What is the data telling us?

The Office for National Statistics (ONS) reports the following main findings from its most recent national survey. In 2004, one in ten children and young people (10 per cent) aged 5-16 years had a clinically diagnosed mental disorder:

• Four per cent had an emotional disorder (anxiety or depression)
• Six per cent had a 'conduct disorder', a complex group of behavioural and emotional problems characterised by difficulties behaving in socially acceptable ways normally expected of their peer group. Conduct disorders are often associated with 'oppositional defiant disorder', which is seen as a precursor to more difficult behaviours in adolescence.
• Two per cent had a hyperkinetic disorder (such as attention deficit hyperactivity disorder)
• One per cent had a less common disorder, such as autism, eating disorders or mutism
• About two per cent were found to have more than one type of disorder.
• The survey found few changes from the ONS's previous survey, in 1999.

The research also showed boys were more likely than girls to have a mental health disorder with prevalence increasing as they reach adolescence. Disorders affect 10.4% of boys aged 5-10, rising to 12.8% of boys aged 11-15, and 5.9% of girls aged 5-10, rising to 9.65% of girls aged 11-15 (ONS, 2004).
Mental health problems in children are associated with educational failure, family disruption, disability, offending and antisocial behaviours, and placing demands on social services, schools and the youth justice system.

Source: Children and Young People's Plan Needs Analysis: As of 26th February 2010

• As of February 2010, an estimated 9.5% of all children and young people in Newcastle had at least one mental health disorder.
• Newcastle ranked 77 out of 152 Local Authorities for National Indicator 50: Emotional health and wellbeing in the TellUs Survey 2009. National Indicator 50 is measured by the percentage of pupils with good relationships with friends and family. Newcastle scored 56.1% against the national average of 56%.
• People with current mental health problems are 20 times more likely than others to report having harmed themselves in the past. (National Collaborating Centre For Mental Health).
• Of 545 young people engaged by Newcastle homeless charity DePaul UK in 2009, approximately 40% of these had one or more mental health issues.

 Trends

• Rates of mental health problems among children increase as they reach adolescence.
• Disorders affect 10.4% of boys aged 5-10, rising to 12.8% of boys aged 11-15, and 5.9% of girls aged 5-10, rising to 9.65% of girls aged 11-15. Source: Mental Disorder More Common In Boys, National StatisticsOnline (2004).
• The number of under 18 year olds who are admitted to adult wards has decreased: 2005/06 - 8; 2006/07 - 6; 2007/08 - 5.

 

Source: Newcastle Young People's Drug and Alcohol Services Local Needs Assessment November 2009. 2009/10 data sourced from local Newcastle Youth Offending Team data - 30/09/2010 Newcastle CAMHS is structured according to the National 4-Tier framework


The 4-Tier Strategic Framework for CAMHS and the corresponding services available in Newcastle (Source: DoH, NSF for children, young people and maternity services, Standard 9)

Mental Health Grant (MHG) notional allocation in Area Based Grant (ABG)


*The significant drop in the DCSF CAMHS grant between 2007 and 2008 is because Newcastle's ranking has moved from the 20th to the 37th worst of the 354 Local Authorities for multiple deprivations.
 
Graph 1: The estimated CAMHS budget per 0-17 year old in the year 2009/10.


       (Source: Children's Service mapping, 2010)
In the North East, the estimated budget spend per 0-17 year old is significantly higher (£81) than the England average (£44).

Graph 2: The estimated CAMHS cases to 0-17 population in the year 2009/10.
(Source: Children's service mapping, 2010)
 

• In the North East, the estimated number of CAMHS cases in 0-17 population is significantly higher (14.3) than the England average (10.8).
• Windscreen model of CAMHS services have been completed and are available overleaf.
• NTW community CAMHS has a current waiting list of 153 (September 2010).
• In the year 1st April 2009 - 31st March 2010 there was exactly 100 referrals to Newcastle CAMHS self harm service. This was down from 106 the previous year.

Table 4 below shows the percentages of primary presenting disorders to CAMHS (Tiers 2 and 3) from the 2009/10 CAMHS mapping exercise in Newcastle.



