Why are mental health problems rising in Suffolk?
- Credit: Lucy Taylor
Huge increases in the number of children in Suffolk suffering from mental health problems were today laid bare - amid major concerns about the quality of services youngsters receive.
An investigation can reveal that referrals for under 18s to the Norfolk and Suffolk NHS Foundation Trust (NSFT) rose by 84% between 2011/12 to 2014/15.
In Suffolk alone that figure was 67%, with 3,972 ‘new episodes of care’ registered in the last financial year - an average of more than 10 Suffolk children a day in need of support for mental health issues.
Child experts put the rise down to a ‘perfect storm’ of increased pressures on young people, reductions in support services provided by charities and a disappearing stigma in people admitting to problems.
Today, concerns were raised that help and support for children in Suffolk is severely lacking in quality. Issues highlighted include:
An historic lack of funding, locally and nationally.
A postcode lottery, with the quality and type of services dependant on where they live.
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A lack of psychiatrists to see youngsters, leading parents to dangerously ‘self-medicate’ their children.
Lack of out-of-hours specialists.
A failure to provide enough regular support.
Fed-up parents resorting to costly private treatment.
Health bosses admit changes are needed and say they are in the process of submitting plans to the government outlining how they intended to ‘transform’ services for children. Earlier this year the Conservatives pledged an extra £1.2bn of funding specifically for child mental health.
Anne Humphrys, of Debenham, jointly set up the Suffolk support group Parents and Carers Together, after enduring problems accessing suitable treatment for her 17-year-old daughter Bethan.
She said: “There are just not the staff to support people with complex behaviour problems. The trust agreed to provide CAT (Cognitive Analytic Therapy) but had no therapists to do it. There was one in the coastal area but that was seen as out of patch.
“We found a private therapist at £40 a session who we used until we couldn’t afford it. It has cost us £7,500.
“Bethan has also been on the waiting list for CBT (Cognitive Behavioural Therapy) since June and there’s still four people in front of her.”
The NSFT, currently in special measures, is tasked with providing mental health care across Norfolk and Suffolk, but is commissioned and receives funding from the Clinical Commissioning Groups in the two counties.
The 42-year-old claimed this has led to a ‘postcode lottery’ and it was generally perceived children in Norfolk and Waveney received a better service, adding: “In Norfolk and Waveney they are one team and if the expertise is needed in one particular area, it goes there. In Suffolk they work in silos and the treatment depends on where you live.
“There’s no child expertise out-of-hours. We’ve called for emergency support and been told to go to A&E. No child wants that.”
The trust has seen its funding overall slashed in recent years and is likely to face further cuts, but has had to cope with rises in adult patients as well.
Bec Jasper, 42, also from Debenham, has had to access services for her son, aged 13, and jointly set up the support group.
She warned some of the problems were leading parents to make potentially dangerous choices, adding: “At times, getting accepted by the service is a bit like finding a needle in a haystack. We have heard of parents giving their children their own anti-depressants as a stop gap. They just want to do what they can.”
Generally a psychiatrist will prescribe medication for children, based on a referral from a psychologist. Mrs Jasper claimed there were shortages of both and said: “My son has been given support, but just for half an hour a week. When when I asked her how many of them there were in Suffolk, she said she was the only one.
“The system is so slow, it’s heartbreaking. I put a message on Facebook and straight away I got so many replies from people going through the same.”
Dr Jon Wilson, a consultant psychiatrist and NSFT’s clinical lead for youth service, said the trust has begun a major redesign of the services aimed to provide earlier intervention. This has already been rolled out in Norfolk and Waveney, but he could not say when the rest of Suffolk would benefit.
He added: “Young people don’t see mental health services as appealing to them but our task is to make young people want to engage with it.
“I’d like fewer people when they are 40 on the books because they have learnt how to cope earlier. That is not just to save money, but society will also be better off.”
A spokesman for NHS West Suffolk and NHS Ipswich and East Suffolk clinical commissioning groups said: “Demand is increasing both locally and nationally. This could be due to the increasing pressure faced by young people in society, as well as the fact that they are far less likely to keep their problems hidden and instead seek the help they need.
