and that these behaviours will continue to affect the mental health of children.

The Dynamic Model of Wellbeing

Certain things (risk factors) make it more likely that children will experience poor emotional wellbeing and mental health.

There is a complex interaction between these risk factors and protective factors. Many children who are exposed to significant risk factors will thrive and develop into confident and caring adults because they are resilient and have enough protective factors to act as a counterbalance.

Understanding these factors is important so that we know how to promote children’s mental health and support them to be resilient.

The four protective factors are influenced by population characteristics, wider determinants and the core economy. All of which are influenced by levels equity and social justice.

Protective and Risk Factors for Emotional Wellbeing and Mental HealthThe dynamic model of Mental Health and Wellbeing15 identifies four core groups of protective characteristics that have a positive influence on the mental wellbeing of children and their communities:

l Enhancing Control: the extent to which individuals and communities have control over their lives has a significant influence on mental health and overall health.

l Increasing resilience and community assets: resilience is the ability to ‘bounce back’ and do better than expected in the face of adversity. Communities with high levels of assets are those where people know and trust each other, do things together and reward kind actions.

l Participation: being involved in activities outside the home, such as cultural and leisure activities, as well as volunteering, membership of clubs and groups.

l Inclusion: The extent to which opportunities such as employment, education, leisure, financial resources can be accessed. People with mental health problems are among the most socially excluded.

15 NMWIA Collaborative,2010

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16 Young Minds risk and resilience handouts

Protective and risk factors that influence children’s mental health16

Protective Factors Risk Factors

Child • Being female (younger children)

• Biological resilience

• Good communication, social and emotional skills

• Good physical health and development

• Secure attachment to parents or carers

• Outgoing temperament as an infant

• Problem solving skills and a positive attitude

• Humour

• Experiences of success and achievement

• Faith or spirituality

• Capacity to reflect

• Genetic influences

• Specific developmental delay or neuro-diversity

• Physical illness/ disability

• Low IQ and learning disabilities

• Communication difficulties

• Difficult temperament

• Academic failure

• Low self esteem

• Who have or are misusing substances, such as alcohol and drugs

Family • At least one good parent- child relationship ( or one supportive adult)

• Family harmony and stability

• Affection

• Supportive and consistent parenting with firm boundaries and limits

• Support for education

• Absence of severe discord

• Family involvement in activities /spending time as a family

• Overt parental conflict, including Domestic Violence

• Family disharmony, instability and break up ( including where children are taken into care)

• Harsh or inconsistent discipline

• Hostile or rejecting relationships

• Failure to adapt to a child’s changing needs

• Physical, sexual and/or emotional abuse

• Parents/ carers with mental illness

• Parental criminality, alcoholism or personality disorder

• Death and loss

• Siblings with serious illness or disability

School • High morale school with positive policies for behaviour, attitudes and anti- bullying

• Whole school approach to promoting good mental health

• Sense of belonging and connectedness between school and family

• Positive peer influences

• Academic achievement

• Difficult school transition

• Bullying

• Discrimination

• Breakdown in or lack of positive friendships

• Peer pressure

• Deviant peer influences

• Poor reading/low school attainment

• Poor pupil – teacher relationships

• Poor attendance

Community/ Wider World

• Wider supportive network

• Good housing

• High standard of living

• Participation in community networks

• Strong cultural identity and pride/valued social role

• Opportunity for participation in a range of leisure activities

• Socioeconomic disadvantage

• Homelessness

• Discrimination

• Isolation

• Disaster, accidents, war or other overwhelming events

• Other adverse events in childhood

Emotional Wellbeing and Mental Health Services in Hampshire

There is a four-tier pathway of services in Hampshire

in line with national policy which places firm emphasis

on prevention and early intervention. ‘Universal

services’ which are accessible to everyone and early

interventions for groups of children and families who

need additional support are usually described as tiers

1 and 2. More specialist services, mainly provided

by the child and adolescent mental health services

[CAMHS] are described as tier 3 and highly ‘specialist

services’ which are available for those children and

young people with the most severe and complex needs

are at tier 4. The framework highlights how children

and young people’s needs can increase or decrease

over time and so they may need to access services in

different tiers at different times and how professionals

can work across ‘Tiers’.

From our consultation we know that the balance

between services in the tiers isn’t quite right for the

needs of Hampshire children and families and that we

need to work to change this.

Tier 4 Services generally referred to as specialist services. In the context of mental health, these services will generally be in-patient units, or highly specialised multi-disciplinary community teams that will work intensively with the child or young person to support them within the community. Referrals will need to be made through other professionals and there will be eligibility criteria for access into the service.

