EMPOWERS What it means to us. Dr Melissa Hubbard, Divisional Chair Caroline Meredith, Associate Director Karen Meadowcroft, Associate Chief Nurse

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2 EMPOWERS What it means to us Dr Melissa Hubbard, Divisional Chair Caroline Meredith, Associate Director Karen Meadowcroft, Associate Chief Nurse

3 The impact.

4 The reasons for us to take control Our teams didn t know how to support our most vulnerable patients at a time that they need us most. What if we make things worse? I have other more sick patients I don t understand mental health I don t know how to talk to these patients I m not trained in dealing with children like this

5 What did we do? Visits to: Huntercombe Hospital, Stafford Darwin Centre, Hartshill

6 What did we learn? We need to change the way we do things: Smoking cessation never occurred to us Security Guards intimidation Environmental changes blind cords Training for our teams education and play Interacting differently with patients resource bags

7 We are on a journey Working together with partners:

8 What next? Supporting our staff in building their confidence to support our vulnerable patients training, education, patient stories - de-mistify mental health Learning from complaints and incidents to ensure we provide a better service Actively listen and learn from patients experiences in order to reform the service Engage with partners and learn from best practice

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10 CAMHS a national & local picture South Staffordshire CAMHS (West Division)

11 Overview Introduction Epidemiology Why is this important? Current Tier System Our local team New Services

12 Introduction CAMHS are a specialist mental health service Age range: 0-18 years Referrals come from: GPs Specialist Doctors like Paediatricians & A+E SENCOs School nurses Social workers

13 Introduction (cont.) CAMHS is a multi-disciplinary service We offer an assessment & treatment service Treatments may involve medication or psychological therapies We jointly work with other mental health services Risk assessment & management service We have a role in child protection & work with relevant services

14 Epidemiology How common is mental health illness in children?

15 1 in 10 children Green H et al; Office for National Statistics; 2005

16 THE WHO SAYS: 1 in 5!!!

17 Epidemiology (cont.) Half of all adults with mental health problems were diagnosed in childhood (Kim-Cohen et al Archives of general psychiatry; 2003) 95% of young prisoners have a mental health disorder (Office for National Statistics; 1997) Around 7% of children deliberately self-harm (Mental Health Foundation National Enquiry 2006) The incidents of self-harm behaviours have increased significantly in the last 10 years

18 10 year changes Self poisoning Girls ,853 Boys Self-cutting Girls Boys Hanging Girls Boys 47 95

19 Self-poisoning Girls Boys

20 Self-cutting Girls Boys

21 Hanging Girls Boys

22 Prevalence in UK 5-10 year olds year olds All children Emotional disorders Conduct disorders Hyperkinetic disorders The British Child and Adolescent Mental Health Survey 1999

23 Increasing demand for CAMHS 89% of CAMHS service providers reported an increase in referrals over the last 2 years (ranging from 20-70%) House of Commons inquiry 2014 The report suggests increase in referrals linked to local and regional cuts on community services and third sector service This is at a time when funding to mental health services is not adequate 2/3 of LAs have reduced CAMHS budget since 2010 FOI request from YoungMinds 2013

24 CAMHS needs parity of funding! At any one time around 1.3 million children will have a diagnosable mental health disorder Only 25% of those who need treatment actually receive it! FUNDING FACTS: 1) Total NHS Budget: 104 Billion 2) Mental Health Budget: 10 Billion (10% of NHS budget!) 3) CAMHS Budget: 0.77 Billion (7% of Mental Health Budget) CAMHS BUDGET IS ONLY 0.7% of NHS TOTAL BUDGET & ONLY 7% OF THE WHOLE OF THE MENTAL HEALTH BUDGET

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26 Why is treating emotional disorders important? Short term risks: Worsening academic performance Substance misuse Suicidal thoughts and self-harm Long term risks: Recurrence of depressive episodes Development of other mental health problems

27 Why is treating conduct disorders important? Without treatment children with ODD can develop a Conduct Disorder Typical features seen in CD: Excessive levels of fighting/bullying Cruelty to other people or animals Fire-setting Stealing Truancy from school 40% of children with CD go on to develop an antisocial personality disorder in adulthood. Zoccolillo M et al Psychol Med; 1992

