In response to the Committee questions:-

· How effective the T4CYP programme has been in promoting the resilience of children and young people through early intervention and prevention

· Access to specialist CAMHS and the next steps for CAMHS; whether we have seen the ‘step change’ in CAMHS needed

Together for Children and Young People Sub Groups of Mental Health Partnerships

YOS Managers Cymru would respond that there are variations in practice across Wales.  YOS Managers from North Wales, Dyfed Powys and Gwent have no knowledge or engagement with any T4CYP sub groups within their areas. 

In South Wales, the Vale of Glamorgan YOS Manager is actively involved in the Cardiff and Vale of Glamorgan T4CYP sub group and its focus on the development of new services for children and young people.  YOS Manager for Western Bay Youth Justice and Early Intervention Service is involved in a wider CAMHS Commissioning Group. YOS Managers Cymru feel that some Health areas across Wales fail to recognise that preventative, early intervention services (i.e. Tier 2 services above school counselling) based on targeting those at risk of developing emotional wellbeing or mental health services within the Youth Justice System will impact on long term outcomes.  Just expanding universal provision will not address the needs of children within the Youth Justice System.

Public Health Wales is promoting greater awareness and understanding of the impact of Adverse Childhood Experiences and concentrating on early identification as a preventative measure.  An outcome of this work is a commitment by Public Health Wales, South Wales Police and Crime Commissioner, Welsh Government and FACT to sponsoring the expansion of the Enhanced Case Management Model within Youth Offending Services across South Wales.

Access to Specialist CAMHS

The extent to which new (and/or reconfigured) services are helping to reduce waiting times in specialist CAMHS.  Whether the improvement in waiting times has been met.

Again YOS Managers Cymru would respond that there are variations in practice across Wales.  YOS Managers have not seen any change in the timescales for accessing Specialist CAMHS.

North Wales and the Gwent areas commission CAMHS services.  The model in the Gwent area has a CAMHS Nurse based within the YOS undertaking consultations with practitioners and ensuring that any referrals made to CAMHS are appropriate referrals.

North Wales – Operate a Health panel which includes the Mental Health Advisor who consults with practitioners and again ensures that referrals to CAMHS are appropriate.

Dyfed Powys commission a Local Authority provision which includes a CAMHS Nurse/Emotional Health Services which offer access to Tier 2 services and can make referrals to Tier 3 CAMHS service.  These services are available to Education, Childrens Services and YOS.

South Wales – There are no CAMHS Nurses available in any of the YOS within South Wales.  Historically there were only CAMHS Nurses in the Western Bay Youth Justice Service. These nurses have naturally moved on not being replaced. This has been a huge loss. The reasoning behind not replacing the nurses has been a combination of the reduced statutory caseload and what seems an ongoing endless review of CAMHS. To base provision on statutory caseloads neglects the prevention caseloads of YOT’s.

Cardiff and Vale of Glamorgan has a Primary Health Nurse who is treated as a trusted referrer but this does not offer any expedited access to CAMHS, a recent referral has taken 4.5 months to be seen.  It is anticipated that improvements will be made in this area following the establishment of better communication links with CAMHS Therapist.

The extent to which changes have addressed over-referral to CAMHS?

As outlined above, due to the arrangements in place within YOS across Wales, our belief is that YOS were not making inappropriate referrals. Due to the medicalization of CAMHS, often children within the Youth Justice System are assessed and if they are not diagnosed with a mental health issue, they are deemed to have no need.  There is a need for a more therapeutic approach to address children and young people’s needs.

Referrals and access to CAMHS by individual Health Boards, including the restrictions and thresholds imposed by CAMHS

YOS Managers do not have a clear understanding of what restrictions and thresholds are being applied.

Whether the changes have helped to improve specialist CAMHS’ ability to respond to out of hours and at times of crisis; whether out of hours care is working effectively and specifically looking at the needs of those children and young people who present and are assessed at hospital A&E Departments

Dyfed Powys, Gwent and North Wales YOS Managers indicated not aware of these services or impact.