During the 09/10 CAMHS mapping exercise, the length new cases in Newcastle had to wait to be seen by various teams is shown in table 5 below.

What is the story behind the data?

Despite overall improvements, there remain big differences in health between those at the top and bottom ends of the social scale. Alongside social factors there are many other 'risk factors' that make some children and young people more likely to experience problems than other children, but don't necessarily mean difficulties are bound to come up or are even probable.
Child risk factors include:

• Poverty
• Family breakdown
• Single parent family
• Parent mental ill health
• Parent criminality, alcoholism, or substance abuse
• Overt parental conflict
• Lack of boundaries Frequent family moves/being homeless
• Over protection
• Hostile and rejecting relationships
• Failure to adapt to the child's developmental needs
• Death and loss, including loss of friendships
• Caring for a disabled parent.

(Royal College of Nurses: Mental Health in Children and Young people, 2009)

• Young people from Black and minority ethnic communities experience a disproportionately high level of factors that are known to put people at risk of developing mental distress, such as exclusion from school and homelessness (Afiya Trust 2010, Department of Health 2008).
• Children and Young People in care experience significantly worse mental health than all children. One study found 45% of children in care aged 5 to 17 have mental disorders, over 4 times higher than for all children. 

Stigma and Discrimination

The latest national statistics on Attitudes to Mental Illness produced by the Department of Health were released on May 8, 2008. Some key findings from the report:

• 1 in 8 people would not want to live next door to someone who has had a mental health  problem
• Nearly six out of ten people describe a person with a mental health problem as "someone who has to be kept in a psychiatric or mental hospital"
• One third of people think people with mental health problems should not have the same rights to a job as everyone else.

A study by YouGov Plc, 2009, indicated a shocking 92 per cent of the British public believes that admitting to having a mental illness would damage someone's career.

A further study by anti-stigma campaigners Time to Change asked more than 2000 people around the UK to imagine that they were interviewing someone for a job, and the interviewee admitted that from time to time they suffered from depression. Despite the respondents considering this person the best candidate for the job, more than half (56 per cent) would not employ them because of their mental illness.

• 17 per cent would not offer the 'best candidate' the job because they considered that mental illness would make them unreliable,
• 10 per cent would worry that if the employee took time off sick, they'd get the blame for employing them.
• 15 per cent worried that they wouldn't work as well as other employees, or that other employees would react negatively towards them, undermining team morale.

Other issues associated with the stigma surrounding mental health include:

• Prevents people seeking help, Delays treatment, Impairs recovery, Isolates people, Excludes people from day-to-day activities

• Certain groups of children and young people are at greater risk of suffering from a mental health problem.
• Emotional problems are more prevalent in children and young people in families undergoing other stresses, such as poverty and family breakdown.
• An ONS survey carried out in Great Britain in 2004 covered children aged five to 16, and found that 11 per cent of boys had a mental health disorder, compared with 8 per cent of girls. Older children and young people were found to be more prone to a mental health disorder than younger children.
• 1.9 per cent of all children had more than one disorder (i.e. one in five children with a disorder).
• Children with an emotional disorder were more likely to come from a single parent family (31 %, compared to 15 % for children with no emotional disorder), and 54 per cent lived in households with incomes under £300 per week. The survey also found that children with an emotional disorder were more likely to suffer poor physical health (23 %, compared to 5 % of children with no disorder). There were no significant differences between ethnic groups.
• It found that the prevalence of mental health problems was higher among children in families where neither parent worked (20 %) compared to those in which both parents worked (8 %), and one parent worked (9 %). Sixteen per cent of children from families with a weekly household income of under £100 suffered from mental health problems, compared to 5 per cent with a weekly household income of more than £600.
• Educational qualifications of the parent, especially the mother, has a strong impact on prevalence of mental health problems. The ONS survey showed a rate of 17 per cent among children whose parent had no educational qualification, as opposed to 4 per cent among those with parents educated to degree level.
• Family make-up can also impact on the mental health of children and young people. Prevalence rates of mental health problems were higher in children from single parent families (16 %) compared to married couple families (7 %).
• The ONS survey found no difference between ethnic minorities. The National Service Framework however, explicitly mentions the need of appropriate mental health provision for families that are seeking asylum and refugees, particularly those from war torn countries. It also emphasises the needs of varying cultures due to the differing concepts of mental illness and understanding.
• The National Service Framework also recognises the needs of those children and young people, such as those in special circumstances or those with learning difficulties and/or disabilities, who are at greater risk of developing mental health problems.
• Marryat and Martin, 2010 found significant associations between outcomes for children and the brief exposure to maternal mental ill-health, but the outcomes for children were less marked than for those repeatedly exposed to a mother with mental health problems. This gradient in differences in outcome suggests that the impact of maternal mental health on children's development may be causal. It was not possible to explore how or why maternal mental health impacted on child outcomes, but they postulate that deficits in attachment may play a role by disrupting the mother-child relationship, inhibiting the nature and quality of their interactions.

