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Young People Mental Health

Introduction

Mental health problems in children and adolescents are an important public health problem. Poor mental health and wellbeing are associated with a range of adverse outcomes including high levels of health risk behaviours such as smoking, drug and alcohol misuse.

Half of all lifetime mental health problems start before the age of 14 years (Kessler et al., 2007). A good start in life and positive parenting promotes good mental health throughout adult life.  Early intervention is at the heart of the government’s approach to improving outcomes for children and young people. This is clearly set out in in the Public Health White paper – ‘Healthy Lives, Healthy People’ (2010) and the Mental Health Strategy ‘No Health Without Mental Health’ (2011).

Mental disorders in children and young people are divided into the following categories: conduct disorders, common mental health disorders (anxiety – including OCD and phobias – and depressive disorders), hyperkinetic disorders (ADHD), developmental disorders (Autistic Spectrum Disorder), eating disorders, substance misuse, psychotic disorders and self-harm

 

What do we know?

Facts. figures and trends

Based on a report by Green et al (2004) the following prevalence of mental disorders in children has been estimated:

  • One in ten children and adolescents between the ages of 5-16 years has a clinically diagnosed mental disorder in Great Britain. This equates to nearly 2,400 children aged 5-16 years in Bedford Borough based on mid 2012 population estimates, Office of National Statistics (ONS)
  • Boys are more likely to experience mental health issues than girls (11.4% compared to 7.8%)
  • Children aged 11-16 years are more likely (11.5%) than 5 to 10 year olds (7.7%) to have mental health problems
  • Population projections based on 2011 estimate that in 10 years’ time there will be a significant increase in the number of Bedford children in the 5-9 year old age group of over 20% (ONS)
  • Rates are significantly higher for Looked After Children

 

Table 1 Estimated number of children aged 5-16 years with mental health disorders in Bedford Borough by age group and gender

 

Estimated number of children aged 5-10 years (2012)

Estimated number of children aged 11-16 years (2012)

Estimated number of boys aged 5-10 years (2012)

Estimated number of boys aged 11-16 years (2012)

Estimated number of girls aged 5-10 years (2012)

Estimated number of girls aged 11-16 years (2012)

Conduct disorders

565

805

410

520

160

295

Emotional disorders

 

275

610

130

260

140

355

Hyperkinetic disorders

185

175

160

155

25

25

Less common disorders

150

175

130

105

25

65

 

Source: CHIMAT : CAMHS Needs Assessment http://www.chimat.org.uk/camhs/tools

Table 1 shows the estimated number of children with each type of disorder in Bedford by applying the prevalence rates from the 2004 report to the 2012 population.

The figures indicate that conduct disorders are the most common type of disorder when looking at all children between the ages of 5-16 years and higher rates are seen in boys (approximately 67%) than girls (33%).  Conduct disorders in childhood or adolescence are associated with 80% of crime (SCMH, 2009).

Emotional disorders are more prevalent in 11-16 year olds than 5-10 year olds and numbers are higher in girls than boys (58% compared to 42% at age 11-16). In girls aged 11-16 emotional disorders are the most common type of mental health disorder.

Hyperkinetic disorders, most commonly Attention Deficit Hyperkinetic Disorder (ADHD), has a stong male predominance.  Of the 360 children estimated to have the disorder in Bedford Borough 315 (87%) were boys.

Less common disorders include autistic spectrum disorder, tic disorders, eating disorders and mutism.

 

Neurotic disorders in children aged 16-19 years

A study conducted by Singelton et al (2001) heas estimated prevalence rates for neurotic disorders in young people aged 16 – 19 years and the table below estimates how many young people in Bedford Borough have a neurotic disorder if the prevalence rates were applied to the local population.

 

Table 2 : Estimated number of males aged 16 to 19 with neurotic disorders in Bedford Borough

 

Mixed anxiety and depressive disorders (males 16-19 yrs) (2012)

Generalised anxiety disorder (males 16-19 yrs) (2012)

Depressive episode (males 16-19 yrs) (2012)

All phobias (males 16-19 yrs) (2012)

Obsessive compulsive disorder (males 16-19 yrs) (2012)

Panic disorder (males 16-19 yrs) 2012

Any neurotic disorder (males 16-19 years) (2012)

225

70

40

30

40

25

380

Source: Office for National Statistics, mid year population estimates for 2012.  . Singleton, N. et al (2001).

