Dr Uju Ugochukwu & Dr Sarah Maxwell - Developing A Youth Mental Health Service in Norfolk
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This document summarizes the development of a dedicated youth mental health service in Norfolk. Key points include collaborating with young people, clinicians, and commissioners to address gaps in services between child and adult mental health. A pilot program was launched in 2012 to engage those at highest risk aged 14-25 through a range of medical, social, and vocational interventions to prevent admissions. Outcomes and further research were planned to evaluate prevention of long-term social disabilities. Challenges included gaining buy-in from all stakeholders and securing necessary resources.
Dr Uju Ugochukwu & Dr Sarah Maxwell - Developing A Youth Mental Health Service in Norfolk
- 1. Youth Mental Health – setting up a dedicated service in Norfolk Dr Uju Ugochukwu (Consultant Adult Psychiatrist) Dr Sarah Maxwell (Consultant Child & Adolescent Psychiatrist) Norfolk and Suffolk NHS Foundation Trust
- 2. Acknowledgements • Professor David Fowler • Dr Jon Wilson • Debbie White
- 3. Collaborations for Leadership in Applied Health Research and Care For Cambridgeshire and Peterborough (CLAHRC CP) Fellowship • Quantitative mapping project – Description of the characteristics of 14 – 25 year olds within the service – Description of mental health services available to young people in Norfolk • Qualitative Study
- 5. How did it all start? • CAMHS perspective • Problems with transfer to AMHS • AMHS/EI perspective • Young people with emerging disorders who are not psychotic • Central Norfolk EIT - Team C – Service to young people with emerging disorders – Mentioned as an example of good practice in SCIE: http://www.scie.org.uk/publications/guides/guide44/pr acticeexamples/norfolk.asp
- 7. Disease Incidence over Age
- 8. All Referrals - CAMHS and AMHS September 2010 – August 2011 All Contacts – CAMHS and AMHS 800 September 2010 – August 2011 8000 700 7000 600 6000 500 5000 Referrals Contacts 400 4000 300 3000 200 2000 100 1000 0 0 14 15 16 17 18 19 20 21 22 23 24 25 Age Age Ugochukwu O, Maxwell S et al, unpublished, funded by CLAHRC
- 9. Making use of opportunities • New Chief Executive – Visits to various teams (EI, Team C) • Trust vision • Cost Improvement Program • Radical Pathway Redesign – Pathway C • Evidence base - EI
- 10. Clinicians who felt that young people Guiding team were falling through set the ball the gaps rolling Influential manager
- 11. Key people attended • Commissioners, senior managers, senior clinicians • Increased enthusiasm
- 12. Project Management • Project Teams • Stakeholders Group • Youth Advisory Council
- 13. Community resources: Non- Education statutory e.g. Statutory e.g. MIND, MAP PRU, Attendance Health Youth Groups teams Social Care e.g. Probation, TAD S Detection, Liaison and Supervision SPOA: Norfolk Wellbeing services & CAMHS (Includes IAPT) Youth Mental Health Service (Case Management, Assertive outreach, Liaison/Supervision) CRHT / Intensive Support Team Crisis Houses / Alternative to hospital CAMHS Tier 4 / Adult In-patient
- 14. YMH Declaration 2011 - Principles • Belief in young people and their potential • Respect for all young people • Protect young people’s right to participate in processes and decisions that affect them • Commitment to uncovering the strengths within young people, their families and communities • Respect for the right to recovery and social inclusion for all young people • Value the importance of personal, social, educational and employment outcomes • Provide accessible, youth-focused services and supports when and where young people need them • Respect for the rights of family and friends to participate and feel fully involved
- 15. Buy in - stakeholder event in October 2011 Engage with young people, commissioners and other agencies Kevin Davis, Youngminds
- 17. What do our young people want?
- 18. Right information in the right way • Accurate and up to date information – Leaflets, websites • Staff qualifications • Patient rights • Confidentiality Adapted from report “Creating the best mental health service” Kevin Davis, Youngminds. Unpublished
- 19. Location and environment The Junction, Lowestoft • Public transport • Not too close to family • Should not be called a “mental health service” • Bright, airy, comfortable, saf e • “One-stop-shop” Adapted from report “Creating the best mental health service” Kevin Davis, Youngminds. Unpublished
- 20. Accessibility • Flexible appointments • Different ways of getting help – Self referral • Quick assessments • Avoid repeated assessments Adapted from report “Creating the best mental health service” Kevin Davis, Youngminds. Unpublished
- 21. Staff • Honest and reliable • Good knowledge base • Experienced • Caring and understanding • “someone who makes you feel like a person and not an illness” Adapted from report “Creating the best mental health service” Kevin Davis, Youngminds Unpublished
- 22. Young people’s involvement • Youth Council – Supported by Youngminds – Vision statement – Name for service • Involvement in project teams and wider steering group • Interview panels
- 23. funded by CLAHRC
- 24. Focus of 12 month pilot • 3 pilot sites • 14 – 25 year olds with complex mental health problems – HoNOS Clusters 5 to 17 – CGAS score, 50 and below • Caseload – 225 CAMHS and 75 AMHS • Consultant cover will be provided by Adult and Adolescent psychiatrists
- 25. Where are we now? • Start date – April 2012 • Resources – Staff recruitment – Staff training and induction • Partnership/case discussion forums meetings • Website – one stop website
- 26. Aims of the pilot service • Actively engage young people at highest risk of developing enduring mental health difficulties • Offering therapeutic optimism • Provide a range of interventions – medical, psychological, social, vocational, physical health and family interventions • Prevent admission where possible through risk management with the IST / CRHT • Ensure that the young person is linked into appropriate community resources (education, youth groups etc.) • Provide step up and step down support working in collaboration with other statutory and non-statutory agencies
- 27. Outcomes • Waiting times for assessment • Reduction in bed days • Time use questionnaire • Global Assessment of Function (GAF) • Pathway to care • Experience of service questionnaire
- 28. Research • Prevention of long term social disability amongst young people with emerging signs of severe mental illness – A pilot randomised controlled trial of social recovery cognitive behaviour therapy for young people with emerging severe mental illness. (NIHR trials funded, UEA led with Manchester) • Detection and intervention with young people at high risk of social disabling severe mental illness (Programme grant bid, UEA with Manchester & Birmingham) • Professor David Fowler, UEA
- 29. Challenges – NoNo • Resistance from some clinicians – Early engagement is vital • Resources – Time – Cost improvement program – Negotiating for staff from teams with stretched resources • Changing culture and mindset
- 30. Change Management Process Communicate Pull Together Develop the Produce Short- Create a Sense for Empower Create a new the Guiding Change Vision term Wins Don’t Let Up of Urgency Understanding Others to Act Culture Team & Strategy & Buy-in Adapted from www.slideshare.net
- 31. Summary • Young people want to be an integral part of the whole process –Their feedback should make a difference • Early engagement of carers, other clinicians and the third sector is crucial Overall an exciting process!