 The risks of not improving child mental health include:

• Failure at school
• An increase in alcohol and drug abuse
• Family discord
• Violent behaviour
• Increased exposure to the criminal justice system
• Increased non-mental health problems
• Increased Suicide

In addition, preventive measures have the potential to reduce the economic burden of mental illness.

If these measures are not met the economic burden increases and leads to a reduction in economic productivity.

Local Views

Children, young people and parents want mental health services which are accessible, provide

support when needed and involve them as service users. They also want to know what services are available to them (National CAMHS Review, 2009).

'Young People's Survey 2010', Newcastle. A survey was constructed based around the You're Welcome criteria. All young people accessing various practices within a 2 week period were given the opportunity to complete a survey. Survey results will be posted up in each practice waiting room and online.

In a 4-day You're Welcome consultation task completed in the waiting area at Benton House by NTW Community CAMHS, the following views of young people using the service were accumulated:

• Was this venue easy to access by public transport - 12 yes, 2 no
• Do you think easily accessible for YP with a disability - 22 yes, 0 no
• Do you think service provided in a safe and suitable environment - 20 yes, 0 no
• Are you comfortable coming to this building - 19 yes, 2 no
• Do members of staff offer advice and information to help you make decisions - 19 yes, 1 no
• Is the waiting area young person friendly and have suitable reading material available - 27 yes, 0 no
• Did you see any info about confidentiality - 0 yes, 17 no
• Were confidentiality and limits explained - 15 yes, 0 no
• Did you find staff welcoming and friendly - 25 yes, 0 no
• Did staff introduce themselves and explain what they can do to help - 11 yes, 4 partially, 7 no
• Do you know how to make suggests / comments or complaints about the service - 7 yes, 12 no
• Did you know that you can decide who attends appointments with you - 13 yes, 7 no
• Did you know you can be seen alone? - 17 yes, 1 no
• Would you encourage your friends to use this service if they needed - 19 yes, 0 no

Key themes revealed by the surveys:

• Lack of knowledge about the rights of young people in healthcare e.g. right to attend at least one appointment without parent or carer involvement.
• Lack of knowledge/publicity information about confidentiality and the limits of confidentiality.
• Lack of knowledge about how service users can comment/complain about the service.

What are the gaps in data?

It has been identified that there are some limitations with data for Newcastle CAMHS services entered in the CAMHS mapping 2009/10 exercise. In particular, there are gaps surrounding the availability of perinatal mental health and infant mental health services in Newcastle. This data can be uploaded at:http://www.childrensmapping.org.uk/dataentry/

What are the national and local drivers?

Newcastle Children's Plan 2009-2010, focuses strongly on the five outcomes identified in the 2003 Government's Green paper: Every Child Matters, stating that all children and young people should:

• Be healthy. Enjoy the best physical, emotional, mental and spiritual health and development, so that they feel good about themselves and their lives.
• Be safe. Be safe and protected from harm within their families, communities and the City as a whole.
• Enjoy and achieve. Realise their ambitions, enjoying and achieving in all areas of life.
• Make a positive contribution. Take an active part in positive opportunities presented in all areas and stages of their life and the life of the community, and be valued for their contributions.
• Achieve economic well-being. Be actively protected from discrimination in order to live free from poverty and hardship.

This vision is reflected in Newcastle Partnership's Sustainable Community Strategy (SCS) and Local Area Agreement (LAA), as well as many other strategies, policies and strategic plans.

