Emotional Wellbeing and Mental Health of children and young people in Medway

1. Emotional Wellbeing and Mental Health of children and young people in Medway

2. Medway vision for CAMHS….. Improve children and young people’s access to, experience of and outcomes from integrated and comprehensive emotional wellbeing and mental health support. Ensuring that those who are most vulnerable to emotional wellbeing difficulties are identified and supported as soon as possible.

3. Key features of comprehensive CAMHSin Medway….. • Involvement of children and young people • in all aspects of commissioning and service delivery including the use of ‘You’re Welcome’ standards. • Strategic pathway planning for vulnerable groups • including teenagers who self-harm, LAC, children and young people with ADHD and/or ASD. • Practice improvements • that ensure that all emotional wellbeing services are delivered to an evidence based model of what works well including NICE guidance and the CAPA standards. • Process improvements • to streamline the referral, access and delivery of services including a Single Point of Access • to ensure that waiting lists are managed effectively • that ensure transition between children’s and adult services is well planned and supported by key processes.

4. Key features of comprehensive CAMHSin Medway cont’d….. • Performance management • that effectively tracks the users experience of the service and outcomes achieved using HoNOSCA or similar tool that measures clinical outcomes and provides key management information to inform service improvements and commissioning decisions. • Communications • to ensure that all referrers including children and young people and families know where they can get support with whatever level of emotional wellbeing need they may have and understand the basic nature of the services on offer in the area (including specialist support). • Workforce development • to ensure that all staff working with children and young people can identify a child or young person who may need access to emotional wellbeing support services and know how to access them as early as possible.

6. Medway vision for CAMHS….. Improve children and young people’s access to, experience of and outcomes from integrated and comprehensive emotional wellbeing and mental health support. Ensuring that those who are most vulnerable to emotional wellbeing difficulties are identified and supported as soon as possible.

7. Developments so far….. Mental health NSF which helped transform services over past 10 years ended in 2009 In 2009 after consultation, previous Government introduced cross Government mental health strategy entitled ‘New Horizons’ with twin aims: • Improve quality and accessibility of services for people with poor mental health • Improve mental health and well-being of the population Continuing twin track approach in development of current draft Cross Government mental health strategy

8. Impact of mental illness….. No other health condition matches mental ill health in the combined extent of prevalence, persistence and breadth of impact WHO (2008) figures for UK (total DALYs) • Mental disorder 22.6% • Cardiovascular disease 16.2% • Cancer 15.9% Mental health problems occupy one third of a GP’s time (ODPM 2004)

9. Economics of Mental Illness…..Interventions to prevent mental illnessand promote mental health Key messages: • In 2003, the wider annual cost of mental ill-health in England was £77 billion while updated figures suggest this figure is now £105 billion • Although future costs of mental illness will double in real terms over next the next 20 years, some of this cost could be reduced bygreater focus on whole-population mental health promotion and prevention, alongside early diagnosis and intervention • Since half of lifetime mental illness arises by the age of 14, prevention and promotion interventions during childhood and adolescence are particularly cost effective • Early intervention programmes for children and adolescents: • have the clearest evidence of cost benefit with economic returns of early childhood interventions exceeding cost by an average ratio of six to one • reduces health care and wider costs. There is good evidence for intervening early with psychotic illnesses and depression. The economic cost of not intervening is significant

10. Cost of Mental Illness • Conduct disorder • Cost of crime attributable to adults who had conduct problems in childhood is £60 billiona year in England and Wales (SCMH, 2009). • Depression • Total annual costs of depression in England is circa £24 billion a year (McCrone et al, 2008). • Anxiety • Health service costs of anxiety disorders in 2007 were £1.2 billion. The addition of lost employment brings the total costs to £8.9 billion (McCrone et al, 2008). • Medically unexplained symptoms • Annual NHS cost of MUS in England amount to £3.1 billion (2008/9) with a further £5.2 billion in lost productivity and £9.3 billion reduced quality of life (Bermingham et al, in press). • Schizophrenia • Total costs of schizophrenia were approximately £6.7 billion per year in England in 2004–05 (Mangalore & Knapp, 2007). Cost of treatment and care was £2 billion, annual costs of welfare benefits were £570 million and the cost to families of informal care and private expenditure amounted to £615 million. Costs of lost productivity due to unemployment, absence from work and premature mortality were £3.4 billion.

11. Cost of Mental Illness cont’d….. • Suicide • Average lifetime cost of each completed suicide for those of working age in England as being £1.7m at 2009 prices (Knapp et al, in press). Since 4200 suicides occurred in 2008, total annual cost is £7.1 billion. • Alcohol misuse • costs the health service £2.7 billion every year. Workplace cost of alcohol is over £4 billion while cost of alcohol related crime and disorder is £8–13 billion. Total cost of alcohol misuse is estimated at £18–£25 billion a year which includes costs of treating alcohol-related disorders and disease, crime and anti-social behaviour, loss of productivity in the workplace and social support for people who misuse alcohol and their families (DH, 2009). • Smoking • Annual direct cost of smoking to the NHS is £5.2 billion (Allender et al, 2009) with smoking responsible for 440,900 hospital admissions in 2007/8 (NHS Information Centre, 2009). Almost half of total tobacco consumption and smoking related deaths are by those with mental disorder. • Dementia • Total annual UK costs of dementia are £17 billion (Knapp et al, 2007). Long-term care for older people with cognitive impairment in England could rise from £5.4 billion to £16.7 billion between 2002 and 2031.

12. Conduct disorder NHS Emotional Wellbeing Depression Local authority Anxiety Police Services for all children Medically unexplained symptoms Some children Schools and Academies minority Schizophrenia Youth Justice Board Suicide Connexions Mental Health Substance misuse 3rd Sector

13. Improved resilience to broad range of adversity Reduced emotional and behavioural problems in children and adolescent including persistence (NICE, 2007; NICE, 2009; Parry-Langdon et al, 2008) Reduced physical illness Reduced health care utilisation Health benefits of mental wellbeing

14. Benefits outside health • Improved educational outcomes • Reduced anti-social behaviour, crime and violence • Healthier lifestyle/ reduced risk taking • Reduced substance misuse • Stronger social relationships • Increased productivity at work, fewer missed days off work • Improved cognitive ability, more flexible thinking

16. What do we know locally?

17. 4 out of 12 providers support children and young people whose mental health prevents them from accessing the curriculum

19. Emotional wellbeing and mental health Operational group’s work programme • Collect service information on each service using a standard proforma. • Create database with information collated from all services. • Cluster services within the 3 tiered CAMH services; Universal, Targeted and Specialist to better understand gaps in CAMH needs met. • Agree language to be used for presenting needs to provide consistency of language and better understanding of level of severity served by each service. • Create pathways for specific vulnerable groups to better understand the customer pathway and transition process between services e.g. teenagers who self-harm, LAC, children and young people with ADHD and/or ASD. • Share/review criteria used by each service and redefine as necessary. • Produce geographic map of Medway and overlay with services provided. • Adopt and embed good practice guidelines as outlined by Choice & Partnership Approach (CAPA). • Setup Triage Team to review and agree interim support to children and families whilst on waiting list for assessment at Tier 3. • Close working with SPA/CAST on reviewing cases that are high level Tier 2 referrals in order to understand commissioning implications and to inform an enhanced Tier 2 service.