Agenda item

This report provides a summary of the activity of Children and Adolescent Mental Health Services (CAMHS) and Emotional Wellbeing and Mental Health (EWMH) services for children and young people residing and receiving education in the London borough of Croydon. The report also provides an update on the position with current waiting times, access and performance.

The Sub-Committee considered a paper set out on pages 19 to 80 of the agenda, which provided a summary of the activity of Children and Adolescent Mental Health Services (CAMHS) and Emotional Wellbeing and Mental Health (EWMH) services for children and young people residing and receiving education in Croydon. The report also provided an update on the position with current waiting times, access and performance. The Senior Commissioner for Children and Young People’s Mental Health introduced and summarised the report. The following representatives were also present and introduced themselves: Karen Stott, Chief Executive for Off the Record; Gordon Knott, Chief Executive of Croydon Drop-In; Harold Bennison, Service Director of CAMHS, South London and Maudsley NHS Foundation Trust (SLaM); and Rod Booth, Director of Performance and Partnerships, SLaM.

The Vice-Chair asked if practitioners felt there were gaps in the current service offer and heard from the Chief Executive for Off the Record that there had been a large increase in demand for services since the pandemic; as a result of this, the length of counselling had been shortened to a standard offer of six. The Sub-Committee heard that young people and practitioners had identified that there were gaps for those in need of more substantial support, but who did not meet the threshold for CAMHS services. The Chief Executive of Croydon Drop-In explained that Off the Record were trialling the ‘First Contact Method’, ‘Waiting List Groups’ and carer helplines, but ultimately these were not substitutes for one-to-one support and did not reduce waiting lists. Members heard that there was good partnership working across the groups to try to identify and mitigate gaps in the offer where possible. The Service Director of CAMHS explained that NHS funding for CAMHS was around 1% of the total NHS budget, and it was known that this was often not sufficient to meet current need; many services had seen a doubling or more in the level of demand since the pandemic. The Sub-Committee heard there were gaps in a lot of the services being offered, but that in-patient care was meeting current demand. It was stated that while the gaps were known, and a national issue, work was being done to target resources where they could do the most good to meet local priorities whilst utilising hotspot and equalities data.

Members asked about the Mental Health Support Teams in Schools (MHSTS) programme and heard that 45 schools in Croydon were receiving this service, jointly delivered by SLaM, Off the Record and Croydon Drop-In in different waves focussing on different areas. The SlaM wave focussed on School Exclusions, Off the Record and Croydon Drop-In jointly delivered a wave focussed on serious youth violence and a new wave had been introduced focussed on COVID recovery. The Sub-Committee heard that practitioners were based in the schools for a day a week for secondary schools, and for half a day for primary schools. Kooth, an online resource, was available for the schools who were not in the MHSTS programme.

The Sub-Committee asked how young people or parents were signposted to the right services or point of entry and heard from the Chief Executive of Croydon Drop-In that school communications were used, as well as the usual marketing, advertisements, social media, word of mouth and service websites. Members heard that it could be confusing for parents and carers, and services tried to redirect service users to more appropriate services where appropriate.

Members asked about the long waiting times for assessments, and how long it took from assessment to receiving services. The Service Director of CAMHS explained that the majority of the longest waits were around the neurodevelopmental pathway and that this was linked to the work being done to change the Autism diagnosis pathway. The Sub-Committee heard that an Autism diagnosis would lead to a number of support packages and was not a mental health condition for which there was a treatment pathway. To reduce Autism diagnosis wait times, work was being done to look at how the system should operate and how it could cope with the current demand, and then to see what was in place to deal with the backlog. Members heard that CAMHS had been working with a private sector company called ‘Clinical Partners’ to increase capacity, reduce the longest waits and ensure a system was in place to manage ongoing demand. On the mental health pathway, waiting lists were being managed with dynamic reviews of risk to ensure the most acute needs were met as a priority; there was a single point of contact that triaged service users to ensure individuals were directed to the correct services through partnership working. The Service Director of CAMHS explained that they were seeking to increase the use of apps and virtual waiting lists so that, once individuals were registered, they could be signposted to services and receive some support whilst they were on waiting lists.

The Sub-Committee asked if there was a knock on effect to Children’s Social Care from CAMHS not having as much capacity as would be desired. The Director of Children’s Social Care explained that there were higher levels of mental health distress since COVID, both nationally and locally, which was a feature in safeguarding referrals. Members heard that this was a challenging aspect of safeguarding and required strong partnership working; where needs were acute the Director of Children’s Social Care often met with Service Director of CAMHS to review cases to see where fast-tracking access to acute provision was needed. The Sub-Committee heard there was a need for every professional and parent to learn to recognise signs of mental distress and to upskill workers in contact with children to provide interventions. The Director of Children’s Social Care explained that there was a Clinical Practice Team and qualified therapists in Croydon who worked directly with families and looked after children; there was also ongoing work focussing on suicidal ideation.

The Sub-Committee commented on the prevalence of teachers in signposting to mental health services, and service users often being fearful of self-referring incorrectly. The Chief Executive of Croydon Drop-In agreed and explained that they were piloting a Parent/Carer helpline to try to help with this. Members noted that it was likely there were more children and young people in need of referrals than was currently known.

Members asked about the introduction of Family Hubs, and heard that an early adopter Hub would be started in Summer 2023; a Best Start offer was being considered and an initial physical location was being investigated. It was not known how many Family Hubs there would be, but these would be spread across the borough. Family Hubs would be delivered in a partnership approach to provide support to families with a ‘one-stop shop’. The Sub-Committee heard that some practitioners would operate in Hubs, alongside staff who could signpost families to other services. Members expressed an interest in visiting hubs once they were up and running. Members asked how families would know where to find Family Hubs and heard from the Director of Education that communications would go out through the partnership, but it was recognised that this was a shift in the way services would be delivered and this would be communicated through a number of platforms.

