Young people with mental health problems: needs and services

1
Young people with mental health problems needs
and services
2
Examples of unmet needs

• There was no-one to talk to about suicidal
  feelings young person kept going to bridges
  to throw himself off
• Behaviour of young person is completely out of
  control only a matter of time before the police
  are involved

3
Tuning into needs

• Listening
• Young person (and where appropriate their carers)
  at the heart of the process
• Multi-perspective
• Partnership is about effective relationships
• Lead professional and clarity of roles
• Joined up thinking but also allow fresh start
  (assertive representation of needs while
  addressing risks)

4
Children Act 2004

• Systematic partnerships
• Duty to co-operate and share info
• Duty to safeguard and promote welfare
• Local Safeguarding Boards
• Childrens and Young Peoples Plan
• Director of Childrens Services Lead Member
• Integrated Inspection
• Clinical expertise in AMH/LD trusts

5
Aims for presentation

• Values and guiding principles
• Needs and service gaps
• Recommendations focus on partnerships, networks
  and care groups
• Next steps

6
Workstreams

• Internal
• Audit of case notes
• Primary Care report
• Data from Psychological Services
• Policy summary
• Literature search

7
Workstreams

• External
• Reports from young peoples organisations
• Population data
• Childrens strategies
• Interviews with carers
• Interviews with commissioners and service
  providers

8
Values and principles

• Holistic approach supported by a unified
  understanding of needs
• Reach beyond the symptoms
• Duty of co-operation
• Collaboration and partnership
• Respect for vulnerability
• Listening and visible action
• Led by users and carers (with support)
• Safe treatment and care in broadest sense

9
Population estimates of need (16-21 year olds)

• Liverpool 9,528
• of whom up to 4,000 are students
• Sefton 4,439
• Needs of carers are in addition
• Young people want action not more consultation

10
Young peoples mental health problems

• High suicide and undetermined injury in age group
  15-34 (local)
• Suicide is third leading cause of death in age
  group 15-24 (national)
• Complex needs - lack of diagnostic labels can be
  an opportunity
• Undetected depression and psychosis
• Role of universal services

11
Gap Analysis

• Young people with mental health conditions
  discharged from CAMHS
• Community, day and in-patient services
  appropriate to maturity
• Transitions planned around young adult mental
  health needs (CPA)
• Student mental health

12
Gap Analysis continued

• Drug dependency treatment
• ADHD
• Aspergers Service
• Mental health needs of young offenders
• Moderate LD
• Psychological needs of young people and their
  carers

13
Gap Analysis continued 2

• Brief psychological interventions in primary care
  for older adolescents/young people
• Detection/risk profiling skills in universal
  services
• Protocols or access to specialist advice around
  recognition of conditions
• Specialist/universal shared care for
  psychological conditions

14
Gap Analysis continued (3)

• Emerging personality disorders
• Unresolved attachment disorders
• 29 of parents of children with a mental health
  problem had hesitated to seek help because they
  feared being blamed or seen as a failure

15
Old partnerships complex needs

• Planned bargaining
• Paternalistic
• Shifting resources among providers
• Example psychiatric/LD resettlements

16
New partnerships complex needs

• Unified person-centred approach
• Understanding is partial without multiple
  perspectives
• Holistic care from productive inter-agency
  relationships
• Requirement of public involvement
• Rooted in networks not structures

17
Transitions

• Stepped Care
• Child to Adult Services
• Across health and social services
• Universal/specialist services
• Educational transitions
• Transition workers and champions with a strategic
  remit

18
Care Pathways

• Mental Health Protection Pathway for Young People
  (public health)
• Mental Health Assessment and Treatment Pathway
  for Young People (specialist)
• Leadership needed for both pathways
• linking strategic and operational levels

19
Starting points for service development

• Developmental journey from adolescence to
  adulthood
• Care pathways for actual care delivery or care
  decision making
• Assessment and treatment of the impact as an
  adult of complex problems rooted in childhood and
  adolescence

20
Starting points for service development
(continued)

• Appropriate strategic group
• Care and service networks
• Interfaces and access criteria
• User/carer involvement/partnerships
• Means to address safeguarding and vulnerability
  issues
• Joint training and joint posts

21
Next Steps

• Extend partnerships with users carers - both in
  care plans and developments
• Strategic partnership agreements
• Care pathway agreements
• Creative events promoting mental well-being
• Promoting CAF/CPA pathways

22
Role of AMH/LD Services

• Standard 9 aimed at much wider readership
• Well-being outcomes all inter-related
• Young carers and parents
• Every Child Matters
• Networks of services

23
Learning and Skills Act

• Educational transitions tied into promoting
  mental well-being
• Identify which educational outcomes for which
  young people require the involvement of AMH and
  LD trusts

24
Young People and Mental Health Act amendments

• Broader definition of mental disorder
• Community treatment orders avoid revolving
  door
• 82 of 16-17 year olds detained under MHA (83)
  were placed on adult wards

25
Youth Matters Green Paper

• Role of mental health trusts omitted
• Young people not in education, employment or
  training (NEET)
• Decrease number involved in crime and anti-social
  behaviour