Newcastle Local Area Agreement (LAA) Refresh March 2010 has a number of priority objectives relevant to children's mental and emotional wellbeing:

• Improving mental health and emotional wellbeing
• Reducing the harm caused by alcohol, drugs and other substances 
• Delivering stronger individuals, communities and better services through partnership working 
• All children and young people are physically and emotionally healthy
• All children and young people are safe from bullying and discrimination
• All children and young people live in families that are free from financial poverty and material deprivation 

National CAMHS Review looked for practical but far-reaching ways to improve the mental health and psychological well-being of all children and young people with the aim to be able to assure children, young people and their parents and carers that, in future, will all be able to expect:

• Universal services that recognise the importance of mental health and psychological well-being
• Services they can access before things reach crisis point
• To be listened to and involved in decisions about services
• The opportunity to develop trusting, ongoing relationships with one or two key individuals
• The necessary information tools and support to 'navigate the system'
• To be treated as individuals with a range of strengths and needs, and as members of their wider families.

The National Service Framework for Children Young People and Maternity Services which was published in September 2007 by the Department for Health, Education and Skills, sets out national standards for children's health and social services. It proposes the following standards for the care of children and adolescents.

• Standard 1: Promoting Health and Well-being, Identifying Needs and Intervening Early. The health and well-being of all children and young people is promoted and delivered through a co-ordinated programme of action, including prevention and early intervention wherever possible, to ensure long term gain, led by the NHS in partnership with local authorities.
• Standard 2: Supporting Parenting. Parents or carers are enabled to receive the information, services and support which will help them to care for their children and equip them with the skills they need to ensure that their children have optimum life chances and are healthy and safe.
• Standard 3: Child, Young Person and Family-Centred Services. Children and young people and families receive high quality services which are coordinated around their individual and family needs and take account of their views.
• Standard 4: Growing Up into Adulthood. All young people have access to age-appropriate services which are responsive to their specific needs as they grow into adulthood.
• Standard 5: Safeguarding and Promoting the Welfare of Children and Young People. All agencies work to prevent children suffering harm and to promote their welfare, provide them with the services they require to address their identified needs and safeguard children who are being or who are likely to be harmed.
• Standard 9: The Mental Health and Psychological Well-being of Children and Young People. All children and young people, from birth to their eighteenth birthday, who have mental health problems and disorders have access to timely, integrated, high quality multidisciplinary mental health services to ensure effective assessment, treatment and support, for them, and their families.

NHS North of Tyne Annual Operation Plan 2009/10

The North of Tyne annual operational plan sets out the developments being planned over the next year to improve health and well-being and health services across Newcastle, North Tyneside and Northumberland. The plan has been drafted in line with national and local priorities and reflects discussions we have had over the past year with key partners including members of the public. Some of the key initiatives aimed at improving services and support for children and young people with complex needs include:

• Implementing a North of Tyne Intensive Community Treatment Service (ICTS)
• Comprehensive and integrated local CAMHS to improve the emotional health and wellbeing of children and young people, especially those with eating disorders.
• Integrated services for those with learning disability or difficulty (LDD) and therapeutic needs. This includes safeguarding vulnerable children and young people and ensuring smooth transition into adult services
• Provide care and support for children and young people with complex health needs to improve quality of life, as per the National Strategy 'Aiming High for Disabled Children'.

The focus on CAMHS in 2010/11 will be to have regard to the full Government response to the CAMHS Review, in particular the best practice guidance on reducing waiting times in CAMHS and the use of outcome measures to identify effective practice (as per DH Operating Framework guidance). From 2011/12 onwards North of Tyneside will invest to further develop a comprehensive CAMHS in all 3 primary care organisations to ensure that national performance targets for the emotional health and wellbeing of children and young people are delivered, recognising that North Tyneside is currently below target.

We will also review our service offer in line with the child health strategy 'Healthy Lives, Brighter Futures', and the national rollout of Sure Start Children's Centres, and ensure that from 1 April 2010 no 16-17 year olds are treated on adult psychiatric wards unless such an admission is in accordance with their needs (DHOF).

