Families of Doncaster youngsters with mental health problems ‘not getting support they need’
Families of Doncaster youngsters with mental health problems are warning that they are not getting the support they need.
In part two of the Free Press’ round table on mental health, one mum tells of the failings she feels she has faced, ihealth bosses outline the improvements they are bringing in to turn things around
Our panel at the NHS’ Woodfield House, Balby, was: John Bottomley, associate medical director, Rotherham Doncaster and South Humber Healthcare Trust; Rupert Sucklin, Doncaster director of public health; Annika Leyland, mental health social worker, Doncaster Council; Lee Golze, head of strategic commissioning and transformation, Doncaster Council; Stephen Emmerson, head of strategy and delivery, adult mental health, NHS Doncaster Clinical Commissioning Group; Andrew Goodall, chief operating officer, Healthwatch Doncaster; Melanie Hinchcliffe, GP, Lakeside Practice, Askern; and Glyn Butcher, Wendy Robinson and Amanda Pratt, all peer ambassadors, Doncaster People Focus Group. Free Press community engagement editor David Kessen chaired.
Wendy Robinson: “I’m a carer for my daughter. She’s 15 and has mental health issues. It’s a struggle for me to get help. My daughter’s under CAMHS – Child and Adolescent Mental Health Services – and has been for three years, and it’s the support that has been a big struggle for me as a carer.
“My daughter's got support, but she’s not had a support worker at CAMHS now for six weeks, because the lady left, so she's not had that support.
“She’s just been allocated a new support worker. This is going to be her 16th support worker at CAMHS. How can you expect a young girl to have a connection with that person? She's got severe anxiety, they say.
“But as a carer I can see different things happening with my daughter. She talks to people in the corner of the room and thinks people are tapping her on the shoulder. CAMHS just put it down to anxiety.
“As a mum, that’s concerning to me. She’s self harming on a daily basis and I feel like my daughter is just lingering, going round in a circle and not moving forward. I ask about medication and things like that and they say she’s at a young age and they don’t want to give her any, but they're not seeing her on a daily basis. It’s heart-wrenching.”
Andrew Goodall: “If you could make the changes to health services, what would they be?”
WR: “More help. Sh’s been with support workers that she can’t connect with because they’re leaving the service. She’s not had one for six weeks. Who does she go to? There’s only me she can speak to and I'm not medically trained.
“I had to take my daughter to A&E two months ago. I had to go through the single point of access team. She was having thoughts about harming herself. I took her to A&E and someone said they would come out from CAMHS to assess her . Not one person came out from CAMHS to asses my daughter. They rang her over the phone.
“How can a young girl, or an adult, be assessed over the phone? They’re going to say oh yes, fine, hunky dory. That’s how it went. It’s not good enough. We had to sit in A&E for three to four hours. When you’re in crisis and you’re not very well that is not a good way to go.”
AG: “Some of the things you’ve said were echoed in conversations we’ve had with people around more support being needed for children and young people in schools, not just in Doncaster but across South Yorkshire. So what needs to change and improve with CAMHS?”
Lee Golze: “A survey nationally revealed a million young people aged 11-18 said mental health was their second priority or area of concern, and I think that is echoed locally.
“Emotional wellbeing and mental health is a significant issue of concern. We know there have been significant developments in children’s wellbeing and metal health over the last three or four years, linked to Future in Mind, a Government document about how we improve children’s mental wellbeing.
“It highlighted factors you’ve raised and how we get continuity of care for young people, how we make sure there is wraparound care for children in crisis, 24/7, and how we link in the support you get between education and schools.
“It’s not always a medical diagnosis, but sometimes a mental health issue around something else. How do we all work together with peers and schools, providing good resilience and wellbeing? While there are still improvements to be made, there are things worth pointing out.
“One is around crisis care, and if children do end up in hospital, or A&E, there are significant developments we are looking at around enhanced foster care provision, for better 24/7 provision within hospitals.
“They will mean that it’s not an-over-the-telephone conversation and people will come and do face to face assessment. We acknowledge what you’ve identified around this.
“But Doncaster is one of 26 areas nationally to be a site for a mental health pilot scheme called Trailblazer, around schools. We are the second largest in the country and there are two elements.
“The first one is the introduction of mental health support teams, of which Doncaster has two, as part of a joint bid with Rotherham, which also has two, and the plan is to provide better support between the CAMHS service and schools, providing face to face support for young people as early as possible at lower levels to try to stop escalation to periods of crisis.
“Doncaster has a model already in place with eight CAMHS locality workers who are the interface between schools and mental health services. We know those workers are doing a great job, but there are not enough of them. Trailblazers will really be able to accelerate the offer around that.
