Agenda item

The Chair opened the meeting by updating Members that the LGA had recently commissioned Isos Partnership to examine and research the systemic and strategic problems and severe lack of funding councils are facing with providing an effective mental health service, given the capacity issues the NHS’ Child and Adolescent Mental Health Service (CAMHS) continue to report.  With the ever-growing rates of mental health issues in children and young people, this research aims to highlight these issues and help Members of the LGA’s CYP Board develop an offer to government and local areas for a better offer for residents, after increased investment.

The Chair then handed over to Natalie Parish, Director of Isos Partnership.  Natalie stated her fieldwork with eight councils in England had almost concluded, and that her PowerPoint presentation today will deliver the head line messages.  Natalie’s presentation focused on:

·    Slide one focused on the four objectives of the research, and certified that this is not just about CAMHS, but also the support local government can provide if fully funded.

·    Slide two discussed the challenging national context, the increasing demand and lack of capacity for child and adolescent mental health needs.  Natalie’s research highlighted that less than a third of children and young people are being treated by CAMHS, despite presenting with mental health issues.  Natalie also discussed underfunding and different grant funding streams.  

·    Slide three discussed CAMHS & local government expenditure.

·    Slide four examined the expenditure per child on preventative measures, which highlighted significant disparity across the country and a postcode lottery.

·    Slide five gave an overview of the fieldwork – it addressed the challenging national picture, but certain actions taken at a local level can address some of these issues.  These nine issues detailed were leadership & vision; self-reflective partnership; integrated commissioning; working with young people; promoting good mental health; developing the children’s workforce; embedded CAMHS; supporting families; and creative solutions to managing risk.

·    Slide six discussed the importance of leadership & vision; expectations for collaboration; robust governance structures; bold, creative service commissioning; and a diverse provider partnership. 

·    Slide seven addressed the keen focus on early intervention and prevention that both elected Members and officers were very keen on pursuing; effectively using the CAMHS as a crisis service.  The slide discussed the concept of including young people in developing service provisions, as well as training young people in peer to peer support. Other aspects discussed were online counselling; mental health promotion programmes in education, youth & children’s centres and perinatal services; normalising common adolescent experiences; ensuring the whole children’s workforce know mental health is everyone’s business; specialist consultations; and mental health support embedded in communities.  Support for the sector’s workforce was also discussed. 

·    Slide eight focused on effective specialist support; discussed the idea of an embedded CAMHS, supporting the whole family (including working with parents); creative solutions for those with the highest needs; and redesigning managing risk. 

·    Slide nine discussed the persistent challenges: ongoing chronic underfunding; rigid pilots schemes; not measuring outcomes; the transition from children’s to adult social care; and the exploration of the national narrative and the need to include education.  An example discussed by Natalie included a young person with acute mental health needs – a male between the ages of 14-17, who often goes missing, and displays disruptive and challenging behaviour.  Natalie commented that more often than not, this common service user has a history of undiagnosed mental health needs. 

·    Slide ten was a write-up of the seven recommendations for national government.  

In the discussions that then took place, the following points and questions were raised by Members:

Members questioned the basis on which the graph that detailed the spending per head was based on?  Members agreed that that every councils measures statistics such as this differently, and raised concerns that the government will see that some areas are delivering services cheaper, they will expect all local areas to provide the same service for the same amount.  In response to this, Natalie stated that this was drawing on the work undertaken by the children’s commissioner, and was meant as a scene- setting exercise on the research that is already available.  Abigail Gallop, Senior Adviser, also stated that this was to negate the need to undertake another survey.

Members questioned how the criteria was met when selecting the eight different authorities, and how satisfied does Natalie and LGA officer feel that this research is getting a good cross-section?  In response, Natalie stated the eight councils were chosen have examples of good practice in the mental health sector, and that had made advances in this area to fill the gap that residents are facing.  They also included a good cross-section of deprivation, size, type of councils and political control. Natalie did concede that it wasn’t a perfect distribution, but the conclusions will be relevant a whole range of councils.  

Members discussed the innovation, need and sustainability of online counselling, and the take up by service users, and requested Natalie elaborate on this further.  Natalie stated that online services are very early in their development, and aren’t as effective as needed, but like all new services, this will develop over time.  However, it is reassuring that councils are developing such services, with the view to ensure they are potentially sustainable.    

Members commented on the idea of an embedded CAMHS, and mentioned the shortage of Educational Psychologists (EP), which are vital in all children and young people’s lives to ensure they reach their full potential.  Members questioned how we can plug the gap of these much needed professionals?  Natalie responded that the workload for EP’s is huge, and whilst collaborative working is essential in the sector, one way areas were getting around this was to use trainee’s to undertake EHCP survey’s, freeing up qualified practitioners times.  

Members discussed why there was an increase in demand, particularly in recent years?  Although there is a need to ensure services are fully funded, Members agreed that the source of the problem needs to be identified.  In response, Natalie stated that there is no simple explanation, but factors from the research include a raised awareness in society of mental health issues, which has been further advertised by high-profile, influential people – it is easier to talk about mental health than ever before.  As well as this, people are reflecting more than ever on what it is like to be a young person now; Natalie mentioned social media and online bullying as one key factor  (bullying always in occurred schools, but now it doesn’t stop when you go home as young people are being bullied online).  Natalie also mentioned austerity measures as another key example – services that had previously supported young people such as youth centres), and early years development (such as children’s centres) have been impacted by these measures, but these do have a significant impact on children and young people’s development. Natalie concluded that everyone has a different answer.  The Chair commented that it is a question that needs answering, but that ultimately, everyone does have mental health, just as they have physical health. 

Members questioned if any of the eight councils included in the research were Government trail blazers.  Natalie confirmed that some of them were trail blazers, including mental health teams in schools, as well as reducing waiting time’s pathfinder authorities. 

Members requested that the presentation be circulated to the Board.

The Chair concluded the discussion by stating that this report should have been launched at the National Children’s and Adult Services Conference, but due to the upcoming General Election and purdah period, the report will now be launched in January.