 

 

Table 3: Estimated number of females aged 16 to 19 with neurotic disorders in Bedford Borough

 

Mixed anxiety and depressive disorders (females 16-19 yrs) (2012)

Generalised anxiety disorder (females 16-19 yrs) (2012)

Depressive episode (females 16-19 yrs) (2012)

All phobias (females 16-19 yrs) (2012)

Obsessive compulsive disorder (females16-19 yrs) (2012)

Panic disorder (females 16-19 yrs) 2012

Any neurotic disorder (females 16-19 years) (2012)

490

45

110

85

40

25

760

Source: Office for National Statistics, mid year population estimates for 2012.  . Singleton, N. et al (2001).

In the 16-19 year old age group, females are more likely to suffer from a neurotic disorder, with mixed anxiety and depression being the most prevalent condition.

 

Figure 1:  Hospital admission rate for 0-17 year olds for more than 3 days for mental illness (2007-2010) for East of England PCTs                       

YPMH1 2015

Source: Child and Maternal Health Observatory (ChiMat), Graph created by Public Health intelligence NHS Bedfordshire

Figure 1 above shows hospital admission rates for mental illness in Bedfordshire compared to other PCTs in East of England.

 

Self Harm

Self harm is an issue that has been raised anecdotally by schools and providers of Tier 2 mental health service providers in Bedford. Most people who self harm have an associated mental illness, however it may not be associated with mental health problems. 

A national report by the Cello Group (2012) on self-harm identified it as the number one issue that young people are concerned about among their peers in a list including gangs, bullying, drug use and binge drinking.  It is also the one issue that all groups (young people, parents and professionals) feel least comfortable approaching with young people.  National figures on the Young Minds website (http://www.youngminds.org.uk/) show:

 

  • Between 1 in every 12 and 1 in 15 children and young people deliberately self-harm.
  • Nationally there has been a big increase in the number of young people being admitted to hospital because of self-harm. Over the last ten years this figure has increased by 68%

 

Figure 2:

YPMH2 2015

 

Source: Child health profiles, Chimat, 2014. Hospital Episode Statistics, Health and Social Care Information Centre.

Figure 2 illustrates that the rate of hospital admissions of 10-24 year olds as a result of self-harm in Bedford Borough has remained similar to the national average over the last 5 years.

However hospital admissions would only represent a small proportion of numbers of children self-harming with most acts of self-harm in young people never coming to the attention of care services.  Feedback from Tier 2 service providers in Bedford highlighted concern over a lack of support for young people who are self-harming. A report into unintentional and deliberate injuries undertaken by Public Health (NHS Bedfordshire 2012) found self-harm was the leading cause of emergency hospital admissions in the 15-17 year old age group.  In line with national trends significantly more girls were admitted for self-harm than boys. 

Higher prevalence of self-harm behaviour is found in more socially deprived areas. Therefore it is expected that there would be more self-harm behaviour in the wards with more social deprivation.

 

Current activity & services

Services in Bedford Borough range from emotional wellbeing support at Tier 1 to specialist mental health services at Tier 4.  Services are commissioned by the Local Authority at Tiers 1 & 2, the Bedfordshire Clinical Commissioning Group at Tiers 2 and 3 and NHS England at Tier 4.  The following diagram gives an overview of services at each tier.

 

YPMH3 2015

 

Tier 1 support ensures that children have the skills early in life to increase their resilience to be able to deal with life events. It includes social, emotional and developmental support from professionals outside mental health services e.g. teachers, social workers, School Nurses. In addition at Tiers 1 and 2 there is a range of providers with varying referral criteria.  The Tier 3 CAMHS Service is currently provided by South Essex Community Partnership (SEPT) which comprises three services: Core CAMHS, Learning Disability Team and the Home Treatment Team.

 

Estimated need for services at each tier

Estimates of the number of children and young people who may experience mental health problems appropriate to a response from CAMHS at Tiers 1, 2, 3 and 4 have been provided by Kurtz (1996).  The following table, produced by CHIMAT shows these estimates for the population aged 17 and under in Bedford Borough.

