Joint Strategic Board for Child and Family Mental Health minutes: 18 December 2024

Attendees and apologies

Present

• Nicola Dickie, Director of People Policy, COSLA, co-Chair

• Stephen Gallagher, Director of Mental Health, Scottish Government, co-Chair

• Karen Lamb, Head of Specialist Children’s Services, NHS GGC

• Kandarp Joshi, Psychiatrist, Royal College of Psychiatry of Scotland

• Laura Kerr, Social Work Scotland

• Emma Currer, Royal College of Midwives

• Hannah Axon, Policy Manager, COSLA

• Carolyn McDonald, Chief Allied Health Professions Officer, Scottish Government

• Andrea Blair, General Manger Specialist Children’s Services, NHS GGC

• Angela Davidson, Deputy Director, Mental Health, Scottish Government

• Carrie Lindsay, Executive Director of Education and Children's Services, Fife Council

• David Mackay, Head of Policy, Children in Scotland

• Joanne Smith, Chair, Parent and Infant Mental Health Scotland and National Society for the Prevention of Cruelty to Children (NSPCC) Scotland

• Judy Thomson, NHS Education Scotland

• Carsten Mandt, Senior Programme Manager, Perinatal Mental Health Network

• Mairi Macpherson, Deputy Director, Improving Health and Wellbeing, Scottish Government

• Cheryl Burnett, Chair, National Parent Forum of Scotland

• Amanda Farquharson, Child and Adolescent Mental Health Services (CAMHS) Service Manager, NHS Grampian

• Aileen Blower, Professional Adviser, Scottish Government

• Roch Cantwell, Professional Adviser, Perinatal and Infant Mental Health, Scottish Government

• Stephen Mcleod, Professional Adviser, Directorate for Mental Health, Scottish Government

• Anne Mcfadyen, Professional Adviser, Perinatal and Infant Mental Health, Scottish Government

Apologies

• Tracy Stewart, Scottish Council of Deans of Education

• Martin Crewe, Director, Bernardo’s

• Leanne Blacklaw, Chief Inspector (Mental Health, Suicide Prevention, CYP), Police Scotland

• Gillian Hamilton, Chief Executive, Education Scotland

• Jane Ford, Principal Public Health Intelligence Adviser

• Alison Sutherland, Head of Support, The Promise Scotland

Guests

• MSP Maree Todd, Minister for Social Care, Mental Wellbeing and Sport

• Councillor Tony Buchanan, Children and Young People Spokesperson, COSLA

Observers

• Ali Macdonald, Public Health Scotland

• Georgia de Courcy Wheeler, Children, Young People and Families Mental Health, Scottish Government

• Harriet Waugh, Self-Harm Policy and Distress Interventions, Scottish Government

• Ruth Christie, Children, Young People and Families Mental Health, Scottish Government Rhona Malcolm, Scottish Youth Parliament

• Maya McCrae, Scottish Youth Parliament

• Laura Meikle, Support and Wellbeing Unit, Scottish Government

• Chloe Duffus, Children, Young People and Families Mental Health, Scottish Government Peter Innes, Children, Young People and Families Mental Health, Scottish Government

• Elaine Tomlinson, Police Scotland

• Rachael Smith, NHS Grampian

• Reece Bunning, Private Secretary to Minister for Social Care, Mental Wellbeing and Sport, Scottish Government

Secretariat

• Alastair Douglas, Secretariat, Children, Young People and Families Mental Health, Scottish Government

• Della Robb, Children, Young People and Families Mental Health, Scottish Government

• Ross Cowan, Children, Young People and Families Mental Health, Scottish Government

• Kelsey Sclater, Children, Young People and Families Mental Health, Scottish Government

Items and actions

Welcome and Introductions

Nicola Dickie (ND), co-Chair of the Joint Strategic Board for Child and Family Mental Health (JSB) welcomed everyone to the meeting.

ND invited any comments or amendments to the minute of the September 2024 JSB meeting. No changes to the September minutes were requested.

Actions

• board members who attended the September meeting of the JSB and not accounted for in the draft minutes to contact secretariat
• secretariat to amend minutes as needed

Hannah Axon (HA) updated the board on the upcoming third February 2025  Demographics of Care Session being held for members of the board and implementation groups.

Minister for Social Care, Mental Wellbeing and Sport and COSLA Spokesperson for Children and Young People

Minister Todd and Cllr Buchanan gave opening remarks, recognising the positive changes that have already happened under the JSB and its predecessors.

It was noted that challenges still remain, including: understanding long term impacts of Covid, cost of living crisis, and wider social determinants, and the pressures on services from high demand.

ND invited any questions from board members for the Minister and Cllr Buchanan.

Questions to Minister Todd and Cllr Buchanan

The Minister was asked how are links across Cabinet on child and family mental health and wellbeing. Cllr Buchanan was asked for any reflections on the work of the board and its predecessors.

