Agenda item

Ms Tina Swain, Service Director for CAMHS and Eating Disorders – Goodall Division at Central and North West London NHS Foundation Trust (CNWL), advised that the team at Hillingdon Child and Adolescent Mental Health Services (CAMHS) provided community mental health services to children and young people up to the age of 18 with complex mental health difficulties (and their families) in a range of different ways, depending on their needs.  A multi-disciplinary team made up of psychologists, psychiatrists and therapists provided assessment and identified the needs of the child in the context of the family.  Treatment could include cognitive behavioural therapy (CBT), family therapy and individuals and group psychotherapy.  Medication was also used when appropriate and would often be prescribed by a specialist but supported by the young person’s GP. 

The Adolescent Community Treatment Service (ACTS) was a community team that provided support for young people aged between 13 and 18 years.  Young people were referred to ACTS by their local CAMHS team because they needed intensive support in the community during their period of mental health crisis.  Wrap around support was then provided for the young person (and their family) and effort was made to keep them in school, etc. 

The CAMHS Urgent Care Teams worked in conjunction with local hospitals and existing local CAMHS services to provide access for children and young people up to the age of 18 to a dedicated crisis and liaison service when they were experiencing an acute mental health or emotional crisis.  A risk assessment was being developed with the hospital team for young people that had presented at A&E. 

Ms Swain advised that there had been an increase in demand for CAMHS services during the COVID pandemic and referrals were now at their highest level ever, impacting on the ability to see children and young people quickly and resulting in a longer waiting list.  However, Ms Swain noted that there had been a reduction in the average time that it took for a young person to receive an assessment after having been referred to CAMHS.  Although Members were pleased that the average wait time for an assessment was down to 10 weeks (against a target of 18 weeks), 10 weeks was still too long for a child to wait to be assessed. 

Members queried how long it would take for these young people to receive treatment after they had been assessed.  Ms Swain stated that she was unable to provide an answer as it would depend on the treatment pathway that each child was following.  Services were designed and offered at a place level in North West London as well as at a system level in an effort to keep the gap between assessment and treatment as short as possible.  Action was also being undertaken to reduce this further and digital initiatives such as Healios had been put in place to support young people outside of traditional interventions.  Other initiatives included weekend clinics, out of hours clinics and Waiting Well (which could keep track of changes whilst a young person waited). 

Dr Azer Mohammed, Clinical Director at CNWL, advised that there was a target for the Mental Health Support Team (MHST) to see young people within four weeks but that it tended to be quicker than this.  Goal Based Interventions (GBIs) had also made a difference by shifting the focus to the goals of the young person.  On 28 September 2022, CAMHS in London and Milton Keynes had met to share quality improvements (QI) learning from their projects and to think about spreading the good work and lessons learned.  During this event, Hillingdon CAMHS had shared information about its GBI work in improving patient flow and treatment access in the Emotional Disorder Team. 

Ms Swain advised that it was important to ensure that young people didn’t fall through any cracks in their transition from child to adult mental health services.  To this end, work had been undertaken to develop a transition offer for those aged 16-25 to ensure that they received early help.  In terms of ongoing support for the 18+ transition and the number of young people accessing the service, Members were advised that the referral to treatment time (RTT) target for each young person was 18 weeks. 

Dr Mohammed noted that Hillingdon had met and exceeded the national target of seeing at least 35% of those young people “estimated” to have a mental health condition in the area (a number of these individuals included in the estimate would be unknown to the services).  He advised that these access targets related to mental health support teams.  CAMHS representation was available at children’s hubs and contact had been maintained with community paediatrics to ensure that there was a joined up approach to things such as autism spectrum conditions assessments.  The CNWL Looked After Children (LAC) team also worked closely with social care colleagues.  Members were encouraged by this work and hoped that Healthwatch Hillingdon had received positive feedback from service users. 

Members queried what would happen to a young person who had started receiving CAMHS treatment elsewhere and then moved to Hillingdon.  Dr Mohammed advised that it was inadvisable for out of area presentations to change service mid-treatment if it could be avoided.  However, this would be assessed on a case by case basis and transfers would be implemented at the right time for the young person rather than sticking rigidly to rules about transfers. 

The Committee was advised that a range of training and advice was available to the parents and carers of young people who were using CAMHS.  This ongoing support was available from the voluntary sector for siblings too. 

Ms Swain advised that, at the end of September 2022, there was only one young person who had waited excessively for an assessment.  Dr Paul Hopper, Medical Director at CNWL, advised that clarity would be sought in relation to what the graphs in the penultimate slide were trying to demonstrate and forward on to the Democratic Services Manager for circulation to Members.  The point being made was that there had been a lot of work undertaken to reduce the number of weeks that young people were waiting for an assessment from CAMHS which increased the waiting time for treatment which was then also reduced. 

RESOLVED:  That the presentation be noted.