Meeting: Communities Scrutiny Sub-Committee (County Hall, Durham - Committee Room 1a - 07/03/2005 10:00:00 AM)
Item: A5 Review Report from the 'Minding the Gap' Scrutiny Working Group
Scrutiny Sub-Committee for Promoting Strong, Healthy and Safe Communities
7 March 2005
“Minding the Gap” Mental Health provision for 16-25 Year Olds and their Carers in County Durham: Review Report
| Report of Head of Overview and Scrutiny |
Purpose of Report
1. To up-date the Sub-Committee about the first review of Minding the Gap.
Background
2. A Scrutiny Group, in February 2004, made recommendations about improvements in services provided to young people aged 16-25 years with mental health problems and their carers in County Durham. The main recommendations were grouped into the following areas:
13. That a review takes place in approximately 6 months time. This will provide an opportunity to:
| Contact: Tom Bolton Tel: 0191 383 3149 |
ATTENDANCE LIST -10 December 2004
Present:
COUNCILLOR EDNA HUNTER in the Chair
Members of the Working Group:
Councillors J Armstrong, Dormer, Douthwaite, M Hodgson, Stradling and Wright
Officers:
CAMHS
Jo Paul (accompanied by Tabatha Tilley, a representative from the Reference Group)
Social Care and Health:
Phil Dyson and Frank Whitelock
Education Service
Lindsay Smith, Keith Hibert, Shirley Woodcock, Liz Jackson, Marysia Holubecki and Patrick Hargreaves
10. The Webster Stratton Project in County Durham aims to assist with early identification, assessment and intervention for pupils with attentional difficulties (including Attention Deficit Hyperactivity Disorder) in order to prevent the development of secondary difficulties including academic failure, social exclusion and mental health problems. Over 163 children have attended “Dinosaur School” programmes and 98 parents have attended “Incredible Years” parent programmes. The programme operates via clinic, school and community based groups. Teacher training is also an important aspect of Webster Stratton. This Intervention will be piloted for the Behaviour and Attendance Strategy in County Durham.
4. A copy of the Action Plan template showing progress against each of the recommendations is attached, together with a note showing progress in the Easington PCT area (which receives 18+ mental health services from the South of Tyne and Wearside and Tees and North
S
Minding the Gap Action Plan - Progress Report 1 December 2004
| Action | Responsibility | Timescale | Progress |
| 1. 1 . County Council to consider (with partners) how the existing Place To Be and Secondary Schools Counselling Projects can be sustained and, wherever possible, extended into more schools. | Director of Education | Report on progress by July 2004 | Mark Cain has met with Patsy Fullen and Clare Henderson from the Children’s Society to consider mainstreaming CAMH Strategy projects including P2B conference being arranged for 2005 |
| 2. 2. Raise awareness amongst teaching staff about the importance of early intervention and the pathways to care for younger children with mental health problems. | Director of Education | Develop approach and contact all schools by July 2004 | Included in CAMH Strategy Ed/CAMHS project workers work-plan Cross-departmental activity in Education has increased, with a focus on how emotional well-being issues can be mainstreamed into the curriculum |
| 3. 3. Ensure, as lead or accountable body in relation to local Sure Start programmes, that the mental health agenda is fully promoted in all local programmes. County Councillors, through their membership of local Sure Start programme boards or committees, should likewise champion mental health issues within Sure Start. | Director of Education County Councillors who are members of local Sure Start Programme Boards/Committees | Raise as agenda item in Sure Start Management Boards or Committees by July 2004 | Close involvement of CAMHS in SureStart generally and in SureStart Children’s Centre developments. The Care Index set up in the Wear Valley SureStart area promoting good attachment and bonding between parents and children. There will be a presentation on 13 December on the success of this project. Further extensions of the ‘Getting Along’ project are now at an advanced stage. This will deliver a social skills and competencies package through all early years settings. |
| 4. 4. Consideration to be given as to how the initiative for developing an Early Intervention Service for 14-35 year olds with first episode psychosis can be supported by the County Council. | Director of Health and Social Care | Report on proposals (if any) by July 2004 | Social Care & Health is supporting development of the service strategically. However, as mental health is not a corporate priority for County Council, funding of any posts related to mental health work highly unlikely. 2 Social Workers have been appointed to the Durham service funded by PCTs |
| Action | Responsibility | Timescale | Progress |