28 Why is treating ADHD important? Children with ADHD can be negatively labelled Learning in a school environment will be challenging Social interactions will be more difficult As a result there is an increased risk of poor school results and exclusion Other social problems later in life

29 Why is this important (continued) Fewer years of school education Earlier tobacco use Greater teenage pregnancy rates 4X increased risk of STDs Less likely to be employed Increased early death risk More accident and injuries

30 Why is this important (continued) With ADHD Without ADHD 10 0 Pedestrian Bicycalist Multi-body injury Head injury DiScala C et al. Pediatrics Dec;102(6): Severe injury Abnormal GCS

31 CAMHS Local Picture There are 193,000 children living in Staffordshire Staffordshire Health and Wellbeing Board Ethnicity: 97% White 1.7% South Asian 1.3% Other Wikipedia! During 2013/14 there were over 1,700 admissions due to self-harm Self poisoning 77% 87% Sharp or blunt object 18% 10% Other or unspecified means 5% 3% Midlands & Lancashire Commissioning Support Unit

32 CAMHS Tier System

33 CAMHS West Structure Predominantly a tier 3 service There is an early years (0-5 years) service Multi-disciplinary team consisting of child psychiatrists, psychiatric nurses, psychologists, social workers, family therapists, art therapists and a very hard working admin team

34 Service development Two new CAMHS services have started this year: 1) South Staffordshire Eating Disorders Team 2) CAMHS outreach service (went live on the 30 th September 2016)

35 References Green, H., McGinnity, A., Meltzer, H., et al. (2005). Mental health of children and young people in Great Britain London: Palgrave. Kim-Cohen, J., Caspi, A., Moffitt, TE., et al (2003): Prior juvenile diagnoses in adults with mental disorder. Archives of general psychiatry, Vol 60, pp Office for National Statistics ( Zoccolillo M, Pickles A, Quinton D, Rutter M (1992), The outcome of conduct disorder. Psychol Med 22: DiScala C et al. Injuries to children with attention deficit hyperactivity disorder. Pediatrics Dec;102(6): Erskine HE et al. Epidemiological modelling of attention-deficit/hyperactivity disorder and conduct disorder for the Global Burden of Disease Study Journal of Child Psychology and Psychiatry. Dec Volume 54, Issue 12, pages Ford T, Goodman R, Meltzer H. The British Child and Adolescent Mental Health Survey 1999: the prevalence of DSM-IV disorders. J Am Acad Child Adolesc Psychiatry Oct;42(10):

36 Any Questions?

37 Empowers

38 Why are we here? What has led us to a highlighted need for better support for patients with a mental health need? At what level was there a need for better mental health support? Highlighted risks What is our end goal?

39 Tom Evans Clinical Lead Nurse in Mental Health at UHNM Recently been appointed as clinical lead nurse for mental health Varied clinical background in supporting children, young peoples and their families with complex mental health problems Take on senior responsibility to identify GAP s in practice and to devise specific actions in order to meet the needs of individuals To provide senior support across the division To become a change agent within the division To support the integration of registered mental health nurses

40 The numbers of children and young people who have presented to A&E with a psychiatric condition have more than doubled since (8,358 in 10/11; 17,278 in 13/14)

41 Kirstie Orr Mental Health nurse (RMN) Currently based on CAU. Appointed in May 16 Background = Adult mental health secure services and Neurological disability (brain injury unit). Debbie Bourne Dual trained paediatric and mental health nurse Working on CAU Worked within child health as a health care for 11 years. Worked as a adult mental health nurse for 5 years Dual qualified children's nurse for 11 years

42 Aim of the pathway. To provide a more thorough admission assessment. To ensure that the patients mental health need is highlighted. To provide support for the admitting staff member (highlight the important questions to ask) To give a better understanding of what the young persons need is. Highlights any risks that may be involved. Provides a clear structure for the staff to understand what steps to take next. For better patient and staff experience.