South Wales – Cardiff and Vale UHB and ABMU have expanded Crisis Services and increased their availability to respond out of hours and undertake assessments at A&E and/or Police Custody as appropriate

Whether there is sufficient in patient capacity in Wales

YOS Managers Cymru’s understanding of provision within Wales, both in North Wales and South Wales Area, is that there is a focus on eating disorders.

Funding

Annual Funding on CAMHS– unable to comment

The extent to which access to psychological therapies for young people has improved.  Whether there has been a subsequent reduction in the use of medication for young people.

Dyfed Powys, North Wales and Gwent not aware of any changes.

South Wales – Cardiff and Vale of Glamorgan have developed core psychological therapies to include family therapist, CBT therapist and generic therapist.  The YOS has only recently established links to 3.5 hour per week therapist who can provide services across Cardiff and Vale.  How funding used to improve provision for children in local primary mental health support services?

Not able to respond.

Extend funding used to meet needs of vulnerable children, i.e. in care, children with ADHD, autistic spectrum disorders, those already in or at risk of entering the Youth Justice Service, including detained under Section 136 Mental Health Act 1983.

North Wales, Dyfed Powys, Gwent areas seen no evidence of improvements.  In Gwent, North Wales both areas receive referrals from Children’s Services to access the services they commission.  Where areas are unable to accept the referrals they can experience criticism even though the service is a commission service for specific client group, not a universal Health service.

South Wales – Cardiff and Vale UHB and CAMHS have developed, are developing or reconfigured a neurodevelopment pathway for diagnosis of children with ADHD, autistic spectrum disorders.  Cardiff and Vale UHB is also developing services for those in care and have introduced an Emotional Wellbeing Service for children and young people.  The YOS is able to refer children to the Emotional Wellbeing Service, but unfortunately for the majority of children involved with the YOS, this service is not equipped to deal with more complex issues, i.e. not operating as a Tier 2 service.

Effectiveness of current planning and commissioning to address early onset of severe mental illness such as psychosis.

Cardiff and Vale UHB Cwm Taf and Barnardos are developing a Youth Psychosis Support Service based in Adult Services supported by Barnardos providing support for young people aged between14 – 25.

Transition to Adult Services

Difficulties continue to be experienced in relation to planning for managing transitions to adult mental health services across all areas.

Links with Education (emotional intelligence and healthy coping mechanisms)

Development of Health and Wellbeing Area of Learning and Experience as part of the new curriculum

Dyfed Powys area Emotional Health Services are commissioned and engaged with curriculum. 

Extent to which Health, Education and Social Care services are working together

Gwent, North Wales, Dyfed Powys, YOS Managers not aware of areas where Health, Education and Social Care Services are working together in relation to emotional intelligence and healthy coping mechanisms.

Cardiff and Vale of Glamorgan, all areas represented on the T4CYP Sub Group and able to influence development of services.

The introduction of WCCIS will enable health and social care services to access and share information.

Take Up and current provision of lower level support and early intervention, school counselling services

Evidence of variance in practice across areas.  North Wales, Dyfed Powys, Gwent not aware of any lower level support and early intervention services except for school counselling services.

Cardiff and Vale of Glamorgan UHB have commissioned an Emotional Well Being Service which provides lower level support and early intervention.  This is a universal service which in the majority of cases does not meet the needs of children within the Youth Justice System so unable to comment on take up.

School Counselling Services– Across Wales YOS Managers Cymru commented that the number of referrals to all school counselling services was excessive and too complex as not operating at a Tier 2 service level.  YOS Managers Cymru believe that the expectations being placed on school counselling services are too great and other services should be developed at Tier 2 to enable school counselling services to concentrate on the lower level issues.  All services appear to be operating at full capacity this leads to questions about how cases are prioritised and the ability to be effective.

Vale of Glamorgan Schools Counselling is currently commissioned out of Families First funding. This service is based in all secondary schools within Vale of Glamorgan. We are aware that every school based counsellor has a waiting list for the service. Expectations of the service are high, schools seem to have lost their expertise in delivering Tier 1 pastoral support to those who require it internally and refer most matters to the school based counsellor, who is commissioned to deliver Tier 2 counselling but seem to be overwhelmed with majority of pastoral issues.