| 5. Priority should be given to implementing the extension of CAMHS provision to 16-18 year olds by ensuring that, within any new CAMHS provision, the specific needs of 16-18 year olds are recognised. | Primary Care Trusts (except Easington) County Durham and Darlington Priority Services Trust | Consideration of the issues by July 2004 | Service model now agreed Service Manager appointed 1st round of appointments completed/operational January 05 Identified temporary base project group and YP refs group established Operational policy in draft form out to consultation |
| 6. Consideration should be given as to how young people’s differing needs are recognised within the broad spectrum of mental health and social care provision for adults (18+) with mental health problems and adequate provision made in the planning and delivery of services. | Director of Health and Social Care County Durham Primary Care Trusts County Durham and Darlington Priority Services Trust South of Tyne and Wearside NHS Trust Tees and North East Yorkshire NHS Trust | Consideration of the issues by July 2004 | Development of transition services/early intervention services (13-35 years) is about recognising the needs of young people/adults and how mental health services are structured/delivered. Planning and delivery of these services will begin from December 2004 and be implemented in the following 2-3 years |
| 7 . Existing procedures for allocating professional staff to individual young people with mental health problems should be reviewed, to ensure that, wherever possible, there is a continuity of staff who deal with individual young people. | Director of Health and Social Care County Durham Primary Care Trusts County Durham and Darlington Priority Services Trust South of Tyne and Wearside NHS Trust Tees and North East Yorkshire NHS Trust | Consideration of the issues by July 2004 | CPA process for all young people over 16 promotes continuity of care and multi-agency approach CDDPS Trust always considers need to ensure continuity of care for all individuals referred to services. Allocation of care co-ordinators recognises the importance of continuity, and wherever possible, this principle is upheld. |
| Action | Responsibility | Timescale | Progress |
| 8. The commissioning bodies should consider whether opportunities exist for befriending schemes for young people with mental health problems to be further developed and promoted. | Director of Health and Social Care County Durham Primary Care Trusts | Consideration of the issues by July 2004 | CAMHS/Children’s - Still to be progressed Adult - See 4 above. Lack of identification of issues by County Council in Corporate Plan make successful funding of initiatives unlikely. PCTs have limited funding and are directing it towards national targets and prioriites |
| 9. Commissioning bodies and providers of mental health services should make specific provision for young people in their services by ensuring that: (i) Leisure and recreation activities specifically targeted at young people are provided in existing or proposed adult acute in-patient facilities (whether in whole units or in a specific room). (ii) CAMHS or Community Mental Health Team (CMHT) waiting rooms have areas specifically tailored to the needs of young people. | County Durham Primary Care Trusts County Durham and Darlington Priority Services Trust South of Tyne and Wearside NHS Trust Tees and North East Yorkshire NHS Trust | Consideration of the issues by July 2004 | CAMHS - Still to be progressed Adult -
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| 10. In recruiting staff who will (either wholly, or in part) work with young people with mental health problems, providers should consider how job descriptions, person specifications and recruitment processes can be used to select applicants who are able to empathise and work effectively with young people. | Director of Health and Social Care County Durham Primary Care Trusts County Durham and Darlington Priority Services Trust South of Tyne and Wearside NHS Trust Tees and North East Yorkshire NHS Trust | Consideration of the issues by July 2004 | CDDPS Trust recognises it deals with some of the most vulnerable people in society. HR management process for selection and recruitment of applicants does very much focus on suitability and attitude. |
| Action | Responsibility | Timescale | Progress |
| 11 . A review of existing day centre/training provision for people with mental health problems should be undertaken, to ascertain whether existing facilities adequately meet the needs of young people, or whether any specific provision is required for this group. | Director of Health and Social Care | Report by July 2004 | CAMHS - Issues discussed at Interagency day in October 2004 Social Exclusion Unit report has a specific recommendation that Day Services need modernisation. The National Institute for Mental Health in England (NIMHE) are developing a programme to assist in this and commissioning strategies need to be developed to take this into account |