• Minister responded that she regularly considers mental health, particularly around prevention. It was recognised that solutions do not lie in health alone, but in other portfolios. Education is key to children’s mental health and definitely things we could do better to meet needs of children. The Minister highlighted the recent commitment to removing the two child cap
• Cllr Buchanan agreed that there are many factors that play a part in the wellbeing of families and their mental health including education, employment, housing. There are still some silos that exist and breaking down these is key

The Minister was asked to provide an update on the ambition of reaching one percent of NHS spend on Child and Adolescent Mental Health Services (CAMHS).

• Minister shared that there are challenges in boards around funding, particularly around psychology work, this will be looked into further in January 2025. The Minister emphasised her commitment to achieving the increase in spend in mental health and specifically on CAMHS. There have been positive steps in CAMHS, as seen in recent statistics

Maya Mackay (MM) shared some of the work the Scottish Youth Parliament (SYP) has been doing including a consultation that received 4000 responses from young people. They highlighted that addressing mental health issues in Scotland was a priority and this became one of SYP’s national priorities campaigns.

The Minister would be happy to meet and work with MM and other SYP representatives on this subject.

It was raised that one of the largest requests of services is around Neurodevelopmental support. There is a lot of distress from families when requests for help are not being met and health services are overwhelmed by these requests.

• Minister responded that support around Neurodevelopmental issues will be a key priority going forward. The answers will not be exactly the same as they were in tackling CAMHS issues but we will need to take a whole systems approach to make an impact on that challenge. Making an impact on children and young people with Neurodevelopmental challenges can make a key difference for the rest of their lives and the appropriate supports can allow a child to reach their full potential
• Cllr Buchanan added that there is a recognition that demand is high and increasing. COSLA are working closely with Scottish Government to progress a review on the National Neurodevelopmental Service Specification for children and young people. There was recognition that we also need to ensure staff are supported through the extra pressure they are feeling with increased demand

A question was raised around prioritisation of resources across Scotland, particularly in relation to children’s services. It was noted that, over the past decade, there has been a steady move away from primary prevention and early intervention services towards more reactive services. Many mental health issues presenting in later life have roots in infancy. It was noted that funding for Infant Mental Health and Perinatal Mental Health services is fragile and doesn’t meet every need. The Minister and Cllr Buchanan were asked how we will ensure that spend in early years intervention and prevention is protected in children service planning going forward?

• Cllr Buchanan responded that it is very challenging to balance funding between prevention and treatment for those needing it now and addressing current pressures on services. More does need to be done on prevention as that is the long term answer which will, in time, alleviate pressures on services but we cannot neglect those in need in the here and now either

Angela Davidson (AD) shared that there is common cause around improving preventative services and that in recent years there has been investment in Perinatal and Infant Mental Health services which is now baselined into budgets. Community based supports have been provided with £15 million per year to support children, young people and families and from next year that will be baselined into local government budgets as well to embed those services and make them a key part of the system.

The Minister and Cllr Buchanan thanked everyone for their questions and opportunity to be part of this meeting.

Actions

• Stephen Gallagher (SGA) to come back to JSB in the new year and share updates on the January conversation with Minister around NHS one percent spend on CAMHS commitment

Neurodevelopmental Paper

Georgia de Courcy Wheeler (GdeCW) presented a paper on Neurodevelopmental support for children and young people to the JSB.

Key points

• in 2021 the Scottish Government published the National Neurodevelopmental Specification
• following publication, Scottish Government provided funding, from 2022 to 2024, to five areas in Scotland to take forward tests of change that would test and implement specific aspects of the specification
• in 2024, four of the five areas which had continued to that point reached their conclusion and submitted reports going through their experience and learning from doing the tests for change
• Scottish Government are distilling those reports into a final paper on the tests of change and will come back to the JSB in the new year with further updates

Next steps

• planned review of the implementation of the Neurodevelopmental specification which will be done in partnership with COSLA in early 2025 and report back to the JSB in spring to consider views
• utilise the findings from the tests of change and bring together the learning from those sites and seek feedback from stakeholders and partners across Scotland
• overarching aim of review is to agree a policy direction to take this work forward, should be underpinned by an approach that addresses the current challenges and implications for local services
• if necessary, update the specification after feedback to take into consideration current challenges
• once endorsed by the JSB, it can go through political processes for both COSLA and Scottish Government

Discussion

• ND asked board members to give their considered feedback to GdeCW in writing or through meeting outside of the JSB
• Judy Thomson (JT) asked if the intention of the test of change sites is to continue with the new service delivery models developed and, if so, whether they have been given resource to enable that? GdeCW responded that there is no additional funding available for the test of change sites to continue the work, but as part of the review the funding situation will be considered. Additionally at some of the test of change sites the work that has been done is now embedded in practice and forms part of their Neurodevelopmental pathways, such as in NHS Fife
• Carrie Lindsay (CL) asked if there are resources that can be shared following this work and how we can ensure learning is most effectively utilised. GdeCW confirmed that they are looking to gather together in one place the resources developed by some of the test for change sites along with resources developed by clinicians and academic in this area
• Stephen McLeod (SMcL) welcomed the review and stated that working with education colleagues is critical
• GdeCW added that Scottish Government policy has had an initial discussion with Royal College of Paediatrics and Child Health about Neurodevelopmental support and are definitely keen to make sure we include the paediatric experience

Action

• JSB members to provide feedback to Georgia de Courcy on any particular groups or stakeholders that should be spoken to during the review of Neurodevelopmental specification

Perinatal Mental Health Service Specification Paper

Anne McFadyen (AM) updated the JSB on the progress of the Perinatal Mental Health Service Specification group.

