Agenda item

To undertake external scrutiny of local mental health services for young people with Ms Sarah Garner (Assistant Director, Southend, Essex & Thurrock Children & Young Peoples Emotional Wellbeing & Mental Health Collaborative/Programme Director Joint Commissioning SEND (Essex)) – please see attached report.

The Chairman introduced Ms S Garner who was the Assistant Director, Southend, Essex & Thurrock Children & Young Peoples Emotional Wellbeing & Mental Health Collaborative and Programme Director Joint Commissioning SEND (Essex)) and was based at St Margaret’s Hospital in Epping. She collaborated with seven Clinical Commissioning Groups and three local authorities. As she was the lead commissioner in Essex, equal access across Essex was important. Targeted and specialist services for children and young people 0–18 were accessed via a single point of access, supported by a County-wide crisis team, learning disability service and eating disorder service. Continued support where clinically appropriate was also available up to age 25. There was a locality hub based at Harlow and others sited in each CCG area. Various mental health disorders were covered, but of all the referrals, including self-referrals, coming into the Essex single point of access, 25 per cent were referred on to other people/organisations. The Crisis Support teams visited individuals to review and assess them 24/7. The Children and Young People Eating Disorder service, which covered anorexia and bulimia, and the Learning Disability service had seen a rise for their services during the lockdowns. There were seven community teams that worked alongside six youth offending service workers. There was a lot of provision with place base teams, life coaching and various support help available. The referrals between 2015 and 2020 had increased annually, but it was better to catch these early. During the Covid pandemic services had continued to operate as usual. Digital help offer had been expanded through apps and online therapy. Group therapy and support offers were widened, as was communication through schools and community groups to reach young people in need. Additional support was being provided for community eating disorder services and the voluntary and community sector to support the Crisis teams and single point of access. Future plans for young people’s mental health services were outlined, which included development of 0–25 services, and getting risk support and the Crisis teams integrated and working across the NHS and Children’s Services.

The Chairman invited the youth councillors and Community, Culture and Wellbeing team to stay and ask questions after members as their input would be welcome. Councillor M Satin continued that mental health services for young people was a very broad area.

Councillor S Rackham asked how many referrals had there been over the Covid period and now the UK was coming out of the latest lockdown would cases decrease?  An increase in anorexia was highlighted but had there been increases in any other mental health issues? S Garner advised that there had been a year-on-year rise in demand for their services predominantly from anxiety and depression, which could be because of parents losing their jobs, losing their home, poor housing could affect children, not having enough food, or anxiety from young people worried about being in a large group. Anyone could self-refer. There had been a sharp rise in young people feeling very lonely and isolated, as well as a rise in anorexia, but there had been an £800,000 funding increase with more bids to the NHS. Numbers had reduced going into the December 2020 lockdown but were increasing as we came out of this lockdown.

Councillor S Murray asked what constituted a crisis? From feedback as a teacher, how long did it take to access these services if it was not a crisis? With the expansion of young people’s mental health services was there a problem recruiting staff? S Garner replied that a crisis was an overdose, self-harm or a young person wanting to take their own life. Those in the middle ground were triaged in as soon as possible but non-urgent cases could take twelve weeks depending on priority of need. Mental health nurses were in decline and Covid had affected the nursing sector but there was no problem in recruiting to less face to face roles.

Councillor D Sunger remarked that although there were lots of referrals from people who recognised there was a problem, what about silent cases, because although early intervention was the best option, how long did it take sometimes to get to a person who was in need? Were teachers trained to see any early signs? Also, the flowcharts were very interesting, and he asked if these could be circulated and included in the minutes of the meeting? Ms S Garner replied it was hard to say about silent cases and that was the fear because a child might need help. There were lots of avenues to go down to assess how much someone’s mental health had deteriorated. There were mental health school teams in 25 per cent of schools, and it was better to meet a person’s need early on.

Councillor H Kane asked if home visits were more reassuring? S Garner replied that the Crisis teams undertook home visits and there were no plans to expand home provision. During the past year most were conducted virtually via video or over the phone, as it was difficult to socially distance in the space in hospital clinics.

Councillor D Wixley asked at what point did you define mental health issues? With the pressures on young people where did you draw the line in that, when must they cope with it and when did you intervene? S Garner replied that she was not a clinician, but they did an assessment to see if the young person could be counselled or needed some form of medication. For psychosis, medication was the only way to help usually, but medicating children was a last resort.

A Zarras asked S Garner what had inspired her to motivate mental health? S Garner replied that she liked mental health. It was a difficult issue, but very interesting and exciting. The stigma had declined, and this had been helped by celebrities coming forward. We needed to normalise mental health and help each other and include people more.

S Bazzoni asked about male suicides, which were astronomically high. What was the main cause and were males in the younger generation less able to speak out? S Garner replied that females had bigger friendship groups and reached out more. Men were seen as strong, independent males and loneliness was a key factor that affected men more. It was ok to not be ok if you were a young man.

Councillor M Sartin asked of the 18,000 referrals this year, had more females in Essex self-referred? S Garner advised that more males were referred by parents and teachers, but she could provide the breakdown of the figures after the meeting. It was noted that the Democratic and Electoral Services Manager would be able to circulate these to members after the meeting.

Councillor A Patel asked how the outcome for a child was measured and what evaluation was done that the right treatment had been provided? S Garner advised that they used a clinical outcome. The GAD (generalised anxiety disorder) score was used and the PHQ-9 (public health questionnaire depression test) score. There was also the patient experience group and a group of young ambassadors provided vital feedback, which was used to improve services. The mental health sector was ever moving forwards and they were continuously adding services. The sector had to listen to these children and every year the Mental Health Transformation Programme Annual Report was published, which was a national document due yearly in September.

The Chairman thanked S Garner for attending and presenting an overview of the young people’s mental health services and answering all of their questions. It had been very illuminating especially the help given to a large number of people in the wider area of Essex. It was very important that mental health was out there in the public domain and that the youth councillors had been able to participate during the meeting.

Resolved:

(1)          That the external scrutiny by the Committee of young people’s mental health services in Epping Forest and Essex, be noted;

(2)          That the presentation slides of the flowcharts be added to the minutes; and

(3)          That the Democratic and Electoral Services Manager was to circulate the breakdown and figures of self-referrals by females/males in the past year to members.