| 12 . Opportunities for providing CAMHS and CMHT services outside normal office hours (on evenings and Saturdays) should be explored. Delivery of services in settings other than clinics should also be examined (i.e. Connexions Centres, Leisure Centres, Durham Young People’s Project). | Director of Health and Social Care County Durham Primary Care Trusts County Durham and Darlington Priority Services Trust South of Tyne and Wearside NHS Trust Tees and North East Yorkshire NHS Trust | Consideration of the issues by July 2004 | As part of the CAMH strategy concerning Out of Hours provision there are two significant developments:
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| 13. The opportunities for delivery of mental health services and support alongside other services in holistic “one stop shop” settings should be explored. A debate locally with other providers about what opportunities exist for developing this type of provision, where a range of services, including mental health services for young people, can be delivered in a non-stigmatising setting should be instituted. | Director of Health and Social Care Director of Education County Durham Primary Care Trusts County Durham and Darlington Priority Services Trust South of Tyne and Wearside NHS Trust Tees and North East Yorkshire NHS Trust | Consideration of the issues by July 2004 | CAMHS - Ongoing dialogue and potential support for End House, Durham CDDPS will look with key partners (e.g. education) in looking at other models for the delivery of services, particularly in non-stigmatising settings such as schools |
| Action | Responsibility | Timescale | Progress |
| 14. Consideration should be given to ensuring that opportunities exist for those young people with whom the Youth Offending Service engages, who need to see a mental health professional, do so. | Head of Youth Offending Service County Durham Primary Care Trusts County Durham and Darlington Priority Services Trust South of Tyne and Wearside NHS Trust Tees and North East Yorkshire NHS Trust | Discussions and any proposals to be completed by July 2004 | Still having difficulty in getting young people known to CDYES, access to services quickly enough CDYES has submitted a growth bid (Nov 05) for CAMHS staff to be deployed to CDYES to facilitate this action and achieve Performance Measure 12 (Mental Health) Improving access to CAMHS is a key target in CDYES Post Inspection Action Plan Still having difficulty in getting young people known to CDYES, access to services quickly enough |
| 15. An up-to-date website about mental health issues, which is young people friendly, should be established and consideration be given as to how this can be effectively promoted. | Director of Health and Social Care County Durham Primary Care Trusts County Durham and Darlington Priority Services Trust South of Tyne and Wearside NHS Trust Tees and North East Yorkshire NHS Trust | Discussions on viability of and proposals for any website to be completed by July 2004 | Stressed out website established |
| Action | Responsibility | Timescale | Progress |
| 16. Clear understandable guidance for users of mental health services about how services are structured and delivered (perhaps in the form of a short leaflet) should be developed. The provision of on-line leaflets (as in the Tees and North East Yorkshire Mental Health Trust) should also be considered. | Director of Health and Social Care County Durham Primary Care Trusts County Durham and Darlington Priority Services Trust South of Tyne and Wearside NHS Trust Tees and North East Yorkshire NHS Trust | Consideration of the issues by July 2004 | IIC/CAMHS user group have developed 2 leaflets re: service provision ‘Changes’ DVD distributed to schools in Durham via Dfes CDDPS continues to work with partner agencies in development of user friendly information |
17. In developing guidance for young people who access mental health and associated social services, consideration should be given to the inclusion of the following information, where appropriate, in any promotional literature, or on websites :
| Director of Health and Social Care County Durham Primary Care Trusts County Durham and Darlington Priority Services Trust South of Tyne and Wearside NHS Trust Tees and North East Yorkshire NHS Trust | Consideration of the issues by July 2004 | CAMHS - Still to be progressed |
| Action | Responsibility | Timescale | Progress |
| 18. Young service users should be given greater opportunities to shape the development of information for young people with mental health problems. | Director of Health and Social Care County Durham Primary Care Trusts County Durham and Darlington Priority Services Trust South of Tyne and Wearside NHS Trust Tees and North East Yorkshire NHS Trust | Consideration of the issues by July 2004 | IIC/CAMH Service user group have developed 2 leaflets re: service provision ‘Changes’ DVD distributed to schools in Durham via Dfes |
| 19 . Existing arrangements for engagement with young people should be re-examined, to explore whether opportunities exist for them to have a greater say in service development and provision. | Director of Health and Social Care County Durham Primary Care Trusts County Durham and Darlington Priority Services Trust South of Tyne and Wearside NHS Trust Tees and North East Yorkshire NHS Trust | Consideration of the issues by July 2004 | Transitional Services Young People’s Reference group established and informing on-going service development |
