‘Are we listening?’ Sabina Hafesji Regulatory Policy Officer (mental health) Are you really listening? Review of children and young people’s mental health services #WeAreListening

CQC’s purpose and role We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve Register Monitor and inspect Use legal powers Speak independently Encourage improvement People have a right to expect safe, good care from their health and social care services Strategy Slides - 24 May 2016 - MASTER

Inspecting Children’s Health and Safeguarding Inspection of children’s health and safeguarding as part of CQC’s regulatory activity in: Acute and Community Health services (also specialist mental health service inspections – CAMHS) Primary medical Services and Integrated care Specialist Children’s Inspections under our Review powers Children Looked After and Safeguarding Inspections Joint Targeted Area Inspection programme Special Educational Needs and Disability Inspection programme

Mental health inspections Child and adolescent mental health wards Child and adolescent mental health services (CAMHS) may assess and treat children and young people as an inpatient in hospital. This may be when community-based services cannot meet their needs safely and effectively because of their level of risk and/or complexity and where they need 24-hour nursing and medical care. Specialist community mental health services for children and young people Specialist community child and adolescent mental health services (CAMHS) provide assessment, advice and treatment for children and young people with severe and complex mental health problems. They also provide support and advice to their families or carers. Services are usually multi-disciplinary teams of mental health professionals providing a range of interventions in the community, working with schools, social care, charities, voluntary and community groups.

Our core work in Children and Young people’s mental health Current Core Service rating for all NHS trusts and independent hospitals Child and adolescent mental health wards (60) Specialist community mental health services for children and young people (67) 24 January 2018

Children and young people’s mental health Mental health problems affect approximately 1 in 10 children and young people But estimates suggest only 25% to 35% of children and young people who need support for their mental health can access services Our phase one report highlighted that 50% of children and young people that are referred to CAMHS are not accepted for treatment #WeAreListening Sources: NHS England, Five Year Forward View for Mental Health: One Year on, 2017 | Department of Health and Social Care, Future in Mind, 2015 | NHS Benchmarking Network, CAMHS Benchmarking, 2016

Jen’s story Jen’s school noticed that she was showing signs of mental health problems. The school referred Jen to the specialist child and adolescent mental health (CAMHS) service. A few months later, a local authority social worker also became involved in supporting Jen’s family, and adult mental health services started helping Jen’s dad. Extract from: Are we listening?, Care Quality Commission, March 2018 #WeAreListening

The journey January 2017 - Review commissioned by the Prime Minister October 2017 – CQC published Phase One based on existing evidence New fieldwork from 10 areas across England March 2018 - Phase Two report published #WeAreListening

https://www.youtube.com/watch?v=jEIYxPpVNS w&feature=youtu.be What we found https://www.youtube.com/watch?v=jEIYxPpVNS w&feature=youtu.be

#WeAreListening

A complex system with many players Local players National players Schools GPs Specialist CAMHS services Local ‘early help’ services that support families to address problems early on Voluntary and Independent bodies Emergency Department staff Social workers Police and youth justice service Housing providers Department of Health and Social Care Department for Education Ministry of Housing, Communities and Local Government Department for Work and Pensions Home Office Ministry of Justice, the Ministry of Defence HM Treasury   Regional players Sustainability and Transformation Partnerships (STPs) Clinical Commissioning Groups (CCGs) Local authority commissioners Health and Wellbeing Boards Integrated Care Systems #WeAreListening

How did we collect our findings? Fieldwork across 10 local areas in England Direct engagement with children and young people We spoke to over 1,300 people across the system including mental health professionals and children and young people Tracked how children and young people moved through the system #WeAreListening

A system under pressure Signs and symptoms of a system under pressure Significant gaps in provision High eligibility criteria Staff shortages “I waited 18 months to get the help I need” – Young Person Pressure on the system #WeAreListening

Person-centred care is key to overcoming barriers ‘despite the system, not because of it’ ‘Where there was a conflict in policy and procedure between partner organisations, staff would place the young person at the centre of the discussion and focus on finding the solution’ CQC Reviewer #WeAreListening

Enfield – case study example Role of the school CAMHS referral Involvement of social care/local authority Working with the family Regular joint meetings Third sector/charity involvement Continuation of support

Southwark – case study examples COORDINATED CARE Proactive GP Case coordinator Family support Help in the local area Communication A WHOLE-SCHOOL APPROACH TO PROMOTING WELLBEING - Cobourg Primary School in Southwark in South London Pilot on wellbeing - whole-school approach Working with SLAM Techniques for managing feelings and behaviour Working with parents

Recommendations: local and regional A shared local ‘offer’ from Health and Wellbeing Boards Commissioners must demand better data Commissioners and providers must draw on evidence and good practice to drive local improvement Regional: STPs and Integrated care systems must collaborate beyond the boundaries of health and social care

Recommendations: national The Secretary of State for Health and Social Care should drive joint action across government with an inter-ministerial group on mental health We welcome the National Audit Office’s value for money study on children’s and young people’s mental health across the system Government, employers and schools to ensure everyone working with children and young people are trained to promote good mental health Ofsted should recognise and assess schools’ role in supporting children and young peoples mental health

What are we doing next? To focus on mental health in the next Joint Targeted Area Inspection (JTAI). To strengthen our focus on children and young people’s mental health with Ofsted through our SEND programme To report on the progress of our recommendations in 2019/2020. #WeAreListening

If you’d like to hear more… #WeAreListening Email: cypmentalhealth@cqc.org.uk www.cqc.org.uk/reallylistening @CareQualityComm #WeAreListening

Thank you www.cqc.org.uk enquiries@cqc.org.uk @CareQualityComm Generic ASC deck (June Final)