“In Suffolk and across the country, clinical commissioning groups are in the process of submitting their children’s emotional wellbeing transformation plans to NHS England. These plans will set out the identified priorities and themes for children and young people’s mental health services locally. ”
Chris Leaman, policy manager at the Young Minds mental health charity, said of the figures: “For too long these problems have been ignored, children’s mental health services have been under-funded and we are now having to play catch up.”
What is being done about the problem?
North Norfolk MP and former care minister Norman Lamb recently launched a new taskforce, which included Dr Wilson, to draw up a report called Future In Mind, looking at children’s mental health services.
The 82-page report highlighted the need for earlier intervention to avoid young people from falling into crisis long into adulthood.
It also raised the issue of a lack of knowledge about the scale of the problem, gaps in available support, complex commissioning arrangements, variable levels of access to crisis and out-of-hours support and particular issues with the support offered to highly vulnerable groups of children.
Earlier this year then deputy prime minister Nick Clegg followed up the report with a pledge to provide £1.25bn of fresh funding over five years to treat 110,000 children, as well as introduce waiting time expectations for certain services.
Today, Mr Lamb urged the new Conservative government to stick to its pledge, adding: “Mental health has always been the poor relation of the health service.
“There is both a moral and an economic case to improve these services. It cannot be acceptable in this day and age that if a youngster suffers from an eating disorder, for instance, they cannot access the required treatment. Meanwhile, it is foolish not to put the investment in to this because it can save the economy in the long run.”
Mr Lamb has been a prominent mental health campaigner and has first-hand experience of the problem as his 27-year-old son Archie was diagnosed with obsessive compulsive disorder aged 15.
Mental Health Trust response
Q: How do services for under-18s work in Suffolk?
A: Alison Armstrong, Director of Operations (Suffolk) at Norfolk and Suffolk NHS foundation Trust, said: “In Suffolk, children and young people have their care managed either within our more generic Child & Adolescent Mental Health Services (CAMHs) or within specialist services.
“Access to these services is via a number of routes including GP referral and referrals from schools or social care staff.
“Once received, a referral might be managed through the Access and Assessment Team (AAT) or through Primary Care Mental Health Workers (PMHWs) employed by our Trust.
“PMHWs work jointly with non-specialist (universal) children and young people services, schools and GPs, regarding early intervention in younger children. They provide a much valued first port of call through which professionals can receive help, advice and consultation which often means children receive help quickly without the need for mental health service intervention.
“PMHWS also work specifically with Youth Offending Services. NSFT has teams of mental health experts from different professional backgrounds who can offer varied therapeutic interventions – we match skill and expertise with need, and have a strong multi-disciplinary ethos. This is so that, even if a child isn’t being seen by a number of professionals, they have access to other views and expertise in the team through their named worker(s).
“We also have teams and expertise in ADHD and Learning Disabilities who work with other agencies, such as schools and other health services, to help children and young people receive the appropriate support and progress with any difficulties.
“NHS England commissions CAMHs inpatient (Tier 4) beds for under 18s from NSFT for Norfolk and Suffolk. These are based at a unit in Lothingland, near Lowestoft.”
Q: Why does Suffolk run the service in a different way to Norfolk and Waveney?
A: “Services are commissioned by local CCGs, based on local need and demand. There might be differences in the services commissioned in one county, or part of a county, to another due to investment levels or the presenting needs of local people. All commissioned services will be evidenced based and delivered following national guidance.
“At NSFT we work closely with commissioners and service users and carers to ensure that our services are developed with that local need in mind. Services are also focussed on ensuring positive outcomes.
“Essentially, across the Trust there are generic services for children and young people and specialist areas such as eating disorders services, or services specifically for children who are looked after (looked after children).
“In Suffolk, community services are organised so that we have Integrated Delivery Teams (IDTs) rather than Community Mental Health Teams (CMHTs).
“The IDTs differ in as much as they are age inclusive so generic CAMH services sit within the IDTs rather than in a separate team. There are, however, specific clinical pathways that work with children, young people and with families.
“The aim of IDTs is to help transition periods become seamless – where a young person moves from children’s to adult services, for example.”
