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“2020health is an important and thoughtful contributor to the health debate”

Dr Sarah Wollaston MP, Chairman, Health Select Committee

 
 

Child and Teenage Mental Health with Tim Loughton MP

Mar 03. till Feb 03.

2020health Expert Roundtable on Child and Teenage Mental Health with Tim Loughton MP

2020health roundtable discussion breakfast event on child and teenage mental health.

Date
March 3, 20112011-03-03T08:30:00 - February 3, 2011 2011-02-03T10:00:00
Time
8:30 AM 2011-03-03T08:30:00 - 10:00 AM 2011-02-03T10:00:00
Location
Portcullis House, Westminster, London

Attendees

1. Tim Loughton MP    Parliamentary Under-Secretary of State for Children    Department for Education
2. Prof Stephen Scott- Professor of Child Health and Behaviour, Institute of Psychiatry, KCL
3. Matilda MacAttram – Director, Black Mental Health UK
4. Dr Samantha Callan - Chairman in Residence    Centre for Social Justice
5. Dr Amanda Killoran - Public Health Analyst, National Institute for Health and Clinical Excellence
6. Michael Kerman    Clinical Director & Child and Adolescent Psychotherapist Kids Company
7. Andy Bell - Deputy Chief Executive    Centre for Mental Health
8. Dr Andrew McCulloch - Chief Executive, Mental Health Foundation
9. Dr Brian Jacobs -    Consultant Child & Adolescent Psychiatrist    Royal College of Psychiatrists
10. Dr Hugh Griffiths    - Acting National Director for Mental Health    Department of Health
11. Liam Strong- - Non-executive Director, NHS Foundation Trust
12. Ivor Frank - Barrister , 7 Bell Yard Chambers, London
13. Paula Lavis - Policy & Knowledge Manager, Young Minds
14. Lisa Mangle -  ADHD Specialist Nurse,Sheffield Children’s Hospital
15. Dr Max Davie -Consultant Community Paediatrician in Lambeth    British Paediatric Mental Health Group
16. Dr Crispin Day - Head of Centre for Parent and Child Support    South London and Maudsley NHS Foundation Trust
17. Dr Bob Jezzard - Retired child and adolescent psychiatrist    
18. Peder Clark - Health Policy Lead, Royal College of Paediatrics and Child Health
19. Howard Jasper - Strategy Adviser – Inclusion Youth Justice Board for England and Wales
20. Julia Manning - Chief Executive, 2020health.org
21 Eleanor Winpenny –Researcher, 2020health.org

Background


•    Tim held the brief for mental health in opposition for many years and led on the mental health act.  
•    At the same time he was shadow children’s minister, so was very conscious of the interactions between mental health and education.
•    He is very pleased with some of the publications and with the approach of the new government.

•    Mental health has long been a Cinderella service of NHS and should have a fairer share of the cake.
•    Mental health problems do not just affect patients in isolation.  These issues affect large numbers of families and also have an impact on a child’s friends, much more than physical health problems.

Funding of provision mental health assistance for children
•    There is an ear-marked Early Intervention Grant going to local authorities.
•    Targeted mental health in schools funding will be continued.
•    Tim is keen that mental health and safeguarding are mainstream in schools, not just an add-on service.
•    The Pupil Premium will be targeted at children who are more vulnerable.  This provides extra support services to help with a variety of issues. Dealing with these issues will make the children more able to learn.
•    Children’s centres are funded through the early intervention grant.  The best ones have many different services so that once over the threshold, users  can be signposted to other services e.g. mental health.
•    Additional health visitors will be provided through the Department of Health.  These will act as an extra set of eyes and ears and an early warning system within homes. As health visitors are generally trusted, and more likely allowed over threshold, they will be able to spot parenting problems, mental health issues, safeguarding issues.  They can then coordinate a joined-up approach with the children’s centre.
•    Family-nurse partnerships will continue.
•    Link between children’s social care and health.
•    Increase in family intervention project.
•    Increase in families with multiple problems project.

Reforms
Key Worker – social worker who is key point of contact and contact coordinator for a child and their family and will have more authority.
Question: What will underpin the authority of a Key Social Worker?
Tim spent a week last October shadowing social workers in Stockport.  Realised the need for a key worker, to manage the needs of each family.  Mental health support is a key need of many ‘multiple problem families’.

Reforms in child social work
-    Social workers should be spending most of the time with the children and families, not at their desks.
-    Need consistency of help for children and families.
-    Final report in May.

Reforms within the health service:
-    The reforms force together children’s social care and health.
-    Currently Directors of Children’s Services report that they have difficulty getting health to engage.
-    Health and Wellbeing Boards will bring together professionals for systematic joint commissioning around preventative measures, dangerous behaviours, mental health, binge drinking etc.
-    Despite the challenges of the reforms, we might end up with better targeted people working on focussed interventions at the right time.

Discussion

 

Challenges of working together
Integration is not a new objective but there are many challenges to joint working.
There are huge cultural differences between social services and the health service.
Very difficult to align financial flows, inspection and regulation so that when things get tough people don’t just pass the problem around.
Q. Is anyone addressing ways to align financial flows, inspection and regulation so that difficulties cannot simply be passed between the parties involved in joint programmes?
Local safeguarding children’s boards will need to be involved.