Table 4: Estimated number of children / young people in Bedford Borough who may experience mental health problems appropriate to a response from CAMHS

 

Tier 1 (2012)

Tier 2 (2012)

Tier 3 (2012)

Tier 4 (2012)

5420

2530

670

30

Source: CHIMAT CAMHS Needs Assessment. Office for National Statistics, mid year population estimates for 2012. Kurtz, Z. (1996)

 

Numbers accessing the services at Tier 1 and 2 was difficult to measure due to the range of services and providers involved.  The largest Tier 2 provider, CHUMS, reported that they supported 308 children in Bedford Borough during 2012/13 through their Emotional Health and Wellbeing service and a further 161 were seen by their bereavement service.

The Tier 3 CAMHS Service provided by SEPT received 2568 referrals during April 2012 – March 2013 across Bedfordshire (Bedford Borough and Central Bedfordshire), 2030 of these were accepted. 

In 2013/14 Public Health in Bedford Borough undertook a review of Tier 1 and 2 Mental Health and Wellbeing Services and Bedfordshire Clinical Commissioning Group completed a review of Tier 3 Child and Adolescent Mental Health Service (CAMHS).  Stakeholder feedback as part of both these reviews reported that waiting times for services was a concern, particularly from assessment to treatment (rather than referral to assessment).  Reported waiting times for a Tier 2 service was up to 12 weeks and up to 30 weeks for treatment at Tier 3.

 

National and Local Strategies (Best practices)

Comprehensive guidance form NICE covers a number of areas relating to promoting social and emotional wellbeing and the management of mental health conditions in children and adolescents including:

Social and emotional wellbeing: early years PHG40 (2012)

http://www.nice.org.uk/_gs/searchtracker/GUIDANCE/13941

 

Social and emotional wellbeing in primary education PH12 (2008)

http://www.nice.org.uk/nicemedia/live/11948/40117/40117.pdf

 

Social and emotional wellbeing in secondary education PHG 20 (2009) 

http://www.nice.org.uk/_gs/searchtracker/GUIDANCE/11991

 

Depression in children and young people: identification and management in primary, community and secondary care CG28 (2005)

http://guidance.nice.org.uk/CG28/NICEGuidance/pdf/English

Antisocial behaviour and conduct disorders in children and young people: recognition, intervention and management CG158 (2013)

http://www.nice.org.uk/_gs/searchtracker/GUIDANCE/14116

 

Attention deficit hyperactivity disorder: Diagnosis and management of ADHD in children, young people and adults CG72 (2008)

http://www.nice.org.uk/_gs/searchtracker/GUIDANCE/12061

 

Autism in children and young people CG 170 (2013)

http://www.nice.org.uk/_gs/searchtracker/GUIDANCE/14257

 

Eating Disorders CG9 (2004)

http://www.nice.org.uk/_gs/searchtracker/GUIDANCE/10932

 

Self harm CG16 (2004)

http://www.nice.org.uk/_gs/searchtracker/GUIDANCE/10946

Psychosis and schizophrenia in children and young people: Recognition and management CG155 (2013)

http://publications.nice.org.uk/psychosis-and-schizophrenia-in-children-and-young-people-cg155

The Joint Commissioning Panel for Mental Health includes the following evidence based guidance for what works to promote mental health in childhood and adolescence

 

Table 5: Mental Health and Wellbeing outcomes for evidence-based interventions in childhood

 

Intervention

Evidence-based outcome

Pre-school and early education programmes as in the Health Child Programme

Improved cognitive skills, school readiness, academic achievement, prevention of emotional and conduct disorder

School-based mental health promotion programmes included Targeted Mental Health Support in Schools (TaMHS)

Improved wellbeing with resultant improvement in academic performance, social and emotional skills, classroom behaviour and reductions in anxiety and depression.

Social and emotional learning (school based intervention) showed 10% reduction in classroom misbehaviour, 11% improvement in achievement tests, and 25% improvement in social and emotional skills.

Source: Joint Commissioning Panel for Mental Health, ‘Guidance for commissioning public mental health services’ http://www.jcpmh.info/wp-content/uploads/jcpmh-publicmentalhealth-guide.pdf Accessed on 25/3/2014

 

Cost effectiveness

The second report on Early Intervention (Allen, 2011) reiterates the massive cost savings achieved as a result of intervening early to ensure improved social and emotional wellbeing of children which in turn leads to better mental and physical health. A costing statement by NICE (2012) on the implications of implementing its guidance on social and emotional wellbeing in the early years anticipates a significant reduction in public service costs, including costs to health, social services, the police and criminal justice system.