Newcastle CAMHS Strategy

CAHMS strategy 2008/11 for Newcastle sets out a number of priority areas for development, taking into account the priorities identified for improvement and action in the APA Self Assessment 2008:

• Increase capability and capacity in universal (Tier 1) services for prevention and early intervention.
• Increase capacity at Tiers 2 and 3 to build capacity for training and advising practitioners working in Tier 1.
• Implement NICE recommendations for conduct disorders.
• Implement a pathway for children with ADHD building on the achievements of the pilot project, working in partnership with parents.
• Manage demand for high cost low volume services through implementation of a High Care Needs process for children and young people requiring CAMHS.
• Ensure access for all, especially those who do not access current services.
• Implement You're Welcome (A self-assessment toolkit for services working with young people to help improve sexual health services for young people).

Commissioning Early Intervention Support Services

In response to the independent CAMHS review in 2007, the government published 'commissioning early intervention support services: Guidance for commissioners 2010' which provides information for commissioning managers in local authorities and primary care trusts to help assess whether The local authority and PCT work in partnership to commission a full range of early intervention support services, delivered in universal settings and through targeted services, for children experiencing mental health problems.

This paper recommends that commissioners should work with others to:

• Assess the current position of your area in relation to the delivery of comprehensive early intervention support services (using the grading system outlined in Section 4)
• Discuss the service specification proposed in this  guidance and its relevance to your local circumstances and needs
• Map the services currently in place in your area which aim to promote psychological wellbeing and mental health, and prevent problems escalating
• Define a comprehensive early intervention service for your locality
• Set priorities for action between now and 2011.

Improving Health is Everyone's Business

Newcastle Wellbeing and Health Partnership and the Local Strategic Partnership (LSP) for Newcastle agreed a ten-year health improvement strategy for Newcastle 2007 - 2017 on the national priorities set out in the DoH White Paper "Choosing health: making healthy choices easier" identifying "improving mental and emotional wellbeing" as the number one priority area for Newcastle identifying four specific subsidiary priorities (Objectives). The Mental Health Improvement Delivery Group produced an action plan to achieve the four priority objectives in Improving Health is Everyone's Business within the key settings of schools & higher education facilities and the community:

Objective 1: To reduce the stigma associated with mental ill health

• Audit content of Personal, Social and Health Education (PSHE) curricula in relation to addressing stigma and present results at an event promoting best practice.
• Use World Mental Health Day to promote use of Anti-Stigma Campaign materials and launch a campaign on the impact of mental health in Newcastle.
• "Mind the Gap", a museum exhibition on the history of mental health in Northumberland ran from October 2008 to January 2009.Self esteem classes to be integrated into Improving Access to Psychological Therapies (IAPT).
• Self esteem classes to be integrated into Improving Access to Psychological Therapies (IAPT).

Objective 2: Promote self-esteem and positive mental health

• Roll out of Department for Children Schools and Families (DCSF) Social & Emotional Aspects of Learning (SEAL) Programme in city schools
• Continue the effective work of the RESPONSE Anti- Bullying Team and Behaviour Improvement Programme (BIP).
• Increase the opportunity for people to have a say about priorities and services through participatory budgeting.

Objective 3: Prevent the development of Mental Illness (at risk groups)

• Develop an approach to identifying and managing children "at risk" of developing mental ill health including people who have suffered or are suffering, violence, abuse or trauma. Also develop approaches to post natal depression.
• Develop a systematic approach to working with children and parents during the transition from primary to secondary schools and with 'looked after children' in the transition to independent living at age 18.
• Build on the success of the Tyne Bridge Suicide Prevention initiative.
• Raise awareness and increase skills in service providers so that they are able to identify and support those at risk.

Objective 4: Encourage early intervention and self-help to prevent unnecessary distress and to prevent progress of the illness

• Ensure individualised coordination of services for young people with mental health difficulties at all levels.
• Ensure information about services is available to schools, parents, children and young people and work with HE institutions to develop support and early intervention systems.
• Increase the range and availability of non- pharmaceutical treatments for mental health problems (to include talking therapies and physical activity programmes).
• Ensure that evidence based self help materials are available in local venues e.g. libraries and GP surgeries.
• Offer an annual Health check for people on Mental Health Register (QOF)
• Establish a recovery orientated approach for people with mental illness including improved diet physical health and smoking cessation.

