Children and Young People's Mental Health Taskforce: delivery plan

Recommendation 1

The Scottish Government should explore the views and experiences of staff working in CAMHS regarding the system's fitness for purpose, current good practice and innovation, and opportunities for improvement in processes as well as the system overall. The Scottish Government should also explore the views of children, young people and parents who do access CAMHS to explore their experiences of the referral system and processes.

The Taskforce will engage with the workforce, children and young people at all stages of its work as a matter of principle. This work has already started and has informed the initial recommendations and the delivery plan.

Recommendation 2

The Scottish Government should request that ISD explore how data can be gathered about Tiers 1 and 2 of CAMHS, so that a full picture of the service being provided to children, young people and their families can be gained.

The Taskforce's Knowledge and Information Workstream will engage with Scottish Government, ISD, and other relevant sources to inform this work.

Recommendation 3

The Scottish Government should consider whether the tiered model of CAMHS continues to be fit for purpose. In the short term it should change the language used to describe services: references to specific tiers are confusing and unhelpful to children, young people and their families.

The Taskforce will consider this issue as it takes its work, including through the specialist and generic mental health workstreams. It will make recommendations on this issue.

Recommendation 4

The Scottish Government should review and if necessary restructure the current system so appropriate services are easily accessible to children and young people with behavioural and emotional problems, alongside a mental health problem not severe enough to fit the eligibility criteria for CAMHS. The Scottish Government should consider whether achieving this aim requires nationwide provision of schools-based services.

The Taskforce will take forward work and provide support to services in considering this change.

Recommendation 5

In carrying out Recommendation 4, the Scottish Government, Health Boards and Integration Joint Boards (IJBs) and local government should ensure services are funded at an appropriate level, available consistently nationwide and measure both waiting times, outcomes and patient satisfaction.

The Taskforce will make recommendations on this as appropriate.

Recommendation 6

ln creating the system suggested at Recommendation 4, the Scottish Government should develop a multi-agency assessment system, with a focus on quickly referring young people to the appropriate service and eliminating the inefficiency of multiple referrals. This should build upon areas of existing good practice.

The taskforce will carry out initial work to provide recommendations on guidelines for referrals to CAMHS through its specialist workstreams and keep this under review during its lifespan.

Recommendation 7

In creating the system suggested at Recommendation 4, all CAMHS teams should publish information on the circumstances in which they will conduct a paper-based assessment. There should be an expectation that face to face assessments will take place in almost every circumstance.

The Taskforce will explore how patient facing websites explaining the referral, triage and assessment processes can be delivered across the country on a consistent basis.

We will explore and report on the capacity to offer face to face assessments.

Recommendation 8

In a well-functioning system, there should be no need for rejected referrals. However, if they do occur, the Scottish Government should require personalised and meaningful signposting to be mandatory.

As a first step we will look to ensure that where a referral is rejected, the young person/family receive a copy of the letter sent back to the referrers. As far as possible, alternative signposting is included where this is available.

Thereafter we will work with Healthcare Improvement Scotland's MHAIST teams to gather referrer and service user feedback about these letters in each Board area.

Recommendation 9

Where this does not already happen, all CAMHS teams should establish regular sessions when a member of staff is available by telephone to discuss potential referral with referrers, to reduce the number of inappropriate referrals received.

The Taskforce will gather data from all teams about what is currently available.

Once this has happened we will make recommendations on a 'best practice model'.

Recommendation 10

All CAMHS teams should review their assessment procedures to ensure they offer appropriate opportunities for young people to speak to professionals without parents being present, and for parents to speak to professionals without children being present, with regard to issues of capacity and consent.

The Taskforce will provide advice to specialist CAMHS teams in response to this recommendation.

Recommendation 11

All CAMHS teams should train those conducting assessments to introduce themselves, explain their role and clearly set out what will happen during the assessment and the possible outcomes; this should also be included in the appointment letter.

The Taskforce will gather information on current practice and work with teams to support the implementation of this recommendation.

Recommendation 12

All CAMHS teams should send notification of rejected referrals to both the referrer and the child or young person, or where appropriate their parent or guardian. Notifications should be written in clear, non-medical language and should clearly identify the team who has made the decision to reject the referral.

The Taskforce will gather information on current practice and work with teams to support the implementation of this recommendation.

Recommendation 13

Notifications of rejected referrals should wherever possible and appropriate include a direct re-referral to a more appropriate service, without requiring the child, young person or their family to start the process again.

The Taskforce will focus initially on gathering information on current tests of change around this in different parts of the country. Thereafter we will make recommendations on approaches which are effective as new services come on stream.

Recommendation 14

All CAMHS teams should publish information on what support is available in a crisis, and where children, young people and their families should be referred in a mental health crisis; including out of hours services.

The Taskforce will work with the Scottish Government, Local Government and CAMHS teams to develop guidance for Boards and local authorities on the use of public facing webpages to communicate this information. We will explore options to effectively and efficiently host this information.

Recommendation 15

The Scottish Government should work with Royal Colleges and appropriate NHS bodies to create training and/or targeted and regularly refreshed resources for GPs to ensure they understand when referral to CAMHS is appropriate and what other services are available, building on current examples of good practice and taking into consideration the local context.