 

Local

The Bedford Borough Health and Wellbeing Strategy (2014) has made mental health and wellbeing a priority and has selected Strengthening Emotional and Mental Health of Children and Young People as one of its five primary objectives.

The 2014-2017 Partnership Framework for Children and Young People in Bedford Borough (2013) prioritises “Healthy children and young people” by supporting them to become healthier, more emotionally resilient and better able to make informed decisions.

Early intervention and prevention is a key approach that underpins both strategies.

The “Toxic Trio” describes three key risk factors in families that may lead to poorer outcomes for children.  They are parental mental health, domestic abuse and alcohol and substance misuse.  The Toxic Trio as an issue is gaining increased attention in view of the latest growing evidence that highlights the overlap between these parental risk factors and the impact on the infant/child (see next section for more information on the Toxic Trio in Bedford Borough).

 

What is this telling us?

What are the key inequalities?

There is a broad range of risk factors, linked to inequality that can make children more susceptible to poor mental health (DH, 2011). They include:

  • Substance misuse and maternal stress during pregnancy
  • Low birth weight
  • Poor parenting
  • Poor maternal mental health
  • Parents with no qualifications or unemployed
  • Social deprivation
  • Child abuse

 

In addition certain groups of children are at an increased risk of a mental health disorder during childhood and adolescence.  These groups are shown below along with the impact on their risk of having a mental disorder.

  • Looked After Children – 5 fold increase of any mental health disorder
  • Children with learning disabilities – 6½ fold increase of mental health problem
  • Children with Special Education Needs – 3 fold increase in conduct disorder
  • Children with physical illness – 2 fold increased risk of emotional/conduct disorder
  • Young offenders – 3 fold increase of mental health disorder
  • Homeless young people – 8 fold increase of mental health problem
  • Young LGBT – increased risk of suicide attempts
  • Children of prisoners – 3 fold increase of antisocial-delinquent outcomes

 

Risk factors are sometimes linked to particular conditions rather than all. For example Autistic Spectrum Disorders and Eating Disorders are not linked with social deprivation.

Risk factors in Bedford Borough

Deprivation

The Child Health Profile (CHIMAT 2014) for Bedford Borough shows that the level of child poverty is better than the England average with 19% of children aged under 16 years living in poverty in 2011.  However the overall picture can mask variation between wards. Data from the Bedford Borough Joint Strategic Needs Assessment shows that nine wards have rates higher than 20% with the most deprived wards being Kingsbrook and Goldington where they have rates of 37.7% and 35.5% respectively. At the smaller Local Super Output Area (LSOA) level there are areas with even higher proportions.  One LSOA in Castle ward has 65% and others in Kingsbrook and Goldington wards have more than 50% of children living in income deprived households

Figure 3 below shows the rate of family homelessness is significantly worse than the England average in 2012/13.

Figure 3 Taken from the Bedford Child Health Profile

 

YPMH4a2015

Source: CHIMAT, Child Health Profile published March 2014

Toxic trio

This term describes the combination mental illness, domestic abuse or substance misuse which can each have an adverse effect on parenting capacity.  It is estimated that 26% of babies in the UK have a parent who is affected by one of the toxic trio (Leadsom 2013).  

A report produced by CHIMAT (accessed 17/07/13) on risk factors affecting outcomes in children looks at each of these factors and states the following:

  • Substance misuse can affect a parent’s ability to care. It often occurs alongside poverty, social exclusion, unemployment and poor mental health.  The Health Survey for England and the General Household Survey estimate that in the UK 30% of children under the age of 16 years live with one binge drinking parent (Manning et al 2013).  8% of children lived with an adult who had recently used illicit drugs (Manning et al, 2013).  During 2011/12 there were 44 parents in drug treatment in Bedford Borough and 42 in alcohol treatment.  Clearly this does not give any indication of the number of parents misusing drugs and alcohol and not receiving treatment.
  • Poor maternal mental health during pregnancy and the first year has potentially long lasting effects on the infant.  A report published by the NSPCC (Hogg, 2013) estimated that maternal mental health issues affect more than 1 in 10 women during this time which would equate to 210 women in Bedford Borough each year (based on the 2011 birth rate). 
  • Parental depression is a risk factor associated with worse cognitive and behavioural outcomes for children at age 5. Parental mental health (excluding postnatal depression) is estimated to affect 9-10% of women and 5-6% of men in the non-elderly adult population at any one time, mostly depression and anxiety.
  • Using national estimates, without taking local variations in to account, approximately 180 children under the age of 5 years are at high risk of being affected by domestic violence in Bedford Borough.  Domestic violence often begins in pregnancy which can result in a 3 fold increase in developing post natal depression (Howard et al, 2013)

