Pathways to care in the absence of a local specialist Forensic Service, what we do in York. By Bekki Whisker

As a lone YOT/CAMHS representative, working with high risk clients without clear referral pathways

 B aged 15,  Arrested for serious sexual offences,  Learning difficulties,  Full care order directly following arrest.  Over a 4 month period he receives 7 different assessments as a result of the pathways leading from the family court system, criminal justice processes and CAMHS assessment.

 P aged 15,  long history of CAMHS involvement  familial sexual abuse and domestic violence.  high risk behaviour within the home, - fire setting, substance misuse, fascination with weapons, sexualised behaviour, animal cruelty, TWOC, physically aggression.  Lack of consensus regarding risk assessment and risk management, from an internal and multi-agency perspective.

 F is 16,  Well known to CS, YOT and CAMHS.  Assessed High risk offender for some time.  Long term neglect and parental substance misuse,  Huge difficulty with engagement with all services.  Receives a custodial sentence.  Within weeks he is sectioned, admitted to a secure hospital and medicated with anti- psychotic medication.

 A aged 14,  Arrested for serious sexual offences  Court bail for an extended period,  Self-harm concern.  Absence of mental illness, no suicidal intent, very little evidence of self-harm – CAMHS discharge.  2 months later the Court outcome is that he is unfit to plead and he receives a Hospital Order.

 Z – 17  serial fire setter  ?LD  CAMHS and CS advice to refer direct to fcamhs due to lack of specialist risk assessment skills – forensic report makes recommendations for the Local Authority and CAMHS

 Lack of local specialist forensic CAMHS and legal expertise  Poor co-ordination of services, a lack of partnership working, no one wants to take ownership of these cases  Limited success in terms of Court diversion  No support/supervision for those staff working as lone practitioners with these high risk clients  No forum to monitor the progress of cases/potential cases- they just get lost in the system, an offence is then often the trigger to action/assessment

 We are a small city, we know our client group and we know our staff  Adult forensic mental health services wanted to help us  CAMHS, YOT and Childrens’ Services representatives had registered an interest in forensic cases  The Yot health Worker had developed a good understanding of the needs of this client group and had built some good relationships across the relevant agencies  There were enough interested and motivated individuals to make a multi-agency panel

 YOT Service Manager (Chair)  YOT CAMHS representative  YOT admin  CAMHS Psychiatrist  CAMH Service Manager  CAMHS Psychologist  Head of Services Resources (Children’s Services)  Adult Forensic Mental Health Practitioner  CAMHS Commissioner – (provided with minutes)

CAMHS Youth Offending Team Children's’ Services Where are the cases coming from ?

 Assessed as posing a high risk of harm to others (YOT ROSH or similar)  Stuck cases  Those at risk of custody  Other forums have not been successful in addressing the emotional and mental health issues

26 cases discussed  3 females  23 males  2 cases raised by Children’s Services  4 cases raised by CAMHS  20 cases raised by YOT

 Clarity to risk assessments  A consistent multi-agency response to risk management  Early identification and intervention  Better outcomes for high risk clients  An enhanced experience for clients in transition to adult services  Identification of local skills, experience and knowledge  An opportunity for professional challenge  An opportunity to explore diversion pathways for individuals

 Expertise  A service – the panel is a forum we don’t provide therapeutic input, consultation, written reports etc  Service Level Agreements and funding  Time – we meet monthly therefore we are not as responsive as some cases require  Court diversion schemes (we have had some success but they are minimal and messy)  Clear pathways and therapeutic provision to those young people who sexually harm  Specialist fcamhs assessments which are locally relevant to the service provision

The panel ‘felt right’ but this publication confirmed what we had identified and developed in York was not a local ‘whim’: Community Forensic Child and Adolescent Mental Health Services (FCAMHS): a map of current national provision and a proposed service model for the future. Final Report for the Department of Health. January 2013

 Are locally relevant, similar issues identified  Evidence the need for Specialist Services and expertise  Highlight the unmet needs (but enables us to recognise the progress we have made in York)  Identify that we are targeting the correct clients for discussion  Identifies need for minimum standards for community FCAMH service provision and a standard commissioning framework to provide a level of consistency

 Thank you, if you have any queries regarding the panel please contact: Angela Crossland, YOT Service Manager: Tel: