Transforming child and adolescent mental health services

As the NHS prepares to mark its 70th anniversary, the Clinical Director at the South London Partnership, Child and Adolescent Mental Health (CAMHS) programme outlines how the New Care Models are leading an ambitious transformation of mental health, aspiring to help an extra million people with high-quality care supported by £1 billion additional investment:

‘You’re the commissioner, what would you do for south London’s children and young people?’

This was one of the questions we posed to clinicians and operational managers at a recent South London Mental Health and Community Partnership workshop.

Five years ago, it would have been hard to imagine such conversations or challenges, covering a population of more than three million people. Or that our three mental health trusts would plan system-wide services together. And even less that the innovations and ideas would become reality.

Thanks to NHS England Children and Adolescent Mental Health (CAMHS) tier 4 New Care Models programme, and the collaboration between Oxleas NHS Foundation Trust, South London and Maudsley NHS Foundation Trust, and South West London and St George’s Mental Health Trust, our clinicians and managers are working together for genuine transformation.

Three trusts that once competed are now collaborating and sharing approaches, pathways, resources and clinical expertise – all for the benefit of some of the most vulnerable of our children and young people.

It has already been an interesting journey. We are able to invest in innovative, community-based interventions and support services. We have made strong progress with a key goal – reducing the number of south London CAMHS patients placed in inpatient beds out of our area, and many miles from home.

We started with shared goals, including services which reduce disruption to children and young people’s social networks, making contact easier for families and carers, and enabling patients to recover sooner, closer to home.

It was important to set clear targets and ensure our work programmes are precisely aligned to delivering them. For example, we want to better support young people at times of crisis – or approaching crisis – such as potential self-harming. Ensuring we have skilled professionals available rapidly, in communities, for risk planning and management, assessment and using interventional therapies improves care and support and will reduce admissions into A&E.

We knew that too many patients needing intensive support are placed in units outside of the partnership. Our analysis showed this was 65 per cent of all inpatient stays in 2016-17. On average these young people were placed 73 miles away from home, reducing their resilience and recovery and having a detrimental effect on family life. That’s why joining up our bed management – covering our trusts’ dedicated 47 CAMHS beds and other CAMHS inpatient facilities inside and beyond south London – was vital.

Alongside developing new pathways with more community-interventions, our closer working and new protocols are having a real impact. Occupied bed days outside the partnership were 38 per cent lower in March 2018 than the 2016-17 average. The average distance was 44 miles away from home in February 2018 – a 40 per cent reduction.

Joint working is paying dividends for our patients, and delivering savings which we can invest in new services. Clinicians have led the way by identifying pathways and solutions that allow us both to benefit from our combined scale and expertise, but also reflect local needs.

Our future plans include enhanced crisis care services, with new teams, extended opening hours for existing services and piloting a new crisis telephone line service. We meet regularly with young people who have been through this experience, including attending A&E and receiving support at home. Their input is helping design the new services. Targeted investment will boost use of dialectic behaviour therapy in south east London, and grow the adolescent outreach team in south west London. We are being funded to pilot a forensic community CAMHS service. We are at the start of considering new pathways and approaches to tackling the growing trend of eating disorders.

It’s an exciting time. Bringing together the combined expertise and commitment of our clinicians, commissioners, partners and patients has given us a real boost.

There is a long-held saying in public services to ‘follow the money’. Now we can increasingly direct that money to where it will make most difference. That’s a challenge we all want to embrace.

Diana Cassell

Dr Diana Cassell is Clinical Director at the South London Partnership, CAMHS programme having worked as a child psychiatrist since 1987.

She became a consultant in 1987 in a community tier 3 team and currently her clinical sessions are in CAMHS Neurodevelopmental Disorders. She has held additional management roles with South West London and St George’s since 2007, and is Clinical Director for CAMHS at the trust.

Throughout her career Diana has championed and raised the needs of young people, and has developed effective local services; recently including providing mental health input to the development of Child Sexual abuse services, and roles for the NHS England CAMHS Tier 4 Clinical Reference Group.