| 20 . A standing group of young people with experience of mental health problems, who can be consulted and have a meaningful role in the planning, development, delivery, performance and evaluation of services provided for them, should be established. | Director of Health & Social Care, Co. Durham Primary Care Trusts, Co. Durham and Darlington Priority Services Trust South of Tyne & Wearside NHS Trust Tees and North East Yorkshire NHS Trust | Consideration of the issues by July 2004 | IIC/CAMHS group established |
| Action | Responsibility | Timescale | Progress |
| 21 . The principle that young people with mental health problems are customers first and should have a real say in how they receive services should be promoted as good practice within all organisations that deliver relevant services to young people. | Director of Health and Social Care Director of Education County Durham Primary Care Trusts County Durham and Darlington Priority Services Trust South of Tyne and Wearside NHS Trust Tees and North East Yorkshire NHS Trust | Consideration of the issues by July 2004 | Linked to 18, 19, 20 above CDDPS, along with National Health Service in general is developing people centred services that offer choice |
| 22. Procedures for provision of services to young people with mental health problems should be reviewed to ensure they are offered choice, both in treatments and services available; where they are delivered; and by whom. Young people should be given clear explanations, both before and after assessment, about how and in which areas they can exercise choice (i.e. if they are unhappy with the service, the treatment offered, or find it difficult to engage with the staff who deliver the services). | Director of Health and Social Care County Durham Primary Care Trusts County Durham and Darlington Priority Services Trust South of Tyne and Wearside NHS Trust Tees and North East Yorkshire NHS Trust | Consideration of the issues by July 2004 | To be progressed |
| 23 . Consideration should be given as to whether opportunities exist within the school curriculum to raise awareness of mental health issues amongst young people; overcome the stigma associated with mental health; build emotional resilience in young people and sign-post pathways to care. | Director of Education | Consideration of the issues by July 2004 | Issue be addressed by Ed/CAMHS project leads ‘Changes’ DVD to be used as pastoral studies curriculum See p1. A great deal activity now around this area e.g. Drug Education has external material that is designed to develop emotional well-being, self-confidence and other resilience factors. |
| Action | Responsibility | Timescale | Progress |
| 24. The Education in the Community Service should play a more pro-active role in promoting understanding of mental health problems amongst young people and overcoming stigma. This should be reflected in the Youth Service Plan and in the work of the Service generally. | Director of Education | Consideration of the issues by July 2004 | Meetings have been held to consider how this activity can be mainstreamed into planning and service delivery. |
| 25. Health Trusts should consider whether they can play a more pro-active role in assisting those staff in colleges who are responsible for young people’s mental health needs and sign-posting pathways to care. | County Durham Primary Care Trusts County Durham and Darlington Priority Services Trust South of Tyne and Wearside NHS Trust Tees and North East Yorkshire NHS Trust | Consideration of the issues by July 2004 | CAMHS has a core principle of working with a wide range of people who engage with young people in whatever settings Regional Grouping of NIACE and NIMHE. Recent report about overcoming institutional barriers to learning for young people with mental health issues |
| 26. Opportunities for joint working with Tees and North East Yorkshire Mental Health Trust in its “Open Up” campaign to reduce the stigma surrounding mental health problems and learning disabilities should be explored and consideration be given to whether the existing “Passionate People” group of staff, patients and carers can be expanded, to share their experiences of working or living with mental health problems with a wider audience in County Durham. | County Durham Primary Care Trusts County Durham and Darlington Priority Services Trust South of Tyne and Wearside NHS Trust Tees and North East Yorkshire NHS Trust | Consideration of the issues by July 2004 | CDDPS Trust does link with wide range of other providers |
| Action | Responsibility | Timescale | Progress |
| 27. The increased provision within the STEPS Therapeutic Team to provide greater support for young people who leave the Looked After System should be regularly reviewed, to ensure that the Team has sufficient capacity to meet the additional demands placed upon it. | Director of Health and Social Care | Six monthly | Continued focus on direct service delivery |