The development of a Perinatal Mental Health Service Specification is a progression of the work that was done on the Perinatal and Infant Mental Health Programme Board. The purpose is to continue to support quality improvement and service development in Perinatal Mental Health services.

AM asked JSB members if this is the best vehicle to support quality improvement and service development and how we can ensure it doesn’t stray into other areas unnecessarily.

Key points

• the paper set out what perinatal mental health services are and confirmed that the scope of this these will be perinatal inpatient and specialist community services
• the aim is to create a helpful document that supports clinicians and managers but also supports service users to understand those services and provides a Scottish context
• it was noted that in Scotland we already have core mental health standards and they have to be central to the specification as we don’t want to re-iterate them
• The Women and Families Mental Health Pledge, Infant Mental Health Pledge, GIRFEC, and UNCRC need to be considered as well
• aim is to finish the specification by March 2025

AM asked the JSB for suggestions on launching the specification, what stakeholders should be involved, personal contacts that can help spread awareness, the role of the Perinatal Managed Clinical Network.

Discussion

• Emma Currer (EC) shared that from the perspective of the Royal College of Midwives anything that adds clarity for members and those engaging in maternity services would be welcomed. There is a concern however that there is a lot of overlap with this and other specifications such as the Healthcare Improvement Scotland standard. AM stated that this specification is a quality improvement document so that should minimise overlap and that there has been a demand for the specification
• ND suggested a further conversation to AM with Haylis Smith from COSLA regarding Suicide Prevention Scotland and the Perinatal Specification

Action

• Anne Mcfadyen to contact Haylis Smith to discuss the Perinatal Specification and Suicide Prevention Scotland

Update from Implementation Group Chairs

Awareness Raising and Promotion Implementation Group - Stephen McLeod

• implementation group agreed milestones to reach in 12 months where there would be recommendations the group could put to the JSB on issues requiring further work
• by March 2025, hope to reach a point where the group would be clear on the outcomes of the group
• initial discussions included bringing together the knowledge about resources currently available
• the group would ensure an added value principle in order to help avoid duplication of existing resources
• members of the group were invited to comment on the terms of reference and were broadly happy with the document
• SMcL met with Scottish Youth Parliament around getting leadership of young people in the group. A future meeting will bring together examples of campaigns young people have been involved and helped develop

Barriers and Access to Support and Service Implementation Group – Dr Aileen Blower

• Aileen Blower (AB) thanked Jackie Hardie for chairing the first meeting of this group
• the group was well attended with good engagement from professionals.
• membership was examined and there may be scope to refresh it as the work of this group continues and evolves
• the purpose, scope, timelines and looking at the work over a course of a year was discussed with the next meeting in January 2025 starting to focus on potential outputs
• Harriet Waugh (HW) gave a presentation at the first meeting on the policy overview for Crisis and Distress in Children and Young People, the group will work alongside the Self Harm and Suicide Prevention policy teams.
• large focus of the group will be access to crisis support for children and young people initially
• many of the points raised in this meeting of the JSB about rights based practice, poverty, and babies, children and families in vulnerable situations and on the edges of care will be given particular attention
• working towards outlining an optimal system of support and pathways at all levels of the system, nationally, regionally and locally to lay out what would effective provision look like. Consideration of how existing provision compares to that and what changes can be effectively made in the short term

Whole Systems and Transitions Implementation Group – Dr Roch Cantwell

• at first meeting of this group the terms of reference were discussed by members with specific reference to the draft Infant Mental Health Service Development Guide
• papers on existing regional structures and barriers to models of joined up working were shared
• membership of the group was discussed and potential for it to change as the work of the group progresses
• next step will be to further consider the terms of reference, group membership, remit and focus
• at this time the next meeting of this group will be postponed to allow Scottish Government and COSLA to consider the terms of reference and remit of the group are fit for purpose at this time

ND thanked chairs for their work chairing the implementation groups.

AOB

Ali MacDonald (AMD) shared some work that Public Health Scotland (PHS) are doing in partnership with Education Scotland and other partners around 'A Public Health Approach to Learning'.

First part is to bring together health datasets with education datasets and provide that linked data at the level of school clusters. The data will only be accessible by the  school cluster. This will mean they will have an accurate picture of data around CAMHS referrals at school cluster level. At this time it is working with one site in Edinburgh as a development approach with view to testing in a number of different areas.

AMD wanted to update JSB and is happy to update again at a future meeting.

Close

ND thanked attendees for their contributions and wished everyone well over the holiday period.