Q: The figures suggest a rise in Suffolk children being referred for mental health treatment. Why is this?
A: “The increase in demand for our youth mental health services is in line with what is being seen nationally. A number of factors affect this including, in particular, rising demand for young people needing help with self-harm and eating disorders.
“By offering earlier intervention, our referrals go up, but if we deal with mental health problems early on, we are able to give young people a much better chance of recovery and living a full life.
“The stigma associated with having mental health needs has also reduced, and young people are becoming increasingly confident in seeking help for themselves or others.
“Social and economic issues have also had an impact on demand for mental health services. Changes to social care services available for children, for example, coupled with schools becoming more aware of children’s mental health needs have been other influencer affecting referrals to children’s mental health and wellbeing services.“
Q: Are there any particular trends you have noticed, such as, more females than males, age groups experiencing different problems?
A: “Demand for our CAMHs services has grown in all areas. We are working with the CCGs while they develop their Transformation Plan to ensure that this demand is recognised and planned for. We are also working closely with Suffolk County Council in order to see how we might further meet that demand across the county.”
Q: Are you confident you can keep up with the demand?
A: “We are confident that the local partnership of providers and commissioners are working together to respond to demand and to local need.
“Our relationships are mature ones which are open and transparent and our commitment is to maximising the amount of income Suffolk can receive – by developing the Transformation Plan – and by making sure that the investment meets demand.
“Recently, we have worked in partnership to contribute to two new local services – Suffolk Family Focus and the Belhaven Project. This is a joint initiative between children’s’ and young people’s services and the Priory Group which will provide Suffolk children in distress or in crisis with access to a local place with psychological support but while maintaining everyday living.
“We have also put forward a business case to the CCGs to invest in an intensive treatment at home service for 14-17 year-olds to help avoid need for inpatient admissions.
“NHS England is, we understand, planning to hold a procurement exercise in the near future. This will be across the country with the aim of ensuring they have the right number of beds, positioned across the country. At this point we hope to be able to increase our bed numbers from 7 to 12 within our Children and Adolescent Mental Health Services (CAMHS) Tier 4 inpatient unit from early 2016.”
Q: How have the recent financial pressures felt by the Trust impacted the service being offered to children in Suffolk?
A: “The Trust does have its financial pressures, as do the commissioning organisations, and our services in Suffolk are part of any review that needs to happen. We are in regular dialogue with our commissioners where we identify that there are financial pressures in our services and we are also very conscious that any services we are commissioned to deliver need to be within the budget agreed.
“Suffolk senior management are looking at where they need to apply any cost improvements in terms of services. We can confidently say that we will not apply any financial pressures to children’s services.“
Q: What changes will be made in the service for children over the next few years, and why?
“More appropriate for CCGs to respond”
Q: In Norfolk and Waveney they talk about a project to ensure earlier intervention. Is that something being rolled out to Suffolk?
A: “Suffolk has always delivered early intervention in psychosis services. There will be new national targets in relation to these coming into place from April 2016 and across the Trust we are planning and developing services to ensure that we are able to meet these targets.
“On a more generic level, the PMHWs provide an early intervention role too – please see above.”
Q: Parents tell of concerns about lack of specialist out of hours services for children in need of help?
A: “With regards to out of hours specialist services in Suffolk, NSFT has a Psychiatric Liaison service which assesses young people (aged 13 upwards) up until 9pm in the evening. The emergency service in Access and Assessment responds from 5pm until 9am.
In universal youth services (Tier 1) (14-25 years) and specialist child and adolescent services (Tier 3) (0-13 years) there are also daily duty systems for responding to urgent changes in care for service users and for providing additional support to children where necessary.“
Q: Have there been any cases this year of children either being placed on adult mental health wards or sent outside of Suffolk for treatment? If so, what is being done to prevent this?
A: “Between January 2014 and June 2015 there were 13 instances when young people aged over 16 years-old needed an admission on to adult wards in Suffolk.
“Our policy is to avoid, wherever possible, admitting admit young people into adult wards. When this is necessary, it is classed as a serious incident and we fully and formally investigate why this happened.
