Neighbourhoods, Networks and Young People’s mental health: what’s happening in City and Hackney   How can we ensure that young people and mental health are not ignored in the new landscape? http://www.cityandhackneyccg.nhs.uk/about-us/our-plans.htm

Neighbourhoods versus Networks In City and Hackney we have 8 neighbourhoods and now 8 networks. A Neighbourhood is a geographical area encompassing schools, pharmacies, parks, shops, community centres etc A Network is a group of GP practices within each neighbourhood working together in a new contractual way and providing the “health hub” for the neighbourhood (physical and mental health)

CYP neighbourhood needs in Hackney impacting on mental health High levels of deprivation and significantly higher numbers of children in Pupil Referral Units than national average. Higher proportion of children with Special Education Needs (SEND), many for “social and emotional” issues, NEETS, school exclusions, conduct disorder, looked after children, gangs. BME prevalence issues. Tier 2 and 3 CAMHS services, good access, high need. (low inpatient bed use) Large ultra-orthodox Jewish community in 1 neighbourhood- 20% of our <5s, highest birth rates in the UK, emerging MH issues. The hidden issue- ALL CYP mental health issues are FAMILY issues- so always bigger than CYP input.

Mental health: adults, showing network links, RAG rated Primary care IAPT Enhanced primary care Primary care liaison Family Action: well family Family Action: social prescribing Clinical Effectiveness Group We have good adult MH network provision- ie practice based services and links.

Current CYP MH provision in networks, RAG rated. Primary care networks/neighbourhoods CAMHS community liaison, Tier 2 provision and schools service Community Paeds Step down from secondary care: ADHD Schools, youth hubs Children centres Childrens social care/ social prescribing Family support/enhanced HV/early help In contrast, our CYP MH network provision is patchy with variable practice links

MH pilots: 1. ADHD in the community Issues: waits for assessments building up and referrals increasing. Small clinical service trying not to over-diagnose and over-use meds. GPs currently prescribing but not doing health screening consistently as per NICE guidance. Follow ups of stable CYP not a good use of specialist time Clinics clogging up- old fashioned out patient model with no patient flow- leading to increasing waits for assessment

ADHD from Sept 19 Step down shared care model. Stable>14 years on meds discharged to primary care specialist nurse caseload, remain under virtual consultant care. 6 monthly reviews in primary care using a template covering NICE recommended care- GPs incentivised. GPs can step up any suspected ADHD cases for nurse to see. Nurse will support with meds advice, crisis management, family support. CYP will not be seen in secondary care unless crisis and GPs continue to prescribe. Transition appointment at 17 built into system + care plan

Enhanced shared care ADHD service Stable ADHD on meds under consultant care Nurse caseload, GP health screens, GP prescribing Transition review at 17: ?needs adult service, ?stable in primary care, ? Has stopped meds. Crisis? Adult services and/or community support

CYP MH pilots: 2. Psych Liaison This pilot will build on a successful hospital CYP psychiatric liaison provision. Will work in 2 networks, clinics and joint sessions, seeing complex cases/MUS/family issues Education and prevention roles- hope to reduce CYP bed days in acute hospital and repeat A&E usage. Hope to start conversations about MUS in children If evaluation positive can roll out across networks. Case studies: paralysis in A&E, gastro admission (>6 months)

What else are we doing? Integrated CYP neighbourhood group meets regularly. We are trying to develop a CYP mental health drop in/hub/café We are using 5 ways to wellbeing across schools/youth hubs/primary care /childrens centres as our common language about promoting good MH www.fivetothrive.net. Transition service: focus on young black CYP to address NEETS/exclusions/MHA usage/crisis all higher in some network areas than others

Networks and CYP Networks may offer local ways to integrate mental health care and wellbeing for CYP in neighbourhoods Flow out of secondary care CYP mental health services needs to happen to manage demand and to use resource efficiently- so must have the “4 Cs” in primary care networks- culture, competence, confidence, capacity. Then primary care management of CYP MH can be facilitated However- CYP MH requires an integrated approach between LA/PH/Social care and health to reduce the social determinants causing ACEs and leading to some mental health issues in later life.