What the Taskforce will do:
The Taskforce has been set up with an intentionally limited lifespan of two years. By direct interactions with service providers over that period, we will seek to ensure that the mental health needs of children and young people receive the attention and priority that has been agreed by Government and COSLA. We will also provide recommendations and advice to support the redesign and rapid expansion of the service response to mental health problems among those aged from 0-25 years.
In taking our work forward we will ensure two key principles are established for children, young people and their families. Firstly services must be delivered at the right time, by the right people with the right skills and in the right place. Secondly anyone engaging with services should expect to ask once and get the help they need. Getting it Right for Every Child (GIRFEC), the national approach to improving outcomes and supporting the wellbeing of our children and young people, is key here. Referral into one part of the system must give access to all other parts of the system in line with each child's needs.
The following diagram seeks to summarise this approach. The bulk of young people accessing services will be those experiencing emotional distress and this should be supported through early intervention in education and primary care. Some young people will require access to more specialist community or neurodevelopment services and should be able to access these from whichever point of the system they contact first. The smallest number of young people are likely to be those with mental health conditions which require CAMHS support and treatment. Again access to this should be possible from whichever point in the system they contact first. Those who are referred to CAMHS inappropriately should be redirected to specialist community or neurodevelopmental services rather than rejected. The principles of GIRFEC should underpin all of these processes.
In the next 6 months the Taskforce will identify in detail what is required to deliver an effective high quality service through providing recommendations and advice on:
- guidance for children, young people and their families on what they can expect and how they might access support;
- how community mental health and family 'hubs' can facilitate links to primary care, education, the mental health third sector, children and family service provision and specialist CAMHS;
- guidance for ensuring that high quality children and young people's services are available;
- referral guidance for general practitioners and other community and educational practitioners to specialist services.
In other words during this initial period the Taskforce will focus on developing building blocks and providing advice to enhance services.
To support this work the Taskforce recommends that a significant proportion of the additional £5m allocated to support our work is invested in CAMHS teams to reduce pressure on the system and to support capacity building in early intervention. There should also be investment in some capacity building in prevention and early intervention. This funding should be sustained across the lifetime of the Taskforce and beyond if required.
Thereafter we will identify organisations who can support service providers to make the change happen through:
- Exploring commissioning processes for services across children and young people's mental health and provide an independent objective assessment to quality assure those processes, while respecting existing local quality assurance processes.
- Working across partners to support the full implementation of the recommendations of the Audit Scotland report and Rejected Referrals report.
- Making recommendations to the Scottish Government and COSLA as and when we need to. We will publish all recommendations irrespective of whether or not they are accepted.
Where the Taskforce will provide input:
There are a number of key deliverables planned or underway to enhance children and young people's mental health services. Working with those responsible, the Taskforce will advise on successful delivery, and advise on further work needed. This may include:
An effective expansion of the workforce
- Any additional capacity developed within CAMHS staffing over two years to provide enhanced specialist support and the specialist CAMHS support required by new community mental health services.
A new approach to prevention and early intervention
- Expansion at pace and scale of the best practice work currently being delivered by primary care professionals, the third sector and within education.
- Additional generic community mental health responses, properly resourced to deal primarily with emotional distress.
- Mental health training and mental health first aid training available for teachers in all schools
- A counselling resource and mental health support available in schools with well used and understood links to school nurses and the mental health resources within the community mental health and family hubs.
Enhanced Neurodevelopmental Services
- The same improved standard of service for children & young people with neurodevelopmental conditions and their families as available to those with mental health conditions.
- Effective links to relevant children and young people services for those with neurodevelopmental conditions.
Digitally enhanced support
- Appropriate digital enhancement of mental health and neurodevelopment services for young people and their families.
A wider range of services
- Improvements to early intervention psychosis services.
- Enhancement of community and specialist perinatal and infant mental health services.
- The extension of the Distress Brief Intervention programme to under 18s.
Support for families
- More effective support for the families of children and young people experiencing poor mental health.
Better data and intelligence
- Data and intelligence routinely available to everyone working in the service so they can identify gaps in services and also the impact their work is having.
- Enhanced data and information linked to other datasets such as those covering education.
Identifying and tracking investment and measuring its impact
A sustainable future approach
- Advise on the functions we would expect within generic, specialist and neurodevelopmental services and for those children and young people at greatest risk.
- Recommendations on a sustainable plan for any service redesign including resource and workforce to inform future policy in this area.
How the Taskforce will operate
- The Taskforce commitment to involve children and young people and their families in the Taskforce and its advice on service redesign will be fully honoured. Specifically an external Children and Young People's Reference Group will be established to support the work of the Youth Commission and Youth Parliament who both sit on the Taskforce.
- The commitment to develop the evidence base for our redesign and collect good practice research on what works from around the world will be delivered through our external academic reference group.
The Taskforce's legacy:
Looking beyond the lifetime of the taskforce we look to see
- Sustainable high quality systems of care for children and young people in Scotland with mental health problems; and
- Children and young people's mental health services have parity with acute sector clinical services and adult & elderly mental health services in terms of prioritisation. funding and workforce.
- Children, young people and their families satisfied with the response and services they received and thriving in their communities.
How Success Should Be Measured:
We will develop a number of quantitative and qualitative measures for children and young people's mental health services. While these will be developed in detail a number of key indicators are clear from the outset. These include:
- A reduction in CAMHS waiting times to within 12 weeks for assessment and start of treatment by 100% service.
- A reduction in rejected referrals to CAMHS.
- A move away from CAMHS referrals being the default response to mental health difficulties among children and young people.
- A process, that is clear to everyone, around managing the redirection of referrals in a caring and compassionate manner.
This Delivery Plan will of course be an evolving document, regularly updated. We must ensure that it reflects emerging influences, such as the delivery of the Mental Health Strategy (2017-2027), the work of the National Suicide Prevention Leadership group, the report of the Review of the Arrangements for Investigating Deaths of Patients in Hospital for Treatment of Mental Disorder and in due course both the report of the Independent Inquiry into Mental Health Services in Tayside and the expert review of mental health support of young offenders along with other future important developments. We will publish a detailed version of the Delivery Plan in April 2019.
Email: Neil Guy