“The other element of Trailblazers that Doncaster was successful in was to pilot how to we get access times down to four weeks. For children who aren’t in emergency or aren’t in crisis and are seen within four weeks of referral for assessment, Doncaster has some of the fastest access times anywhere – the sixth quickest in the country from being referred to being assessed.
“Clearly there is lots more that we can do and we have a very active relationship with young people and parents around how we will continue to improve services. There have been some significant improvements, but there is further work to be done.
“There is money in Trailblazers over the next three years being spent on mental health support teams and the reduction to four week waits. We’re supporting community schemes too like Doncaster Parents’ Voice, our young advisers, and how we develop a campaign to promote well being and mental health.
“There will be a Doncaster festival, around mental wellbeing, and we’re providing additional psychological support. We think its better to train staff up in schools to identify issues earlier.”
WR: “That's a major thing, where teachers get that on their shoulders, and don’t exactly know what they’re doing.”
LG: “Trailblazers will mean access for 40,000 pupils. It’s trying out new ways of working to improve things for the better. Referrals into specialist services on their own tend not to work. Where families are working in harmony with schools and with other service providers that support, that’s where we see the most success. That’s really where the focus of our transformation plan has been and is.
“We’re seeing more children getting access earlier. We’ve seen a significant reduction in children being admitted to acute mental health beds, a 77 per cent reduction as a direct result of the introduction of the new services.”
Glyn Butcher: “But there are only eight people. How many kids are on that service?”
LG: “They see around 150 a month. But eight isn’t enough. The new mental health support team will bring in probably another 12 workers.”
GB: “That's 20. so when are they coming in?”
LG: “They’re just finishing their training at university. They will be in place for December.”
GB: “Some of the training needs to be done within the community. Don’t just look at the schools and institutions. Children are everybody’s business. It is the community that raises a child, not the services. so I’d ask you to look at it creatively and let’s have a plan together and look at where the best place would be. We not going to fix every problem, but we need more resources into it.”
LG: “You said communities raise children. Specialist mental health services alone do not, for want of a better term, fix mental illness. It is around how we collectively all work together and that’s why the real focus is around making sure that schools provide support with CAMHS workers, with families, with communities.”
WR: My daughter was supposed to have a CPN – community psychiatric nurs – support worker from early on. She came to introduce herself last year and has not come out since. No connection or anything from early intervention psychosis team.”
Stephen Emmerson: “That can’t be acceptable on any level.”
WR: “They’ve said CAMHS are doing the work but if there is a CPN for my daughter I want them to come out and see her. I want to see more workers and more support. CAMHS initially said it was just anxiety. Things escalated and I asked for another assessment. It didn’t come forward.”
SE: “We’ve talked about resources and there are a lot more resources for mental health services that have come into the system. I think our challenge is that as resources becomes available, how we connect with the likes of your story, how we design services and put in place our response to that.
“For both adult mental health and children’s mental health, there is an accelerated programme of investment, higher than the relative growth in general health investment, so it’s how we tap into that and make sure we’re reflecting local needs.
“This is helpful and part of that debate but we have other forums too. If you’re experiencing issues now, how do we prevent someone going through the same?”
GB: “The disconnect for me is not the resources, it is between where the resources are going and people's understandings and beliefs on the ground, because they don’t see it visually. For the people on the street, life isn’t any different.”
SE: “Sometimes it takes time, from making the resource available to mobilising it and making it happen. But you’re right, the test is being able to see a real difference. That’s where we want your voice, as part of that.
“It’s keeping it running and making sure we’re being informed by real people, real users of the system telling us that we’re making a difference.”
Rupert Suckling: “You’re right, there are resources coming in. There is a challenge about how we make sure that they’re used for the right way to meet the needs locally rather than ticking a national box. We’ve also talked about the role communities in general serve, and don’t forget local authorities have a big role and they’re resources have gone down and down.
“Councils still have millions of pounds in savings to make next year. The challenge is although we’re getting resources in one place, we’re also seeing resources go out of another place and I think clinicians will be wrestling with not wanting to over medicalise some of these challenges, but if you don’t over medicalise them you run the risk of creating a big gap between what people are experiencing and what they need. It's a very tricky time to be operating.”
SE: “The focus on joint commissioning then comes into play – what kinds of interventions are required, and joining together so we get the right outcomes and are more flexible in how funding is used. I think we’ve got more of a sense of opportunity than we’ve ever had around that.”
John Bottomley: “In our services in Doncaster, to look at community nursing and mental health as a foundation, we’re expected to make cost savings each year. We’re looking at £3 million savings this year before we have any extra investment at all.”
SE: “You’re right, there are efficiencies, but it can’t get to a point when you’re looking at an impact on frontline services. Yes, there is new investment to cover the spread of services, but we have to make sure we’re not creating gaps within that as a consequence of other pressures in other directions.”