The Sub-Committee asked where parents/carers could go initially to find support services for mental health for children and young people if they did not want to go through their school. The Service Director of CAMHS explained that often this happened through General Practitioners (GPs), but acknowledged the difficulty of taking the first step to getting support; work was being done to look at cases where young people’s first interactions with services were a result of presenting at the hospital Emergency Department to see where interventions could have happened earlier. The Director of Children’s Social Care explained that digital poverty, children not being in education settings and having parents with English as a second language were the biggest barriers to finding support services easily. The Director Quality, Commissioning & Performance agreed and explained that support services needed to be multi-channelled and highlighted the importance of Early Help; it was explained that Early Help directories were being refreshed constantly to try and ensure parents and young people received help as early as possible. The Director of Performance and Partnerships, SLaM explained that there were planned trials and projects to integrate mental health support specialists into GPs and to draw as much funding from the NHS into these projects as possible.

Members asked what was available for young people whilst they were waiting for assessments. The Service Director of CAMHS, SLaM explained that there was not a lot that was offered for these individuals but that there were attempts to make it clear how long people would be on the waiting lists, however, there were not sufficient resources in place to do much more. The Sub-Committee asked if it was possible to capture the impact of long waiting times on young people and heard that it was clear longer wait times often led to an increased cost of intervention at a later stage. The Chief Executive for Off the Record explained that they had set up a ‘First Contact Team’ to try and quickly meet with, assess and provide short term interventions for young people, and it was found that this had reduced counselling waiting lists. The Chief Executive of Croydon Drop-In explained that there were welfare check-ins for those on the waiting list for counselling that took place roughly every four weeks.

The Senior Commissioning Manager for Children & Young People Mental Health explained that the ‘Talk Bus’ was used to get to hard-to-reach children and young people. The Chief Executive of Croydon Drop-Ins explained that the bus operated twice a week to try to reduce the pressures on the hospital emergency department and that mental health services in Croydon were currently more joined up than they had been in the past.

The Sub-Committee asked what the financial impact was to the Council as a result of unmet mental health needs leading to increased social care demand. The Director of Children’s Social Care responded that this was very hard to quantify, but that there was a specific support offer to families awaiting Autism assessments. Members heard that mental health issues for young people with Autism were often a result of operating in a world that did not account for neurodivergence, which could cause significant stress and difficulty. The Corporate Director for Children and Young People highlighted the huge pressures on social care and mental health services and the importance of being transparent about this between partners.

Members asked about the pressures on services following the wind down of the Community Fund in 2023 in a context of existing funding pressures for services. The Sub-Committee heard that this would reduce the capacity of services, and that the ‘Talk Bus’ would likely see 1500 less young people than in previous years. The picture was difficult nationally and it was increasingly hard to bring in additional grant funding to supplement Council funding; the NHS were being looked at to supplement reduced funding from other areas. The Sub-Committee asked about the future of the ‘Talk Bus’ post March 2023, and heard the funding bids to continue this work had been developed over the previous 12 months. The Chief Executive of Croydon Drop-In explained that money had been saved over a number of years to replace the ‘Talk Bus’ with a more eco-friendly bus, and this had now been ordered; this was a shared community resource and every effort to continue funding it would be made. The Director of Performance and Partnerships, SLaM explained that all the organisations represented at the meeting worked together in partnership to deliver services and unlock resources to direct them where they were needed. The Chief Executive of Croydon Drop-In explained that they had received funding from the National Lottery to build a ‘sensory room’ for neurodiverse young people to use before counselling sessions. Members heard that a joint project between Drop-In, Off the Record and CAMHS on custody suites would be undertaken to provide counselling to young people.

The Vice-Chair asked about the possible implementation of a cap for Croydon Drop-In and the implications of the headquarters being on the Council asset disposal list. The Chief Executive of Croydon Drop-In stated that new premises were being considered in case the headquarters were sold, but that this would be disruptive for services and service users. On the cap, Members heard this was a very sensitive and drastic measure and that any decision on this would not be taken lightly.

The Chief Executive for Off the Record Croydon explained that Off the Record had adopted a new vision statement about building a compassionate mental health community for children and young people, and the importance of delivering this in partnership. The Chief Executive of Croydon Drop-In agreed and explained that increasing demand on services was thought to be a socio-economic issue related to a large number of factors. The Service Director of CAMHS noted the importance of supporting staff in delivering services, and of providing support to families and carers to try to reduce the use of institutional solutions. The Senior Commissioner for Children and Young People’s Mental Health added that the commitment to partnership working to address the needs of children and young people in the borough remained and that a number of new services and projects were being looked into. The Director Quality, Commissioning & Performance thanked the representatives in attendance and acknowledged their hard work in Croydon. Members heard that there were opportunities as a part of the South West London Integrated Care Board to think creatively about how to deliver services, learn from colleagues and achieve a fair level of funding for Croydon. The Cabinet Member for Children and Young People commended the fantastic work of the partners and thanked them for attending the Sub-Committee.

Conclusions

The Sub-Committee were grateful for the open and honest answers given by SLaM CAMHS and its commissioned provider partners in the meeting.

The Sub-Committee commended the work being done by SLaM CAMHS and its commissioned provider partners in a challenging national and local context.

The Sub-Committee concluded that CAMHS should be included on the work programme for 2023/24.

The Sub-Committee concluded that the Cabinet Member should continue to explore alternative funding streams for Children and Young People’s mental health services that had previously relied on the Community Fund.

The Sub-Committee requested that a summary of current signposting for Children and Young People’s mental health services be provided.