What is currently working here or elsewhere?

Recent waiting list audits from Newcastle Community CAMHS, has shown significant decreases in children and young people waiting to access their services. Following various interventions the waiting list has currently 'turned the curve' however; further reviews are required to ensure the turn-round is ongoing.

• Recent audits of children's service in Newcastle by Ofsted have revealed that the services are "performing well, and exceeding minimum requirements, with the effectiveness of CAMHS services remaining good". This annual assessment of children's services is derived from the performance profile of the quality of services and outcomes for children and young people in each local area.

• In early 2011, NTW Community CAMHS will fully implement The Choice and Partnership Approach (CAPA) model. CAPA states that: "Children and young people with mental health problems represent some of our most vulnerable people. Their mental health is of paramount importance to the future health, wellbeing and prosperity of our society. However many people in this position may find it difficult to access professional support services. A clinical system that aims to improve the efficiency and applicability of Child and Adolescent Mental Health Services may potentially influence service provision for the better. CAPA aims to improve mental health services by increasing service efficiency and by placing the needs of children, young people and their families closer to the centre of the decision making process. The system uses quality parameters combined with processes to facilitate pathways through the service, avoiding unnecessary waits. It attempts to place families at the centre of CAMHS and there is a shift in perception from "clinician with power" to "facilitator with expertise". CAPA has 11 components which revolve around the themes of management, choice appointments, transferring families to partnership appointments, conducting partnership appointments, appropriate discharge and the importance of team away days."In Newcastle, Health visitors and 2 pilot site children's centres are currently undertaking the Solihull Approach foundation training, which is a recognised early/brief intervention approach for use with families experiencing mild - moderate difficulties with behaviour, sleep, feeding and toileting. This approach is also used to address relationship difficulties in the parent/child relationship. The fact that this is being rolled out on such a wide scale is a new way of working and one that should hopefully see a reduction (long term) in referrals to CAMHS and community paediatrics for behavioural difficulties. As it is an early intervention model, one would also hope to see a long term reduction in conduct disorder and

• The CAMHS partnership has ensured that shared quality assurance systems are incorporated within service specifications and contracts. One of these assurance systems is the requirement for all CAMHS services to implement You're Welcome. You're Welcome is a quality criteria which sets out principles that will help health services (including non-NHS provision) become young people friendly. It covers areas to be considered by commissioners and providers of health services. Content is based on examples of effective local practice. This second edition includes a new section covering Child and Adolescent Mental Health Services. You're Welcome has also been included in the NHS Operating Framework for 2009/10 and highlighted in DH/DCSF Healthy lives, brighter futures - the government strategy for children and young people's health. Some services have already undertaken and implemented You're Welcome (Streetwise) with others going currently at various steps within the process (Newcastle community CAMHS).

• In Newcastle, Health visitors and 2 pilot site children's centres are currently undertaking the Solihull Approach foundation training, which is a recognised early/brief intervention approach for use with families experiencing mild - moderate difficulties with behaviour, sleep, feeding and toileting. This approach is also used to address relationship difficulties in the parent/child relationship. The fact that this is being rolled out on such a wide scale is a new way of working and one that should hopefully see a reduction (long term) in referrals to CAMHS and community paediatrics for behavioural difficulties. As it is an early intervention model, one would also hope to see a long term reduction in conduct disorder and mental health problems but as this a long term outcome, this has not been evidenced as yet.

• NHS North of Tyne has successfully procured a new Child and Adolescent Community Intensive Treatment Service for Newcastle, North Tyneside and Northumberland. The contract has been awarded to Northumberland Tyne and Wear Foundation Trust for a period of three years. Children, young people and their families will access this new service via an enhanced CAMH pathway for approx 12 weeks of intensive community treatment as 'stepped up' provision from their existing Tier 3 specialist community service or to facilitate discharge from In-Patient Treatment. The Service begins full operational delivery in April 2011. This exciting development aims to:
  • Reduce out of area placements
  • Reduce in-patient admissions
  • Facilitate earlier discharge from in-patient admissions
  • Offer a service within service user's own homes and communities.
  • Provide evidence-based and effective highly specialist mental health care to those children, young people and families with acute, severe, and complex health care needs to achieve the best outcomes
  • Provide a crisis response to those in need of urgent intervention
  • Provide integrated care packages in partnership with children's services in each

• The NHS White Paper "Equity and Excellence: Liberating the NHS" will create far reaching reforms of the NHS and Newcastle Children's trust will need to respond to the change to ensure CAMHS is a priority in the new system.