 

Employment and crime

Figure 4: Taken from the Bedford Child Health Profile

 

YPMH5 2015

Source: CHIMAT, Child Health Profile, published March 2014

 

The above numbers, which relate to 2012, show that 57 children entered the youth justice system for the first time, this is lower than the England average.  The number of young people not in education, employment or training (NEET) was worse than the England average. 

Young people who are NEET are more likely to be involved in delinquency and crime. Being out of work can lead to poor mental health (e.g. depression) and make them more likely to turn to drugs and alcohol (Sissons & Jones 2012). A report by the University and College Union (Young Minds 2013) states that a third of NEET young people have suffered depression and 15 per cent have a mental health problem

Looked After Children

At the end of 2013 there were 245 children in care in Bedford Borough (see Figure 3 above) giving a rate of 69 per 10,000. This is similar to the England average.  Looked after children have a higher incidence of mental health disorders with 45% estimated to have a disorder (Meltzer, 2003).  This would equate to 110 Looked after Children in Bedford Borough in 2013.  A Tier 1 / 2 CAMHS Early Intervention Service for Looked After Children has been commissioned and has been operating since 2013.

Children with learning disabilities

Using national prevalence rates local estimates of the number of children in Bedford Borough with a learning disability can be made.  Of these the following table shows the number of these children who are likely to have a mental health problem.

Table 5: Estimated total number of children in Bedford Borough with learning disabilities with mental health problems

 

Children aged 5-9 years (2012)

Children aged 10-14 years (2012)

Children aged 15-19 years (2012)

Bedford Borough

40

90

115

Source: CHIMAT CAMHS Needs Assessment, using data from Office for National Statistics mid-year population estimates for 2012. The Foundation for People with Learning Disabilities (2002).

 

SEPT provides a Learning Disability Team that provides an integrated service for children up to the age of 18 years.

What should we be doing next?

Progress on priorities in the JSNA

The last JSNA chapter on Child and Adolescent Mental Health identified the following priorities for Bedford Borough:

  • Early intervention
  • Service integration
  • Transition from child to adult services
  • Deprivation
  • Vulnerable groups
  • Robust local pathways
  • Data collection
  • Drug and alcohol surveys
  • Think family approach
  • Increase awareness

 

The importance of early intervention is reflected in key strategies including the Health and Wellbeing Strategy and the Children and Young People’s Framework and emerging strategies around Early Help.  The programmes to expand the Health Visiting and School Nurse provision in response to the Government Call To Action (DH, 2011 and 2012) are progressing in Bedford Borough.  An expanding workforce will help to ensure the Healthy Child Programme in Bedford Borough is able to deliver on both a universal and more targeted basis to ensure those families with greater need are identified and supported.  The structured programme of assessments and reviews are key to early intervention and prevention.

 

Since the last report there have been a number of new services commissioned providing Tier 1, 2 and 3 support including:

CHUMS  - Since 2011 they have provided an open access emotional health and wellbeing service (Tier 2) in addition to their bereavement service. 

Early Intervention Looked After Children’s Service (since 2013)

The Aspire Programme for vulnerable children susceptible to poor outcomes is run in 4 schools in Bedford Borough.

The Targeted Mental Health in Schools Project (TAMHs) is no longer running in Bedford schools.

Unmet needs/service gaps

In 2013/14 two separate reports reviewed services for children’s mental health in Bedford Borough.  Public Health reviewed services for Tier 1 and 2 and Bedfordshire Clinical Commissioning Group reviewed Tier 3 Services. The aim of these reviews was to evaluate current provision and gaps. 