The Taskforce will work with Scottish Government and its partners as required to inform this work. In particular our work on referral guidance and information sharing will be relevant.

Recommendation 16

CAMHS teams should ensure all those who can refer into them have child­centred and developmentally appropriate information which they can provide to children, young people and their families at the point of referral, setting out what will happen next and signposting to sources of information.

The Taskforce will work with a range of partners to gather examples of good practice on how this information can be shared through web services.

Recommendation 17

Normal practice should include a conversation between the referrer and CAMHS teams before rejecting all but the most clearly inappropriate referrals, to establish whether any other information is available. Good practice should be that child or young person planning meeting minutes are included.

The Taskforce will work with partners to support the adoption of the protocol on communication between CAMHS teams and referrers.

Recommendation 18

All bodies responsible for children's services should intensify efforts to ensure GPs have sufficient information about non-CAMHS services in their area and are aware of resource such as the ALISS database.

Through our Generic Workstream the Taskforce will work with partners to identify best practice on communication between children's services and GPs.

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Recommendation 19

The relevant and responsible bodies should review their CAMHS and adult mental health services to ensure all those aged up to 18 can receive a service, regardless of educational status.

For those who are approaching the age of 18 are either helped within CAMHS or quickly routed into adult services.

The Taskforce will work with Scottish Government, Boards and Local Government on the delivery of this recommendation, being mindful of local circumstances.

Recommendation 20

The relevant and responsible bodies should encourage and support the establishment of peer support groups for parents caring for children with emotional, behavioural as well as mental health issues.

The Taskforce will gather information on good practice in this area and work with partners to extend it consistently, in line with local need and where appropriate.

Recommendation 21

The relevant and responsible bodies should review their mental health services to ensure they are available for children and young people who have Autistic Spectrum Disorder, or a learning disability alongside a mental, emotional or behavioral problem.

The Neurodevelopmental Workstream will take this recommendation forward as a significant element of its work, supporting the relevant and responsible bodies.

Recommendation 22

The relevant and responsible bodies should review their mental health services to ensure provision exists for children, young people and their- families where the child is no longer attending school but has emotional, behavioural and mental health difficulties.

The at risk workstream will take this recommendation forward as an element of its work, supporting the relevant and responsible bodies..

Recommendation 23

ISD should agree with Scottish Government and NHS Boards ongoing data needs around rejected referrals to improve the experience and outcome for children and young people.

Through the Information & Knowledge and Specialist Workstreams the Taskforce will work with ISD on the implementation of this recommendation.

Recommendation 24

ISD should work with third sector organisations to understand the services they provide to children and young people and explore sharing data between these organisation and statutory services to ensure full pathway information is available and used for improving services and experience.

The Information & Knowledge Workstream will work with ISD on the implementation of this recommendation, aligned with the wider ongoing work on data sharing. It will be important that we consider the legal position on data sharing from the outset.

Recommendation 25

The Scottish Government should request ISD to begin enhanced data collection and publication of rejected referral information on a routine basis. This would allow for further analysis in such areas as SIMD, geographical areas and service delivery differences. In particular, the Scottish Government should request research comparing the demographic profiles of those who are rejected from CAMHS with those who are not, to establish whether particular groups are being especially disadvantaged.

Through the Information & Knowledge Workstream the Taskforce will work with the Scottish Government and ISD on the implementation of this recommendation.

Recommendation 26

The Scottish Government should request ISD to undertake further work to understand what happens next to the children and young people e.g. usage of other services. This could be achieved through linkage of records included in the audit to other services.

Through the Information & Knowledge Workstream the Taskforce will work with the Scottish Government and ISD on the implementation of this recommendation.

Recommendation 27

ISD and Scottish Government should work with NHS Boards to standardise the definitions of all data items relating to CAMHS including 'Referral Source', 'Reason for Referral' and 'Rejected Referral Reason'. These should be adopted and implemented by all Health Board; to ensure consistency and comparability. This would include less use of 'Other' categories.

Through the Information & Knowledge Workstream the Taskforce will work with the Scottish Government and ISD on the implementation of this recommendation.

Recommendation 28

The term 'rejected' is emotive and distressing. However, the qualitative element of this research indicates a lack of evidence that referrals are genuinely being 'redirected', which is the preferred alternative term. The Scottish Government should act on the recommendations in this report to create a system that minimises inappropriate referrals and ensures that those which do occur are demonstrably redirected. Only at this point should a change in language be considered.

The Taskforce is mindful of this recommendation in taking their work forward.

Recommendation 29

NHS Boards should have clear referral protocols available to all referrers, including GPs and teachers, which clearly define the process of referrals and what services the NHS Board provides through:

• Enhancement of existing referral pathways and development of standard referral pathways which are clearly written, freely available and easily understood by all referrers
• The development and use of a standard referral form, clearly indicating which information is essential before a referral can be considered. This form should include space for input from GPs, schools, parents and the child, so that as much information as possible can be provided. It should also include space to indicate what services and approaches have already been tried, to avoid unhelpful signposting in case of rejection.
• Considering the development of standard referral criteria which applies to all services across Scotland.

The Taskforce will carry out initial work to recommend guidelines for referrals to CAMHS through its Specialist Workstreams and revisit this as an ongoing area of work.