43 Which patients will the pathway be used for? All young people that are being referred for mental health needs such as: Suicide and self harm Depression Psychosis Intrusive thoughts

44 Where will the pathway be implemented? The pathway admission will begin on the children s assessment unit. Follow the patient up to discharge A trial of the pathway will begin after the second launch night. 6 month trial and will be reviewed after

45 Folders are being placed by every bed space throughout the wards and CAU. Aims to provide some key information for patients. Includes emergency helpline numbers for patients to gain support if required. Important to make patients aware that these are available.

46 What is included? Stress ball Note pad Pens Rubber band Colouring book Magnetic emojis Aim of the bags? How will they benefit the young person? Patient feedback forms included in the bags

47 Any Questions?

48 Royal Stoke University Hospital Hospital Teaching Service by Donna Mitchell

49 The aims of hospital education The aim of the hospital provision is: To provide access to appropriate education for all children and young people with medical needs, keeping education alive in the student s life, maintaining progress and enabling them to achieve their potential, whilst in the hospital.

50 Merit Pupil Referral Service There are 3 strands to the Pupil Referral Service: Merit Pupil Referral Unit, which is a specialist short stay school that offers appropriate teaching and interventions to vulnerable students with medical and mental health needs in a supportive and structured setting. Personal Tuition, which can take place at the home, Merit PRU and another designated space such as the library or the hospital. This service is provided for students who cannot attend Merit PRU or mainstream school and can be also used as a stepping stone between hospital and a successful return to school. Hospital School, that provides quality education for all students between the ages of 4 16 years and includes short and long term patients which often includes pupils with Cystic Fibrosis and from the Oncology Department. The commonality between the strands is to ensure that illness does not have a devastating effect on a student s education.

51 The Curriculum The hospital school follows the EYFS, Primary and Secondary Curriculum from Phonics to Physics! A structured maths lesson takes place every morning in the classroom for all children to access and in addition to this, liaison with schools takes place for individual pupils in order to identify the correct content and level of work required. Core subjects are the main areas taught, with bespoke resources often created to meet the needs of individual children. Work is marked in accordance to the school policy, assessed and evidenced. Work is then returned to the parents or ed to schools on discharge with a report if required.

52 Why education is important for children with mental health issues Normality Routine Purpose Alleviates anxiety of missing school Non-medical setting

53 Art therapy Art therapy sessions can take place in a one-to-one setting or within a group. If a child or young adult feels isolated, or finds it difficult to get to know people, then group art therapy can be very helpful. If however, a child or young adult feels more comfortable sharing their thoughts and feelings with just the therapist, then a one-to-one session may be preferable. As with other types of therapy, the relationship between students and the art therapist is extremely important as they will be working together to explore difficult feelings and experiences and learn how to better cope with them. Arts therapies can be particularly helpful if a child: Feel distanced from their feelings Finds it too upsetting to talk about painful experiences Kevin Benson Art Therapist

54 Music Therapy Philip uses music as therapy in his work with children, young people and adults to help them to explore their thoughts and feelings in a calm, non-threatening, verbal or non-verbal way. This can be done through song writing, musical improvised stories, instrument playing and listening to music. These activities enable children and young adults to bring new positive thoughts, feelings and hopes into the lives of patients and their families and give a sense of achievement through learning an instrument or taking part in a performance. Phillip Nankivell Music Therapist

55 The future The amount of children requiring teaching at the Royal Stoke University Hospital is increasing year on year partly due to the closure of Stafford Hospital. The amount of children and young adults with mental health difficulties is also rising. Therefore, the demand for teaching provision across the wards is continually growing. We currently are 1 x full-time teacher and 2 x part-time teaching assistants. Our hope is for an increase in staff/hours in order to meet the shortfall in demand for teaching requirements, as the Royal Stoke University Hospital continues towards its vision of becoming a Children s Hospital within a hospital

56 Ofsted quotes and outcomes Ofsted inspection outcome January 2016 confirms that Merit is GOOD with OUTSTANDING leadership and management, behaviour and safety of pupils. EYFS KS4 demand is considerable, but we have highly flexible provision and strong evidence of student progress "Written comments from parents of children in hospital were universally positive about the attention to their children s needs "The strong commitment of staff have contributed to substantial improvements in home and personal tuition and the hospital teaching service"

57 CAMHS Stafford Participation Group Our Experience Miriam and Jess