Lifespan Mental Health in Sheffield Dr Girish Vaidya Consultant Child and Adolescent Psychiatrist Assoc Medical Director, Sheffield Children’s NHS FT Assoc Clinical Director, NHS Sheffield CCG @DrGirishPsych

Sheffield Forensic CAMHS/ Aldine House Secure Children’s Home A bit about myself Sheffield Forensic CAMHS/ Aldine House Secure Children’s Home Looked After Children’s Mental Health Team Assoc Medical Director – Sheffield Children’s NHS FT Assoc Clinical Director – NHS Sheffield CCG/Sheffield City Council (People’s Portfolio) Medico-legal work – family court, criminal courts

What is Lifespan Mental Health A seamless continuum of care which: Focuses on prevention and early intervention; Is based on a person centred holistic approach; Is designed around need not availability; and Does not have transition points rather ‘warm handovers’. In short – moving from ‘silos to solutions’ For service users and their carers, this will mean that they will have the same positive, welcoming experience whichever ‘door’ they knock on.

What Are We Trying To Solve (1) Sheffield is an outlier in terms of a several Child Health Indicators. Case Study – Public Health England Child Health Indicators Infant Mortality Poor Reception Scores Poor School Outcomes Children in Low Income Families

What Are We Trying To Solve (2) Case Study – Exclusion Rates

What Are We Trying To Solve (3) Current services are commissioned, and therefore delivered, based on defined specifications which delineate between services. As commissioners we have built transition points into the system. Services are commissioned based on an expectation that a certain proportion of individuals will become ill. We are configured to respond to illness, not to promote wellness. Providers are largely rewarded for delivering ‘units of activity’, not for preventing activity. We do not reward preventative interventions. Case Study – Community Eating Disorder Services Community Eating Disorders Services Spend Activity Spend (£000) % Treatment £1,170 97.5% Prevention £30 2.5%

What Are We Trying To Solve (4) One in ten children aged between 5 and 16 years has a clinically diagnosable mental health problem that warrants support and treatment. Only 30% of the one in ten actually have an appropriate intervention at a sufficiently early stage. In Sheffield therefore there are around 4,000-5,000 children and young people at any given time who do not receive (or have not received) an appropriate intervention. Vulnerability and Adverse Childhood Experiences are important predictors of adult health, both mental and physical. This correlation is not however routinely factored into planning processes. Commissioning is generally based on reactive demand management; an acceptance that some unwell children will become unwell adults. Services are often commissioned inconsistently, meaning the act of transition is sometimes not possible. Access to services is based on age, diagnosis, severity of illness, geography and service availability. Generally access is not based on an individuals holistic needs.

What Are We Trying To Solve (5) Levels of Acuity and Demand are rising in both CYP and adult services. We need to enact a commissioning approach that will have a long-term sustainable impact on the wider system not just on specific parts of the pathway. Case Study – Referrals to Community CAMHS Year Referrals 2015/16 2,217 2016/17 2,366 2017/18 2,455 2018/19 2,623

What Are We Trying To Solve (5) 10. At a national level this will reflect in the need for the following workforce – that’s only in CAMHS.

What Are We Trying To Solve (6) We need to Break the Cycle. Low Income Households in Deprived Neighbourhoods Higher Infant Mortality Poorer School Readiness Higher Primary/Secondary School Exclusions Poorer Educational Attainment Working Poor/ Benefits Poor

What Do We Want To Achieve (1) A system where we focus on early intervention and prevention. This means changing the way in which we commission and provide services, with a greater emphasis on preventing illness. A reduction in the number of individuals who develop severe and enduring mental ill health. We will achieve this, in part, by increasing access to services, particularly those aimed at mild to moderate conditions. Genuine adoption of person centred care principles, where services are provided based on need. Age can no longer be used as criteria for determining access.

What Do We Want To Achieve (1) An approach to commissioning where ‘non-health’ issues are taken into account when determining packages of care and support; such as housing, debt and employment etc. A greater focus on the whole, rather than individual component elements of our families. As we now know the family dynamic during pregnancy, infancy and childhood has a direct impact on a child’s mental health and wellbeing.

What Do We Want To Achieve (2) There can be no ‘incorrect point of entry’ for anyone wanting help and support for any aspect of their health or wellbeing. Improved Infant Mental Health measured by school readiness and Improved School Mental Health measured by reduced school exclusions in primary and secondary school. A ‘one stop shop’ for MH problems; parents and their children being treated by a single team of MH professionals. A greater focus on reducing intergenerational adversity A ‘family based approach’ to mental health services Moving from ‘Commissioning for Activity’ to ‘Commissioning for Impact’ within objective public health determined parameters

A story

Any Questions? Girish.vaidya1@nhs.net