| 28. The expanded role of STEPS in supporting young people beyond 18 and up to 24 years of age should be promoted amongst professional staff across all agencies to ensure they are aware of the support available. | Director of Health and Social Care | By July 2004 | Close liaison between agencies Information about STEPS now available on County Council website |
| 29 . A Conference about young people’s mental health, to which key partners are invited and which provides opportunities for young people to put their views should be organised. Hosting such a conference would also further build upon the initiative developed by the Director of Social Services for closer working with agencies delivering mental health services | Head of Overview and Scrutiny Director of Health and Social Care Director of Education | Before May 2004 | Held on 11 May 2004 and attended by delegates drawn from the Social Care, Health, Education and Voluntary Sectors |
| 30. Closer working between Sure Start and CAMHS in County Durham should be promoted. | Director of Education County Durham and Darlington Priority Services Trust | Discussions by July 2004 | Work be addressed by CAMH Strategy & Services Manager Mark Cain and SureStart lead Frank Firth. Series of regular meetings is being held to consider how the emotional well-being agenda can be promoted in County Durham SureStart and how to develop and implement new ways of working between the two agencies Closer working between Sure Start and CAMHS personnel is also happening. |
| Action | Responsibility | Timescale | Progress |
| 31. The process of dialogue instituted by the County Council with providers of mental health services, which aims to bring together service providers in a forum where issues of common interest can be discussed, should be built upon and sustained. | Director of Health and Social Care | Ongoing (the proposed Conference may reinforce this process) | The Provider Forum is now well established and is a positive group. The issues of services for 16-25 year olds will be placed on the agenda for a future meeting |
| 32. Local Strategic Partnerships should be asked to consider the issues in the Working Group report, to determine to what extent and in which manner, if any, they can play a role in promoting young people’s mental health. | Head of Overview and Scrutiny | By July 2004 | Still to be progressed, deferred in consultation with Chairman |
| 33. Colleges of Further Education should be asked to consider whether there would be benefit in establishing a joint forum to share best practice (such as the work underway at Derwentside College and New College, Durham) and discuss common issues linked to supporting young people with mental health problems. | To be determined | On or before the date of the proposed Conference (i.e. before May 2004) | Some progress with New College, Durham and Derwentside College) Informal links via NIACE/NIMHE process. |
| Action | Responsibility | Timescale | Progress |
34. Consideration should be given to the joint funding and appointment of a link worker (initially on a pilot basis across two PCT areas), whose role would be to:
Detailed consideration would need to be given to the grading of the initially temporary post. | Director of Health and Social Care County Durham Primary Care Trusts | Consideration of the issues by July 2004 | The County Durham Consortium of Voluntary Sector Mental Health Providers have appointed a project worker The provider forum (see recommendation 31) has strengthened links across all sectors. Common issues are being addressed in a whole systems way |
35. Consideration should be given as to how the training of professional staff delivering services to young people with mental health problems can be:
| Director of Health and Social Care Director of Education County Durham Primary Care Trusts County Durham and Darlington Priority Services Trust South of Tyne and Wearside NHS Trust Tees and North East Yorkshire NHS Trust | Consideration of the issues by July 2004 | Learning & Development CAMHS lead appointment process commenced November 2004-11-23 CAMHS module and Teesside University CAMHS foundation 1 day training to be commenced in five localities |
| Action | Responsibility | Timescale | Progress |
| 36. Training for voluntary workers in the Education in the Community Service about mental health issues, including specifically, mental health and pathways to care, should be mandatory, instead of voluntary as at present. | Director of Education | Consideration of the issues by July 2004 | This issue has been picked up by the Service and is being given consideration. The CDDPS Trust engages with the Workforce Development Confederation in supporting development of partnerships across agencies and professions in delivering training |