Tier 1 and 2 Services

Consultation with stakeholders including service providers and commissioners identified gaps in current services and areas for improvement. A summary of these is below:

  • Referral routes to access services - There are currently a number of ways in which a young person can be referred to child and adolescent mental health services. This has been reported as causing confusion and delays and a need was identified for a single point of referral. Bedfordshire Clinical Commissioning Group, South Essex Partnership Trust (SEPT) and CHUMS are piloting a single point of referral for Tiers 2 and 3 CAMHS in 2013/14 which can inform development of a referral route for all Tiers of CAMHS.
  • Awareness of services – There was a lack of clarity about current services available locally and a need was identified for a directory of services to be available, which could be used for the development of a pathway for child and adolescent mental health in the longer term
  • Tier 2 demand and longer term Tier 2 support – Most of the current Tier 2 services reported waiting lists and more demand than capacity allows. There is also limited provision of Tier 2 family based and group based mental health and wellbeing services. The majority of current Tier 2 services in Bedford Borough are short term (e.g. CHUMs: 4 sessions; Relate: usually up to 6 sessions; Open Door: usually up to 12 weeks).
  • Increased early prevention/Tier 1 work – was identified as an area that could be further strengthened e.g. through the Healthy Child Programme (School Nursing and Health Visiting). This includes the promotion of health and wellbeing, building resilience and self-esteem.
  • Family based mental health and wellbeing support –were identified as an area that could be expanded (rather than child only services)
  • Pathway for children with autism – was identified as an area that could be strengthened
  • Continuity of Care– between children’s and adults mental health services was identified as an area of weakness as eligibility criteria differ between these services, which can interrupt service provision
  • Communication between Service Providers – some areas were identified where service providers could better share information and where awareness of available services could be improved among the public and professionals to improve onward referral, for example to secondary care.
  • Gaps in specific services – some service providers perceived there to be few services locally for addressing self-harm, prevention of drug addiction (rather than treatment of an existing addiction), sexualised behaviour.  It was felt there was a lack of services for Under 5’s and young carers.
  • CAMHS service and outcomes information – The review process also highlighted the need for consistent reporting to measure activity and outcomes. Outcomes and activity data reported by providers of Tier 1 and 2 services often did not include outcomes data as part of routine monitoring of information or a breakdown of data by local authority area.

 

Tier 3 Services

Feedback from clinicians and managers identified the following as gaps within the current commissioning arrangements:

 

  • Sexualised behaviour services – there is a need for psychosocial assessments and treatment reducing harm to others and the community
  • Eating disorder services - the need for early referrals with up to date record of weight and BMI. The degree and rapidity of any weight loss, details of any physical investigations performed and their results should also be recorded.  
  • Forensic Service – this is needed to address the needs of young people who display anti-social, high risk and/or offending behaviour
  • Family based interventions and support - local CHUMS data suggests that 50% of children referred to their emotional health and wellbeing service also have a parent with a mental health issue
  • Paediatric psychology – currently there is only 1 post based at the Luton and Dunstable Hospital
  • Complex Case Management - SEPT (Tier 3) and other Tier 2 providers have highlighted a rise in the number of complex cases. This leads to an increase in indirect work such as liaising with social workers and an increased time needed per case. Although the recent withdrawal of Social worker posts in SEPT (Bedford Borough) may also be a factor in this issue. In April 2012 to March 2013, there were 2042 indirect contacts with SEPT (16%) compared to 12440 (84%) direct contacts. 
  • Moving between tiers - Feedback from professionals and stakeholders have emphasised that there are users who need a higher level of input than Tier 2 offers but do not reach the threshold for Tier 3 referral. The results of a questionnaire circulated to GPs and Social Workers/Children’s Services professionals found that referrals are being rejected as patients do not meet the threshold for Tier 3 services.
  • Referral Pathway - There are a significant number of cases referred from tier 3 to tier 2, which indicates that the pathway is not very clear to those referring and those using the services. This is further supported by the recent CAMHS Benchmark data.

