The YJB welcomes the opportunity to respond to the inquiry specifically on Specialist CAMHS and funding.
Specialist CAMHS
Following the publication of the joint Welsh Government/YJB policy implementation guidance on ‘addressing the mental health problems of children and young people in the youth justice system’, the YJB in 2015 commissioned a review of mental health and youth justice. This review specifically looked at how services were organised and delivered and informed subsequent terms of reference of a task and finish group set up under the Together for Mental Health Delivery Plan. This report[1] has been shared with the Together for Children and Young People Programme and we have liaised with CAMHS clinical directors via the Welsh Government to arrange to discuss the recommendations of the report.
Funding
When the additional recurring funding for CAMHS was committed in 2015, £250,000 was ring-fenced to improve access to emotional and mental health support for children and young people in contact with the youth justice system. As a result the YJB has been working closely with the Welsh Government and the All Wales Adolescent Consultation and Treatment Service (FACTS) to develop an enhanced service offer to youth offending teams and Parc Young Offender’s Institution. This includes providing access to clinical psychology. This additional money was to enhance the services that are provided to children and young people rather than addressing gaps in service provision across a number of YOTs.
Most young people in contact with the youth justice system experience emotional and mental health difficulties that often fall below the threshold for successful referral to CAMHS. The complex problems that young people face often stem from early adverse childhood experiences which impact on normal child development. Being able to assess the seriousness of emotional and mental health difficulties to determine whether to refer to specialist CAMHS is a key concern amongst YOT professionals. When access to CAMHS liaison and support is available YOT professionals feel better able to make these judgements and deliver low levels of appropriate care.
Between 2013 -17 we worked in partnership with the Welsh Government, FACTS and YOTs to develop and test the Enhanced Case Management approach[2]. This approach recognises the prevalence of attachment and trauma related difficulties in the lives of children and young people in the youth justice system. It utilises a clinical psychology case formulation approach which is underpinned by a theoretical framework, the Trauma Recovery Model (TRM), to help practitioners guide young people through change. During the test the clinical psychology input was commissioned from FACTS, who we have continued to work in partnership with. The test has shown beneficial in improving the knowledge and skills of the workforce, achieving organisational change and improving outcomes for young people.
One of the benefits of the additional CAMHS money is that a further trial of ECM is being conducted in the context of ACEs across South Wales YOTs. This is being taken forward as a partnership between the YJB, Welsh Government, FACTS, the South Wales Police and Crime Commissioner, YOTs and Public Health Wales. The three YOTs that participated in the test will also be supported by FACTS to sustain the approach long-term. As a result half of Welsh YOTs will be using the approach by the end of the year.
This is viewed as a positive and significant step-change in how emotional and mental health services can be provided. While developed and tested in a youth justice setting the learning from the Enhanced Case Management approach is transferrable across other children’s settings, particularly specialist CAMHS, social care and youth work. We are keen to engage with the Together for Children and Young People programme to explore this possibility.
The additional funding has also benefitted Parc YOI which has experienced a number of challenges over the years of being able to access NHS secondary mental health services. Between January and May this year approximately 85 staff were trained in attachment and trauma based ways of working. Parc will also benefit from a half time psychologist. Prior to this additional funding service provision in Parc has mostly been driven by the availability of funding and resources rather than based on need. Access to psychology and speech, language and communication services is a long-standing issue. The cohort in the youth secure estate has changed and is predominantly made up of young people with complex and interlocking problems. It would be pleasing to see the health board work with the FACTS to understand the level of need and to provide the required resources.
Hillside Secure Children’s Home has six juvenile justice beds and 14 welfare beds. It has not benefitted from the additional funding available. All health services in Hillside are commissioned or provided in house. This is a matter which would warrant further exploration by the Welsh Government and health boards.
The ambition is for practice across youth justice services to be trauma-informed but further funding is required and a shared national vision is needed to make this happen. We have already started to progress this with the Welsh Government and FACTS but would welcome the input from the Together for Children and Young People Programme.