“Of course, we always have to take into consideration the needs of the patient and may take the decision that safest and most appropriate course of action is to admit a young person into an adult ward under close professional supervision at all times.
“In these situations, the wards are fully assessed for any potential risks and a young person will be cared for by two members of staff throughout their stay.
“We have reviewed all of these cases with a view to putting forward a business case to the CCGs to invest in an intensive treatment at home service for 14-17 year olds.
“Out of area placements: At the moment we are waiting for confirmation of activity data and will need to come back on this issue.
“Some young people will need to go out of area to receive appropriate inpatient care within units that specialise in their particular needs, or issues, such as eating disorders.
Q: Parents also claim a ‘postcode lottery’ in Suffolk services with skills available in some geographical places, but not others. For instance, cognitive behavioural therapists. Is this the case?
A: “We have no specific understanding that this is the case. Where issues are brought to our attention then we will always investigate and respond.“
Q: Is there a waiting list for children to see a cognitive behavioural therapist? If so why and how long?
A: “At the moment we are waiting for confirmation of activity data and will need to come back on this issue.”
Q: We’ve also heard concerns about a waiting list for children under 14 to see a psychiatrist and that this has caused some parents to self-medicate. Is this the case and if so why?
A: “At the moment we are waiting for confirmation of activity data and will need to come back on this issue.
“We have no information relating to parents ‘self-medicating their children’ - we are not sure exactly what this means or looks like.“
Q: What advice would you give to parents who are worried about their son or daughter’s mental health?
A: “Our advice would be to contact your GP to discuss your concerns in the first instance. They can advise if it is appropriate to make a referral for assessment with local services. Or you can speak to our primary care service, Suffolk Wellbeing.
“If other professionals, such as a teacher with pastoral care responsibilities or a social worker, are already involved with the child or young person they can also contact our Access and Assessment Team to discuss a possible referral.
“Assessment is crucial as both mental health illnesses and high levels of distress due to social and environmental factors can display themselves differently in children or young people.
“Of course, mental health is a wide term, and everybody’s ‘mental health’ varies with life events and daily pressures. Everyone should be encouraged to foster good communication with the children in their care. This is not always easy with teenagers but encouraging them to find and utilise safe adults - teachers, extended family or family friends - can allow them to communicate, reflect and develop.”
Q: How do you work with other organisations to provide good mental health care for children?
A: “NSFT works within the Children’s Assessment Framework (CAF) and Team Around the Child (TAC). Both approaches are multi-agency based, child-centred and family inclusive in order to meet the needs of the child or young person within their community and family context.
“Trust services are a critical partner to the Multi Agency Safeguarding Hubs (MASH) to ensure that, where necessary, children and young people are safeguarded from risk and exploitation.
“NSFT employs Primary Mental Health Workers who share our specialist mental health expertise with schools, school nurses and others similar professional working with children and young people, helping them spot the signs of a possible mental health issue and take the appropriate supportive action.
“This can often help young people avoid the need for specialist mental health services, or can ensure if it is needed, they are referred.
“The third sector organisation 4YP works with both our Suffolk Wellbeing and secondary care services to deliver a child and young person-centred approach to mental health as well as access to other universal opportunities for children and young people – leisure, activities, volunteering and employment.
“Suffolk Public Health has recently led a multi-agency review of the TAMHS (Targeted MH in Schools) project this included NSFT and have a plan around how this will be rolled out.“
Q: We have also heard concerns about the youth service being split into under 14s and 14-25s – differently to how it works in Norfolk. Why was that? Is that the best way to run the service?
A: “Our services have been designed in line with Suffolk County Council’s Children and Families and Youth Pathways. This enables our services to work even more collaboratively with our social care colleagues and third sector organisations, helping local family receive more seamless care.”
NSFT will hold its AGM on Thursday, October 8 at 2.30pm at The Great Hospital in Bishopgate, Norwich and says it will launch a new set of values and behaviours and a new strategy underlining its commitment to placing service users and carers at the heart of everything it does.
On Monday: Why are more children suffering from mental health problems - and what can parents do about it?
If you have experienced mental health problems and are willing to talk about your experiences please call investigations editor David Powles on 01603 772478 or email firstname.lastname@example.org