Agenda item

Gill Mills, Integrated Care Director, NELFT, gave a presentation, which outlined the local position in regards to ‘Tier 4’ provision for Child and Adolescent Mental Health Services and availability of acute and crises inpatient services for young people with mental health problems.  This was particularly in the public eye following press reports concerning a 16 year old girl who having been sectioned had to be held in custody by Police in Devon over a weekend due to a national lack of beds for adolescent mental health crisis.

Since April 2013, CAMHS Tier 4 inpatient beds have moved from being locally commissioned to being nationally commissioned by NHS England (NHSE).  Gill Mills drew the Board’s attention to the map showing provision across the country, from which it could be seen that beds centred around London and the South East and also showed there was demand on local beds from across the country.  A review had been undertaken and as a result NHSE would be tending in the new financial year to increase the number of CAMHS specialist beds by 50.  There would also be three new case managers for the London area.  Overall it would improve the way young people move in and out of specialised care and provide consistent criteria for admission and discharges based on best practice. 

A longer-term strategic review of CAMHS would be undertaken as part of a wider review of specialist services. 

Whilst there are sufficient beds in the London area, for London Children, there was pressure on these beds caused by shortages elsewhere.  This had resulted in children being moved across the country, sometimes over some distance, into those beds.

Brookside, which was one of 10 facilities in London, had 14 beds acute beds and 4 high dependency beds for 12 to 18 year olds who had severe psychological, behavioural or emotional difficulties and also provided a day service.  NELFT also provided the ‘Interact service’ which enables care to be provided in the community and minimised the need for admission.  There had been over 130 admissions to Brookside in the past year and 60% of young people admitted had a personality disorder and work was being undertaken to reduce the need for admission.  The presentation provided details of the admissions from various authorities to Brookside during the twelve month period August 2013 to August 2014 and also the out of area CAHMS beds. 

Gill Mills advised the Board of a pilot scheme which was being run to extend access to services until 9.00 p.m., the results of which would be fed into future commissioning. 

In response to a question Gill advised that wherever possible a local bed was provided for local young people and also that early intervention and support reduced the need for bed admissions.

The Chair commented that she was concerned that because of the national pressure on local beds there was still potential for a 12 to 18 year old being in a cell rather than a hospital bed.  In response Sean Wilson, Deputy Borough Commander, informed of the vigorous risk assessment at point of entry and exit from Police custody and that there were often difficulties on security at hand-over to other partners, which sometimes tied-up several police officers.  Alcohol and drug abuse were also an issue.  Sean Wilson added that he felt that it was highly unlikely for a situation such as had occurred in Devon to occur in the Metropolitan Police area, primarily due to the size of London and the Metropolitan Police.

Councillor Turner asked if there was currently sufficient bed provision locally to meet demand.  Gill Mills responded that general indications were that there was but they were reviewing provision national and locally to see if there was any under capacity for London children in London.

Matthew Cole commented that in the past month there had been over 120 referrals to CAMHS and asked how quickly they had been treated.  Gill Mills advised that all referrals were prioritised and all are seen within the 18 week guidelines.  Matthew Cole said that he was concerned that 18 weeks was a long time for a child to receive help and there could be an escalation to needing a bed or self harm that could be prevented with early support.  Marie Kearns also raised Healthwatch’s concern that whilst young people were initially assessed within the 18 weeks there could then be an eight month wait for treatment.

The Board

(i)  Noted the report and received the presentation, which outlined the local position around the availability of acute and crisis inpatient services for young people with mental health problems, including the nearest local bed provision at Brookside in Redbridge, which was one of ten Tier 4 adolescent units within London and contained 14 acute beds and 4 high dependency beds for 12 to 18 year olds;

(ii)  Noted the review and pilot that was being run in regards to extended hours and local provision, the results of which would be fed into future commissioning.

(iii)  Noted that there was a higher level of bed provision in the London area than in the rest of England and wished to place on record the Boards concern that young people from the rest of the England were being set to London area which was not close to family and friends and the equally young people from London and the South East might be sent out of London due to the pressure for beds.