| 37. Consideration should be given by Cabinet as to whether representations should be made to the Government about the reduction in real terms of funding via the adult mental health grant paid to the County Council and the difficulties this is causing in placing limitations upon the way existing services are delivered and stifling opportunities to develop new innovative ways of working. | Director of Health and Social Care County Treasurer | Consideration of the issues by July 2004 | Not yet known if representations made. Social Care and Health have received notification of another cut in provision for 2005/6. This will place pressure on the existing budget and no new developments are planned as a result. |
| 38. Consideration should be given as to whether key workers who interact with young people with mental health problems should receive suitable training to enable them to deliver basic benefits advice, if they are not already in possession of these skills | Director of Health and Social Care County Durham Primary Care Trusts County Durham and Darlington Priority Services Trust South of Tyne and Wearside NHS Trust Tees and North East Yorkshire NHS Trust | Consideration of the issues by July 2004 | CAMHS - Training/Development lead post for to pick up CDDPS is working with all staff to ensure they can signpost people to appropriate advice, including benefit, as required |
| Action | Responsibility | Timescale | Progress |
| 39. A sample audit of casework involving young people with mental health problems should be undertaken, to determine whether adequate support is being provided to carers, or whether a more pro-active approach should be adopted in relation to assessment of carer needs. In the light of the audit findings, consideration should be given as to whether existing policies and procedures require revision. | Director of Health and Social Care County Durham and Darlington Priority Services Trust South of Tyne and Wearside NHS Trust Tees and North East Yorkshire NHS Trust | Consideration of the issues by July 2004 | CAMHS/Children’s - To be progressed An audit could be commissioned through the CDDP Trust Audit Department, including samples of case work |
| 40. The Working Group should review progress six months after consideration of its report by Cabinet. | Head of Overview and Scrutiny | October 2004 | Review meeting 10 December 2004 |
MINDING THE GAP - PROGRESS IN EASINGTON PCT AREA
Rec. 4 . Two years funding agreed for Easington Early Intervention in Psychosis services (as part of Teeswide & Easington service), Specialist Practitioner and Care Co-ordinator in post. Further 3 year development plan being proposed through LDP process, potential opportunity to consider social work staff, co-ordination of social care funding to support this
Rec. 6. The report is being used to advise service development and modernisation of services through the Partnership Board, LIT and LDP process
Rec. 7 . This is being addressed through developing care co-ordination policies, and is a key element in the development of clinical pathways and transition protocols.
Rec. 9 . This recommendation will be considered in line with the reprovision of in-patient facilities within the Business Cases for both Trusts.
Rec. 10 . Each organisation has recruitment policies and procedures in place. This is also being considered in the developingmulti-agency workforce development plan for Easington
Rec. 11 . A proposal to extend day service provision and changes to out-patient facilities will take this into account. A bid for Capital Expentiture Programme could support this.
A review of day services is planned through an integration paper and in response to LDP
Rec. 12 . The CMHT and out-patient facilities - it is planned to extend to 7-day week in line with crisis service, to provide comprehensive 7-day a week service.
A number of projects such as sportworkers, employment link services and day services are provided in community settings.
Rec. 13 . PCT is looking at development of Estates Strategy to support development, mental health has welcomed the opportunity to be considered in these developments.
Rec. 14 . Specialist practitioner for Early Intervention in Psychosis is involved in younger persons workstream to ensure engagement and access to appropriate services. Mental Health services are looking at screening process and single point of entry, also timely access and signposting to appropriate services.
Recs. 15 /16 /17 . Sub group 2&3 of Adult LIT looking at information available through Service Directory, comprehensive leaflets for all users and carers in relation to care co-ordination.
Recs. 18 / 19/ 20 / 21 Much energy has gone into user / carer events and development of user/carer forums in Easington. More work is needed to provide a specific younger people's focus.
Recs. 25 / 26 Commitment to Open Up campaign - Easington staff already actively engaged in 'Passionate People' group, working in local schools and colleges. Very positive feedback for the scheme, to continue to develop in Easington.
Rec. 29. Conference attended by multi-agency representation from Easington
Recs. 35/36/38 Easington Multi-Agency Workforce Development Plan is considering the recommendation with Trusts and WDC as to best way forward.
Rec. 39 To be picked up through Governance framework and piloted in developing EIP service
Attachments
MINDING THE GAP 3.doc;
Minding the Gap 2.doc;
minding the gap review 1.doc