BOND – WORKING WITH THE WHOLE SYSTEM Elaine Willis, Kevin Ford, FPM 10 th September 2013 London

BOND (Better Outcomes, New Delivery) is a two year project funded by Department for Education that aims to increase the capacity of voluntary and community organisations to provide early intervention mental health support services for children and young people.

The Government’s Mental Health Strategy emphasises the crucial importance of early intervention in tackling emerging emotional and mental health problems for children and young people. Intervening early has been shown to achieve improved outcomes for children, families and wider society such as increased learning and educational attainment, better physical health, improved long term mental health and reduced health and social care costs. Voluntary and community organisations have an important role to play in providing effective, high quality early intervention services as they are local, flexible, trusted, informal and friendly.

50% adults with lifetime mental health problems experience symptoms before 14 years of age. 75% adults with lifetime mental health problems experience symptoms before their mid 20s. Fewer than 50% were treated appropriately at the time. (Taken from Mental Health Strategy 2011 DH)

Some people are more at risk due to individual, family and social factors – knowing this can help target resources Early intervention can be protective (protecting those with risk factors against developing problems later on) or it can be remedial or therapeutic (improving the situation for those in the early stages of problems) There are instances where early intervention acts as a screening for those who will need more sustained or intensive interventions later.

Around 1 in 12 young people self harm (Mental Health Foundation, 2006) and around 25,000 are admitted to hospital every year due to the severity of their injuries (Fox & Hawton, 2004) with a 68% increase in the last 10 years 1 in 10 children experience problems severe and enduring enough to meet the criteria for a disorder (ONS 2004) In an average classroom: 10 young people will have witnessed their parents separate 8 will have experienced physical violence, sexual abuse or neglect 1 will have experienced death of a parent 7 will have been bullied (Faulkner, 2011)

Tier 1 - provides treatment for less severe mental health conditions, such as mild depression, while also offering an assessment service for children and young people who would benefit from referral to more specialist services. Tier 2 - provides assessment and interventions for children and young people with more severe or complex health care needs, such as severe depression. Tier 3 - provides services for children and young people with severe, complex and persistent mental health conditions, such as obsessive compulsive disorder (OCD), bipolar disorder, and schizophrenia Tier 4 - provides specialist services for children and young people with the most serious problems

Tier 4: Inpatient Care Infrequent competition amongst larger MH provider trusts Some variety of providers More frequent tendering + increasing competition (usually LAs, NHS) Numerous providers + commissioners Large + small organisations More VCS Less clinical governance Smaller contracts Frequent tendering Tier 3: Clinical/ medical care (diagnosis/ medication) Tier 3/2 interface: Primary MH services LAC, YOS, other targeted CAMHS Tier 2/1 interface: ‘Generic’ School + community based e.g. counselling + IAG services Related services e.g. drop-in, youth support, family support Limited contestability Increasing levels of competition

Mental health expertise Service ‘tiers’ 14 Access School Counselling Activity based Mediation Young Carers D.V. Drop in Mental Health Services

Publications & resources Pilot programme National Strand Master classes Commissioning support programme Sustainability – collaborative models ACE-V Workforce Development Work with schools as commissioners

Greater autonomy, devolved funding…. How are they shaping up as ‘commissioners’? What helps and hinders?

Buy in expert capacity Work with or refer to external services Build internal capacity Counselling Family support Additional assessments X-School Inc. support roles Internal ‘case’ management Knowledge and Expertise/training Other services e.g. CAMHS, H&SC, VCS External processes e.g. CAF Activities

Increasing MH needs (more accurately described as emotional and social difficulties that manifest in behaviour issues) Dissatisfaction with stat services/thresholds A very few pupils taking up a lot of staff time Impact of parenting and difficulty in engaging or knowing how to work with parents effectively Closing the gap; behaviour and attendance – underlying problems

Language of ‘mental health’ Lack of understanding of link between MH and academic attainment Knowing which schools are interested No one ‘model’ of intervention or what good looks like Lack of systematic info on needs e.g. young carers, bereavement, family problems Schools may lack confidence, knowledge and skills to commission; not see it as their role; not know what is out there

What other schools are doing References from schools/trusted colleagues Speed of response to problem Price and added value Flexibility and integration in school Examples of good practice & cases Experience of results! E.g. improved behaviour

Examples of good practice/ideas To be able to find services which can work in schools – particularly for individuals Efficiency through joint commissioning (although many still dependent on LA to facilitate this) Big interest in HOW schools can work with emotional difficulties effectively - ‘sub statutory services threshold pupils’ How to build in effective processes, systems, approaches to school inc. roles, staff skills, etc

No school reported using any national guidance Schools did not see themselves as commissioners Structures within schools did not allow for a commissioning approach – silo approaches and lack of budget overview in relation to vulnerable pupils Special schools often buy in professionals and integrate in to school workforce – much to learn from re BESD Little linkage between research evidence and practice – more evolved in response to

New relationships between commissioners and providers – different and better understanding of each others’ roles and requirements New ways of working together – more collaboration and dialogue Some new (or safeguarded) money to VCS: £225,000 additional investment in Tees Valley from LA, CCGs & NHS Tees; new money to VCS in Cumbria and Cambridgeshire Greater involvement of schools; raised awareness in schools of commissioning questions

Leadership development for school commissioners - Commissioning for emotional and mental health’ for Head teachers and Early Years leads, in collaboration with National College for teaching and Leadership Active role of CVS and CVAs in developing the roles of VCS as providers – e.g. Middlesbrough Voluntary Development Agency (CVS) supporting development of a VCSO consortium to provide universal, flexible, responsive early intervention services

What is the role of the CVS or infrastructure body?  Bring people together within interest areas eg young people or mental health and across interest areas  Help develop market readiness – build the capacity of vcs to respond to the needs in schools and of commissioning  Work with commissioners to show how vcs can be engaged  Break down the `us’ and `them’ – promote open dialogue  Support consortium to develop and respond  Be proactive with key vcs organisations to develop local strategies and approaches

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