Ways to improve working together:
Colocation of workers from different sectors.
Joint training – this needs to improve.
JSNAs - GP consortia need to be compelled to listen to the recommendations of the JSNAs.  
Suggested Action: The wording in the Health Bill should be stronger so that GP consortia are compelled to listen to JSNA recommendations.

Perverse incentives
The failure of service provision may be due to perverse incentives.
Why would a head teacher not want to do the best for a child?
There may be perverse incentives not to identify those in need of help, due to lack of capacity in intervention services .
The lack of funding for additional services leads to setting thresholds and barriers to services, which may cost money in themselves or increase costs in the long run.
In the end the biggest cost is the cost of failure.
There is a perverse incentive for a child to end up in a Young Offenders Institute, as this takes them off the hands of the social services.  The government aim to improve this, moving to a “payment by results” approach.

Changes to grant structure
The new Early Intervention Grant includes many separate grants which existed previously – this allows more local decision-making about use of funding.
The Department is now being more rigorous about giving out voluntary services grants to ensure value from the programmes funded.
CAMHS grant is no longer ring-fenced.  At the point when the ring-fencing stopped the contribution of LAs to children’s mental health decreased by a half.
Q. Can anything be done about the fall in local authority contributions to children’s mental health which resulted from removal of ring-fencing?
The aims of the changes are:     to remove perverse incentives created by targets and ring-fencing.
to give more control to professionals and local authorities.
Local practitioners may occasionally make wrong decisions, as often the decision is based on a value judgement rather than scientific data, but it is better for them to have the chance to make decisions rather than simply tick boxes and then not provide the service needed, as in for example the Baby P case.

Children in care need more high level support
Example given of a court case between a child and father. The child clearly needed psychiatric help, but wasn’t given any help in case it interfered with the trial.
There is a Minister for Prisons, but not a Minister for Children in Care.
S.A. Create Minister for Children in Care
There is a need for somebody with the power to intervene in cases such as the above.

Key worker model
The Kids Company programme works using the key worker model.  
One professional is the main contact with a family and is supported by different specialists.  
This means the child doesn’t have to tell their story many times over to different people.

Identification of need for help
S.A. Teachers need training to identify children with mental health and special needs.
In Sheffield only 1% of children are diagnosed with ADHD, although it is known from research that 3-5% of that population have ADHD.  
There is a problem that if more are diagnosed there is no additional capacity within the treatment services.

Parents
Most parents are a very good resource to use when trying to improve the care of children and it is vital that they should be engaged.
Q. Is the engagement of parents central to government policy?
Teaching young mothers about child development helps them to understand why their child behaves in certain ways.
Grow Brain – a publicity campaign for parents and children.
Parents may need pushing in the right direction.
In one example a parent was given the chance to either sign up to a program, or have her children taken into care – this provided the kick-start necessary to help this family.

Evidence
Need to measure quality of interventions – need for the development of quality and outcome measures before renewing funding.
Q. Where will the parameters and quality standards for joint commissioning come from?
NICE would welcome the requirement to develop joint commissioning guidance, to guide Health & Wellbeing Boards with quality standards.
Activity isn’t the same as effectiveness.
S.A. Universities can help with ensuring effectiveness of programmes – there is a lot of information about what works.
There is a need for all programmes to be evidence-based.
Unfortunately some cultures want interventions which look good politically, for example with bosses or constituents, which may conflict with the evidence base.

Barriers to setting up programmes
Example: Tried to set up some programmes in schools – how to run classrooms and working with children on their social skills.  It was hoped that these changes would help those in the class with difficulties to learn.  The program is based on NICE guidance around social and emotional wellbeing in education.
Barriers:
-    culture
-    wish of the school to own things
-    dependence of a programme on one individual
-    difficulty of teachers not having spare time to engage (or not being given time by Head Teachers)

Training of professionals
Cotraining helps to build better coworking.
Q. How can training be adapted to encourage the understanding of different skills and cultures?
Medical students and social workers should have joint training from the beginning.
Dr Richard Gray, in Brighton, was involved in the design and implementation of the undergraduate first year clinical practice modules which included interprofessional education involving nursing, midwifery, pharmacy, social work and medical students.
Q. How can the work of Dr Richard Gray in Brighton, on interprofessional education, be replicated?
Child development is not part of basic teacher training – many attendees were shocked when they first heard this – surely an understanding of child development is key to being a teacher.

Young adults
Questions around which sectors and services should be used to engage this group.
Interventions which build resilience and promote mental health are important, but would not necessarily be badged as mental health interventions.
Can engage young people through job-seeking organizations, universities.
‘Staying Put’ pilots provide support for young adults, into their 20s, providing a safety net in case of need.

Changes to the NHS resulting from Health Bill
Q. Many schools will cross consortia boundaries - how do we ensure coordinated provision and equality of provision across boundaries?

Worries about Any Willing Provider model leading to greater fragmentation.
One doctor currently talks to all the schools in Lambeth, and they come to him when they need help. Building this relationship will help future implementation.
Worried that other providers coming in will break down this clear relationship, and disrupt the ability to do projects with many different schools across an area.

Q. Who will have the ultimate responsibility in the new system, with health and wellbeing boards?
The govt is working on this – the position of Directors of Children’s Services on the H&WB is important.  
Developing protocols for H&WBs to identify someone who will have ultimate responsibility.