Agenda item

a)    Report of Head of Service, CAMHS Durham and Darlington

b)    Presentation by Michelle Trainer, Project Manager TEWV Foundation Trust

The Committee considered a report of the Head of Service, CAMHS Durham and Darlington that provided an overview of the Children and Young People Mental Health Crisis, Liaison and Intensive Home Treatment Services. The Project Manager, Tees, Esk and Wear Valley Foundation Trust provided members with a presentation detailing the current provision and future developments (for copy of report and slides, see file of minutes).

The CAMHS Crisis and Liaison service ran an open referral system that meant that in some cases young people could refer themselves.  Members were advised that a crisis was defined as whatever it was to a young person.  The service was both flexible and responsive and was provided to children and young people up to the age of 18 years.  The aim of the service was to reduce the waiting times for psychiatric assessment for when young people faced a crisis; to reduce the impact on accident and emergency services and paediatric beds and to reduce emergency admissions to CAMHS in-patient beds by supporting children and young people and their families in their homes in the community.

The Project Manager informed members that patients, carers and families receiving a 24/7 dedicated contact resulted in immediate de-escalation of emotional difficulties.  The new service had resulted in a reduction on the pressure within CAMHS community services, greater working relationships within teams, there had also been a reduction on the pressures within emergency departments, and there was a stronger working relationship with external stakeholders.

Members learned that the Crisis, Liaison and Intensive Home Treatments service had won several awards and were shortlisted for more since they began three and half years ago.  The Project Manager advised that Durham was leading the way and was being used as a national benchmark.  The service was also helping to set up provision in other areas.

Councillor Kennedy asked if young people would be signposted and transferred to Adult Services when they turn 18. The Project Manager explained that from a wider county perspective a transition policy was in place. Many go back to community based services such as GPs and not all transition to Adult Services. She added that the transition should be a seamless as possible and there were many good examples of young people that have transitioned to adults who have had multiple complex needs.

In response to a question regarding telephone assessments and how to judge if that young person requires follow up without any face to face assessment, the Project Manager advised that the telephone assessment would include talking to family and carers as well as the young person before making any decision. From a crisis perspective, the motto is ‘if in doubt go out.’ Anyone that phones with concerns has a reason for calling therefore the team would do a face to face assessment with the young person and their parent/carers for their perspective.

Responding to Councillor Kennedy’s query regarding assessment times, the Project Manager advised that for non-urgent calls, every young person would have their first assessment within 4 weeks and a second assessment within 9 weeks which was on target. Regarding a crisis perspective, the target to start assessment was within 4 hours which would also include a safety plan and was 92% on target, the remaining 8% was in some cases the patients or family’s choice not to compete within the 4 hours.

Councillor Hopper asked if there were any issues in recruiting or retaining staff to maintain service delivery. The Project Manager advised that the crisis and liaison team have a low turnover of staff and currently retain 80% of the workforce and the remaining 20% had left due to promotion.

Councillor Blakey queried the time scales for referrals to the CAMHS team. The Project Manager clarified that the first appointment by open referral would take place within 4 weeks and would receive an assessment by telephone or face to face. The target for a second appointment was within 9 weeks in total and in some cases they may have had 4 or 5 appointments within that timeframe.

Referring to key issues and the need for a non-medical place of safety, Councillor Patterson asked if there was any scope to use community hospitals. The Project Manager explained that some young people end up in medical beds that actually require a safe place with support rather than treatment. She highlighted that some buildings have restrictions as to what they could be used for.

Councillor Maddison referred to the recent publicity around the general shortage of psychiatrists and asked what the position was in County Durham. The Project Manager advised that she was not aware of any vacant posts currently across the County, however a couple of retirements were coming up that were being planned for. She added that the Crisis Service was a nurse-led service which also helps with cost efficiencies as well as making sure they remain connected to the locality psychiatrist.

Councillor Wilson asked if work had been carried out with schools to publicise the service and get the information out to parents and children. The Project Manager advised that school resilience nurses, the crisis team and wider service all publicise for each other and they were promoting whichever service was approached, they would be signposted to the relevant service. She assured that the information was out there, however, they were conscious that many families were still not aware of the service.

Mr Conlon referred to media updates regarding the increase of children calling Childline with suicidal thoughts and asked if the crisis team had experienced a similar increase. The Project Manager explained the lethality challenge the service was facing in that there had been a change from overdosing, injecting and cutting which have a period of time to seek help, support and treatment, to an increase in the use of substances and methods that have a more immediate impact. She recalled a number of cases where young people who had attempted to use those methods had all been regretful.  The Project Manager also explained that many young people act impulsively which was not always driven by mental illness but by environmental factors. The impulsivity as an adolescent presents a risk that requires creative thinking to educate young people, manage and contain the risk through positive risk management and helping young people and families to understand the triggers.

The Chairman thanked the Project Manager for Tees, Esk and Wear Valley Foundation Trust for her presentation and commended the team for the positive impact the service has provided to young people in County Durham.

Resolved:

That the information contained in the report be noted.