 

Recommendations

  • Develop an emotional health and wellbeing strategy for children’s mental health in Bedford that can build on the recommendations from the CAMHS service reviews.
  • Increase resilience in children for example by embedding the enhanced School Nurse Service Tier 1/2 Emotional and Behaviour Management pathway including School Nurse Drop-ins at all middle and upper schools and interventions where appropriate.
  • Increase awareness of existing Tier 1 and 2 services and how to access them to make referrals easier.
  • Develop a pathway of care across all Tiers and providers to ensure gaps where children may fall between services are identified and reduced.
  • Improve access by developing a single point of referral
  • Improve local data to understand the prevalence of mental health issues and self-harm in children and young people in Bedford Borough.
  • With regard to the Toxic Trio: increase awareness within services that are treating adults around mental health, substance misuse and domestic violence to ensure that they have a “Think Family” approach to identify support for children affected by parental issues and link with parenting support services to help support parents fulfil their role as a parent.  Ensure maternal mental health is assessed and supported throughout pregnancy and during the first year

 

References

Allen G (2011) Early Intervention, Smart Investment, Massive Savings. HM Government. Available at www.gov.uk

Bedford Borough Joint Strategic Needs Assessment. Available at https://www.bedford.gov.uk/health_and_social_care/bedford_borough_jsna.aspx

Cello Group (2013) Talking Self harm http://www.cellogroup.com/pdfs/talking_self_harm.pdf

Child and Maternal Health Intelligence Network (CHIMAT). Child Health Profiles for Local Authorities 2014. Available at: http://atlas.chimat.org.uk/IAS/dataviews/childhealthprofile

CHIMAT. Key risk factors indicating harm or poorer developmental outcomes in children: Bedford Borough. Available at: http://atlas.chimat.org.uk/IAS/profiles/profile?profileId=48&geoTypeId=    (Accessed 17/07/2013)

Cuthbert C, Rayns G, Stanley K (2011) All Babies Count Prevention and protection for vulnerable babies: a review of the evidence. NSPCC. Available at: http://www.nspcc.org.uk/Inform/resourcesforprofessionals/underones/all_babies_count_wda85568.html

Department of Health (2012): Getting it right for Children, Young People and their Families; Maximising the contribution of the school nursing team

Department of Health (2011). Health Visitor Implementation Plan 2011-15. A Call To Action

Department of Health (2009) Healthy Child Programme

Department of Health (2011) No health without mental health; A cross-government mental health outcomes strategy for people of all ages. Analysis of the Impact on Equality (AIE) Annex B – Evidence Base.

Department of Health (2010) Healthy Lives, Healthy People: Our strategy for public health in England

Department of Health (2011) No health without mental health; A cross-government mental health outcomes strategy for people of all ages.

Green H, McGinnity A, Meltzer H, Ford T and Goodman R (2004) Mental health of children and young people in Great Britain, 2004. Office for National Statistics. London, HMSO

Howard L., Oram S., Galley H., Trevillion K. and Feder G. (2013) Domestic violence and perinatal mental disorders: a systematic review and meta-analysis. PLOS Medicine. 10(5)

Joint Commissioning Panel for Mental Health, ‘Guidance for commissioning public mental health services’ http://www.jcpmh.info/wp-content/uploads/jcpmh-publicmentalhealth-guide.pdf Accessed on25/3/2014

Kessler RC., Aminger GP., Aguilar-Gaxiola S et al (2007) Age of onset mental disorders: a review of recent literature. Curr Opin Psychiatry, 20(4), 359-64

Kurtz Z. (1996) Treating children well: a guide to using the evidence base in commissioning and managing services for the mental health of children and young people. London. Mental Health Foundation.

Leadsom A. (2013)  1001 Critical Days: The importance of the Conception to Age Two Period A Cross Party Manifesto.

Manning V., Best DW., Faulkner N. and Titherington E. (2009) New estimates of the number of children living with substance misusing parents: results from UK national household surveys. BMC Public Health 9:377

Meltzer H., Corbin T., Gatward R., Goodman R., Ford T (2003) The mental health of young people looked after by local authorities in England. ONS

National CAMHS Support Service (2011). Better Mental Health Outcomes for Children and Young People. A directory for commissioners

NICE (2012) Social and emotional wellbeing: early years: Costing statement – Implementing NICE guidance

Sainsbury Centre for Mental Health (SCMH) ( 2009) The Chance of a Lifetime. Preventing early conduct problems and reducing crime. www.scmh.org.uk/pdf/chance_of_a_lifetime.pdf

Singleton, N., Bumpstead, R., O’Brien, M., Lee, A. and Meltzer, H.(2001) Psychiatric morbidity among adults living in private households. Office for National Statistics, London. HMSO

Sissons P., Jones K. (2012) Lost in Transition? The changing labour market and young people not in employment, education or training. The Work Foundation

Young Minds http://www.youngminds.org.uk/

 

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