Tier 3 Services generally referred to as community specialist services. These are services which continue to be accessed from within the community but services usually work in a multi-disciplinary environment due to the complexity and severity of the needs of the child or young person and the requirement to have input from specialists from a variety of professional backgrounds. It is unlikely that services will offer self-referral and may need to be referred into the service by another professional.

Tier 2 Services generally referred to as targeted services. These are services are generally available to specific groups of children and young people, for example children with disabilities, who may need some additional support. Self-referrals may still be possible but there is likely to be a level of eligibility criteria applied. Interventions are usually delivered in a single-disciplinary environment, who may access support from other services as and when required. the types of services that may be available include, support groups, counselling, outreach workers, consultations and assessments.

Tier 1 Services generally referred to as universal. These services are generally available to all children and young people and service users can make direct contact with them. These services include Schools, Children’s Centres, Nurseries, GPs and Health Visitors.

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We need to:

l raise awareness of the importance of good mental health in children amongst all those who work with children.

l promote good mental health in children by working across organisations to build protective factors and reduce exposure to the risks for poor mental health in children wherever we can.

l invest in services to support children with mental health needs at an earlier stage to reduce the future social, health and economic costs associated with poor mental health.

l intervene earlier when a child has a mental health problem before it becomes significant.

l identify children and young people who are at higher risk of mental health problems so that we can ensure that they get the right support.

l continue to support Early Intervention policies to build the social and emotional bedrock in children aged 0-3 years.

There is good evidence to show that these actions can improve mental health in children:

l Promoting the mental and physical health of parents

l Improving parenting skills, particularly in infancy and early childhood

l Building resilience in children and young people

l Promoting good physical health in children

l Prevention of violence and abuse

Specialist Child and Adolescent Mental Health Services (CAMHS)

In 2010 the Child and Adolescent Mental Health Service contract for Hampshire was awarded to one NHS organisation. Working with the new service we have:

l Implemented a Hampshire wide intensive home treatment service. This service provides intensive community support for children and young people with complex mental health difficulties, supporting them in the community and reducing the need for inpatient admissions.

l Re-structured all Child and Adolescent Mental Health teams across Hampshire to provide a more equitable access to mental health services.

l Implemented the Choice and Partnership Approach (CAPA) across Hampshire, which has increased the focus on choice for the child or young person and better management of capacity within the service.

l Decreased the number of missed appointments where the child or young person did not attend their appointment, which has enabled more time to be spent with children and young people.

l Introduced Hampshire wide referral criteria, which have improved consistency in accessing the service.

l Successfully bid for the ‘Increasing Access to Psychological Therapies (IAPT)’ Programme which will enable staff to deliver more evidence based interventions.

l Implemented a consistent approach to performance reporting which has led to a better understanding of the needs of children and young people accessing the service.

What do we need to do now in Hampshire?

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Our Priorities

The following priority areas for action have been identified and take account of what children and their families have told us. They are a good fit with and build on existing work.

1.0 Emotional Wellbeing and Mental Health in Hampshire is Everyone’s Business

There are many factors that influence good emotional wellbeing and mental health. We want everyone to understand what these factors are, including the importance of physical health, and how they can help to promote mental health in children and remove the stigma that is often associated with mental health problems. We want to increase awareness and knowledge about mental health problems amongst people working with children and young people and improve understanding of when it is necessary to seek specialist support.

Key outcomes How will we know we have made a difference?

A greater awareness, amongst professionals who work with children and young people, of why good mental health is important and the factors that influence it in children.

People working with children will report:

• a greater awareness of the factors that influence mental health in children and young people

• a greater awareness of why good mental health is important

• an increased confidence in having conversations with children who have additional emotional wellbeing and mental health needs

The importance of good mental health in children and the influences on this continue to be reflected in strategic plans, for example continued prioritisation of investment in the Early Years and action on maternal mental health.

• Actions for improving mental health in children are included within multi-agency supported strategies.

Children and young people have the skills they need to stay emotionally healthy.

• More children are resilient

• There is a reduction in the need for specialist treatment and interventions

Key Actions

ADevelop a coordinated approach to enable everyone working with children, young people and their families to undertake training so that they are more knowledgeable about emotional well being and mental health and are better equipped to support them.

BIncrease the focus on promoting and improving children’s mental health at a strategic level across organisations.

CEmbed the importance of good mental health in children across all partner agencies, including health, education, children’s services, social care and third sector services.

DWork with Early Years settings, Children's centres, voluntary organisations, schools and colleges so that they can better support the mental health of children and young people, especially at times of transition.

EEncourage schools to adopt a whole school approach to promoting resilience and good mental and physical health through the Hampshire Healthy Schools programme and/or the Young Minds framework.