What should we be doing next?

• As highlighted in the windscreen model, there remains a gap in services which provide parents and carers with an understanding of emotional development and mental health of their children.
• As suggested by various health professions and services attending the CAMHS partnership and other events, there seems to be a persistent lack of success around streamlining the transition of young people to adult services.
• Two service user consultation exercises highlighted some recurring themes surrounding the communication and publicity of issues such as confidentiality and rights of young people in healthcare.
• An estimated 40% of homeless young people in Newcastle have identified mental health needs with different organisations using different techniques/services to support this need.
• A consultation event held with BME individuals using services in Newcastle and Gateshead concluded that often young people do not hear about available health services and developments unless they attend their G.P's more than often.
• There is a perception that we need to review the targeted and specialist services for 0-5 year olds. There are some limitations with data for Newcastle CAMHS services entered in the CAMHS mapping 2009/10 exercise. In particular, there are gaps surrounding the availability of perinatal mental health and infant mental health services in Newcastle. Newcastle Community CAMHS is a 0-18 service and is therefore not included on this area of CAMHS mapping. "Infant mental health" is defined as the healthy social and emotional development of a child from birth to 3 years; and a growing field of research and practice devoted to the:promotion of healthy social and emotional development, prevention of mental health problems; and treatment of the mental health problems of very young children in the context of their families. (Zero to three Task Force, 2001)

  Summary conclusions

  The following recommendations are based around the findings of the needs assessment conducted by the Newcastle CAMHS partnership in October 2010. 

  • Researchers believe that there is a critical and sensitive window of brain development in an infant with the first 2 years being the critical period. (Schore, 2001). Early intervention with families experiencing difficulties is essential as early as possible while the brain is still developing. Due to the need for experience to determine which synapses are active, the parents have a direct effect on which pathways are 'hard wired' in the baby's brain. Lack of interaction and stimulation from parents will usually result in a child not achieving the normal emotional and physical developmental milestones. Getting the first, prototypical relationship of anyone's life more or less right is a necessity, not a luxury. (Balbernie, R 2004).
  • Early intervention with families experiencing difficulties is essential as early as possible whilst the brain is still developing its 'wiring'. Later intervention means some plasticity does exist but it takes longer and interventions may be more costly. There is a growing evidence base that demonstrates how early, targeted and strength based interventions focussing on relationships can bring about positive changes in the emotional environment of vulnerable babies.
  • With increasing research mounting on the association that maternal mental health can affect children's emotional well-being and their cognitive and behavioural development in particular ways, further analysis of our own data would provide a better perspective as to the needs within Newcastle.
  • With growing evidence surrounding the association between mental health needs and speech, language and communication needs, some work around the current provision is required to ensure the estimated need is being met effectively.
  • Some attention needs to be focussed towards developing services which help further the understanding of mental health for parents and carers of service users.
  • Build on the work currently being completed to improve and streamline the transition process from children and young people services to adult services.
  • Services need to apply some focus onto improving young people's knowledge of confidentiality and the limits of confidentiality, especially the availability of publicity within waiting areas and consultation rooms.
  • Furthermore, services need to increase the knowledge of young people's rights in healthcare, for example, that they can be seen alone, and chose who attends consultation with them.
  • A north east BME consultation group recommends that information about how to use health services, and about service changes and developments, should be more readily shared with local young people through communication and partnership work with local young people's projects, schools, colleges, pharmacists and initiatives such as Connexions.
  • It has been identified that there are some limitations with data for Newcastle CAMHS services entered in the CAMHS mapping 2009/10 exercise. In particular, there are gaps surrounding the availability of perinatal mental health and infant mental health services in Newcastle. This data can be uploaded at: http://www.childrensmapping.org.uk/dataentry/