Report of the Director of CAMHS (Child and Adolescent Mental Health Services)

This report builds on the report to Scrutiny Committee on 20 July 2022 and provides an update on the exploration of the impact of COVID-19 on children and young people’s mental health and well-being. Within this paper evidence suggested that children and young people’s mental health and wellbeing has been substantially impacted during the pandemic, which has resulted in higher prevalence, demand and acuity (complexity) for CAMHS.

The Committee considered a report and presentation of Al Ford, Director of CAMHS (Child and Adolescent Mental Health Services) which built on the report to the Committee on 20 July 2022 and provided an update on the exploration of the impact of COVID-19 on children and young people’s mental health and well-being.  Within this paper evidence suggested that children and young people’s mental health and wellbeing had been substantially impacted during the pandemic, which had resulted in higher prevalence, demand and acuity (complexity) for CAMHS.

Key points and themes in the report and presentation included:

·         Information on the impact of COVID-19 on children and young people’s mental health and well-being;

·         Manchester CAMHS waiting time and demand; and

·         CAMHS response and transformation.

Some of the key points and themes that arose from the Committee’s discussions were:

·         To welcome the work taking place;

·         Work in relation to development trauma and Fetal Alcohol Spectrum Disorder (FASD);

·         Waiting times and cancelled CAMHS appointments;

·         Medication shortages for Attention Deficit Hyperactivity Disorder (ADHD);

·         The role of schools in supporting children and young people, and support for schools; and

·         The under-representation of males in the children and young people receiving treatment from CAMHS.

The Chair advised Members that the Committee would receive a report on FASD at a future meeting.

Al Ford, Director of CAMHS reported that CAMHS was not commissioned to provide a FASD service but that his service was developing a business case in relation to this as it was recognised that there was a gap in the health system in relation to FASD.  He informed Members that children who did not have the typical physical symptoms of FASD were often misconstrued as having autism or ADHD and that the service had a social development clinic which worked with children who were difficult to diagnose and that this clinic could diagnose FASD.  In relation to trauma, he reported that Greater Manchester was signed up to be a trauma-informed region and that CAMHS had a whole workforce transformation programme around trauma-informed practice.  A Member commented that autism could arise from FASD and that these were connected.  She also emphasised the importance of diagnosing developmental trauma.

The Executive Member for Early Years, Children and Young People suggested that a larger piece of work on FASD was needed, involving both social care and health, and he asked the Strategic Director of Children and Education Services to discuss this further with the Member who raised it and CAMHS outside of the meeting.  He expressed concern that children’s well-being was not prioritised by the Government during the pandemic and that the COVID-19 Inquiry was not sufficiently focusing on this.  He also highlighted the impact of the cost-of-living crisis and rising poverty on children’s well-being.

The Chair supported the Executive Member’s comments about children not being prioritised during the pandemic.

Al Ford confirmed that the service kept a record of all cancelled appointments, whether they were cancelled by the service or the family, reporting that capacity issues and industrial action had led to some appointments being cancelled.  He informed Members that the service had a high level of demand and a finite capacity so had to prioritise children with the highest level of clinical need, meaning that some families were waiting for two years.  He stated that he recognised that this was an unacceptable length of time to wait for diagnosis but that the service had been successful in receiving an NHS Pathfinder Pilot Award to develop an under-5s programme, delivering intervention alongside assessment, which was cutting assessment times by 50% and providing help and support upfront.  He reported that Manchester Foundation Trust was seeking to stockpile an amount of ADHD medication for the most clinically vulnerable and that prescribers were being encouraged to move away from prescribing branded drugs and use alternatives as well.  He informed Members that communications were being sent out in relation to this issue, including to schools, and offered to provide further information on this.  He stated that it was hoped that the medication shortage issue would be resolved by the end of the year.

The Executive Member for Healthy Manchester and Adult Social Care highlighted some of the key issues within the report and how he was responding to these, including informing Members about discussions taking place on how the Council could work in partnership with CAMHS on a whole-system approach. 

Al Ford reported that Manchester Thrive in Education was currently providing support to 35% of schools in Manchester but that there was a commitment in the NHS long-term plan to cover all education settings, while recognising that this required a major workforce expansion.  He informed Members that Manchester was further ahead on this work than most areas and that, as long as the national Government remained committed to this agenda, he was confident that all education settings in Manchester would have a Mental Health Support Worker within the next 5 to 7 years.  He informed Members about a pilot project taking place in the Pupil Referral Unit, advising that education settings with greater need were being prioritised for quicker and more intensive support.  In response to a question from the Chair, he informed Members that some primary schools were already covered by Manchester Thrive in Education and that all education settings in Manchester could contact the Mental Health Support Team Leads to obtain consultation support  He reported that schools could access CAMHS digitally or by telephone and that schools were encouraged to have a Mental Health Champion in their senior leadership team who could act as a conduit between the mental health support system, including CAMHS, and the school.  In response to a question from the Chair, he offered to circulate contact details to schools via the local authority, in case any were not clear on who to contact with regards to mental health issues.  He recognised that the large-scale transformation programme would require a large communications strategy to ensure schools were aware of the changes and how to access to the right support.

In response to questions from the Chair, Victoria Smith, Greater Manchester Integrated Care, reported that most of the schools already covered by Manchester Thrive in Education were secondary schools and that expansion had to be incremental as there was not capacity to provide this to all schools at present, although other support was available to all schools.  She confirmed that schools did not pay for Manchester Thrive in Education but could pay for additional support.

In response to a Member’s question about looking for alternative approaches and best practice from elsewhere, Al Ford reported that his service was a national pathfinder on a number of initiatives and was happy to taking learning from elsewhere.  In response to a Member’s question, he provided information on the Adoption Psychology Service, advising that the service provided support to children living up to 40 or 50 miles from Manchester, and he offered to provide additional information on this service.  In response to a further question, he provided information on the well-being support available to CAMHS staff.  He reported that the under-representation of males in those receiving treatment through Manchester CAMHS reflected the national picture and that the service had a 16+ service which provided outreach to teenagers who were not accessing its services.  The Chair commented on the level of suicide among young men, the other support which was available such as CALM and some of the ways that could be used to communicate this, such as billboards and social media.

The Chair expressed concern at the increase in students struggling with mental health and that teachers were having to deal with these issues on a regular basis.  She also expressed concern at the increase in eating disorders.  Al Ford reported that eating disorders had worsened due to the pandemic, when families had been unable to access early intervention and prevention, but that post-pandemic there was still a higher prevalence of eating disorders, not only in Manchester, for a range of reasons, including the increased pressures on children and young people.  In response to a question from the Chair about staff absences, he reported that a third of his service’s absences were due to stress and anxiety and that the service was providing programmes of work to ensure that its staff stayed healthy and in work. 

In response to a question from the Chair about Educational Health and Care Plans (EHCPs), the Strategic Director of Children and Education Services reported that 78% were completed on time, which compared favourably to comparable local authorities, and that this was at a time of increased demand, without additional resources.  He suggested that the Committee receive a report on children with Special Educational Needs and Disability (SEND) at a future meeting. 

Decision

To note the report and support actions that enable services, including education settings, to collaborate effectively to meet the emotional wellbeing and mental health needs of children and young people.

[Councillor Nunney declared a personal interest as an employee of Manchester Foundation Trust.]

[Councillor Reid declared a personal interest as a Governor of Manchester Foundation Trust.]