2.0 Earlier recognition and intervention for mental health problems in children

We know that earlier intervention of mental health difficulties improves the life chances and opportunities for children. Parents and carers told us that there are gaps in services for children suffering from ‘low-level’ mental health difficulties. Professionals told us that they wanted more information about the best way to support children with mental health needs who do not require a specialist mental health service to help ensure that their health does not get worse. We will work across agencies to develop early intervention services for children with mental health difficulties and to ensure that there is easy access from these services to more specialist advice when needed. We will continue to work across agencies in the development of a multi-agency early help response for children and young people who have additional needs, such as Looked After Children.

Key outcomes How will we know we have made a difference?

Additional emotional wellbeing and mental health needs are identified early.

• Reduction in the number of urgent referrals to the specialist Child and Adolescent Mental Health Service.

Services are provided at an earlier stage. • An increase in the proportion of referrals being received by the appropriate service first time.

• An increase in the proportion of appropriate referrals to the Specialist Child and Adolescent Mental Health Service.

The development of services have involved seeking the views of and working with children and young people.

• Children and young people have been consulted over the development of services and their views have been incorporated.

Key Actions

AReview and implement improved ways of working between Early Help Hubs, being led by Hampshire County Council, and the Specialist Child and Adolescent Mental Health Service to ensure specialist mental health advice, guidance and support is available at an earlier stage.

B

Review currently commissioned Tier 1 and Tier 2 services, using the recently developed needs analysis as a basis for decision making regarding future service provision. Specific areas for early review include a review of parenting support across Hampshire, parent/carer health, management of self-harm and targeting groups most at risk of developing mental health difficulties.

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3.0 Improve information and advice available for children, young people, families and professionals with regard to emotional wellbeing and mental health.

Through the consultation, we heard that families feel they need additional support, but often struggle to receive the right support at the right time. This is because they do not know where to find information about services that are right for them and how to access the support that is available. We will make it easier for families to find out about services in Hampshire so that they can make informed choices about what type of support they need and how to access it.

Key outcomes How will we know we have made a difference?

Parents/carers and professionals have access to a variety of resources in one place in relation to emotional wellbeing and mental health.

• Emotional Wellbeing and Mental Health resources are available through the Early Help Hub, the directory of services and the Local Offer.

Key Actions

AReview the information, advice and guidance available to children, young people, families and professionals and work with them to improve the quality and accessibility of such information and improve the awareness of services that are available locally.

4.0 Ensure all children, young people and families have access to timely, evidenced based, high quality specialist mental health support, when it is needed.

Specialist mental health services are needed for children with more complex and severe mental health needs. Through the consultation, we heard that parents and carers felt that their children often had to wait too long to access these services. Professionals identified a need for better information for both professionals and families about specialist services and some were concerned about the capacity of specialist services.

Key outcomes How will we know we have made a difference?

Children who require it, have timely access to evidence based interventions.

• Implementation of the IAPT Programme for children as part of a specialist service.

• Continue to monitor and improve waiting times for the Child and Adolescent Mental Health Service.

Looked After Children and other vulnerable groups of children, who require support from specialist services, have access to it in a timely way.

• All Looked After Children and other vulnerable groups have timely access to specialist services.

Key Actions

AEnsure that our Specialist Child and Adolescent Mental Health Service can meet the needs of the increasing numbers of Looked After Children and other groups of vulnerable children in a timely manner.

BContinue with the implementation of the IAPT Programme and ensure that Routine Outcome Measures are rolled out across the whole of the Hampshire Child and Adolescent Mental Health Service.

How will we deliver the strategy?

A Strategic Group for Emotional Wellbeing and Mental Health (Children and Young People) has been established to oversee the development and implementation of the strategy.

The group will develop a detailed action plan setting out the short, medium and long term actions needed to deliver the priorities. The group will review progress against the plan regularly and ensure that it is delivered. The group is multi-agency and consists of young people, and representatives from Parent/Carer Groups, Children’s Services, Public health, Health, Schools and the Voluntary Sector.

The strategy will be reviewed each year.

The structure below shows the governance arrangements for the Strategic Group for Emotional Wellbeing and Mental Health (Children and Young People) and its links with overarching bodies.

Strategic Group for Emotional Wellbeing and Mental Health

Child Health Prevention &

Early Intervention Delivery Group

Health and Wellbeing Board

Joint Child Health Commissioning

Board

Children’s Trust Board

This document is available in Braille, large print, other languages or audio format on request. To request an alternative format,

email NEHFCCG.public@nhs.net, call 01252 335154 or write to:

NHS North East Hampshire and Farnham Clinical Commissioning Group

Fourth floor, Aldershot Centre for Health Hospital Hill, Aldershot, Hampshire GU11 1AY

CS38697 – NHS Creative – September 2014