Information

Mental health strategy 2017-2027: second progress report

Our second progress report on the Mental Health Strategy 2017-2027.

This document is part of a collection


Appendix 3: Audit of Rejected Referrals – Scottish Government Action

Recommendation

Action

Rec 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 Children and Young People’s Mental Health Taskforce and its associated work streams engaged with the full range of professionals represented in CAMHS and in the wider children’s services system. Additionally, the Children and Young People’s Mental Health and Wellbeing Programme Board are currently developing a CAMHS service specification which states that all CAMHS need to work in partnership with children, young people and their families in all aspects of service design and delivery. 

The Scottish Government funded a Youth Commission on Mental Health Services. The Commission was made up of over 20 young people who spent 15 months on an in-depth review of Children and Adolescent Mental Health Services and the wider support that is available. They published their final recommendations in May 2019 and the Scottish Government is responding in this Annual Report. 

Rec 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 Scottish Government is working with Information Services Division (ISD) on a number of actions to improve the data that is collected regarding referrals to CAMHS.

Rec 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 Children and Young People’s Taskforce recommended a model of supporting children and young people’s mental health, based on GIRFEC principles, including clear criteria and the role for CAMHS and Neurodevelopmental Services. The Children and Young People’s Mental Health Programme Board is tasked with implementing this model. 

This year our Programme for Government contained an action to develop community mental health and wellbeing services. These services will be put in place to support the mental health needs of children and young people, using an open access model that also allows self-referral.

This service is being progressed though the Children and Young People’s Mental Health and Wellbeing Programme Board. In the coming months we will be announcing how we will fund and deliver these services.

Rec 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.

This year our Programme for Government contained an action to develop community mental health and wellbeing services. These services will be put in place to support the mental health needs of children and young people, using an open access model that also allows self-referral. 

This service is being progressed though the Children and Young People’s Mental Health and Wellbeing Programme Board. By the end of this year we will be announcing how we will fund and deliver these services.

Rec 5

In carrying out Recommendation 4, the Scottish Government, NHS 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.

In 2017/18 we delivered on our commitment to invest one billion pounds in mental health. Additionally, our 2019/20 programme budget for mental health has been increased by £15.3 million, from £70.2 million last year to £85.5 million – up nearly 22%. This increased funding will support actions to improve early intervention for those who require support for their mental health.

The Scottish Government is working with Information Services Division on a number of actions to improve the data that is collected regarding referrals and access to CAMHS.

Rec 6

In 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 Children and Young People’s Programme Board has agreed a model for accessing mental health support, that is based on GIRFEC principles. This year our Programme for Government contained an action to develop community mental health and wellbeing services. These services will be put in place to support the mental health needs of children and young people, using an open access model that also allows self-referral. 

This service is being progressed though the Children and Young People’s Mental Health and Wellbeing Programme Board. In the coming months we will be announcing how we will fund and deliver these services.

Rec 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 Minister for Mental Health wrote to all NHS Boards in July to seek assurance that information about referral criteria should be published in an accessible way. 

The Children and Young People’s Mental Health and Wellbeing Programme Board is currently developing a CAMHS service specification which includes Boards making eligibility criteria clear and easily accessible and provide guidance on how assessments should take place. 

Rec 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.

The Scottish Government is working with Information Services Division on a number of actions to improve the data that is collected regarding referrals to CAMHS, including the reasons for why referrals may be rejected and what signposting is given.

This year our Programme for Government contained an action to develop community mental health and wellbeing services. These services will be put in place to support the mental health needs of children and young people, using an open access model that also allows self-referral. 

This service is being progressed though the Children and Young People’s Mental Health and Wellbeing Programme Board. In the coming months we will be announcing how we will fund and deliver these services.

Rec 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 referrals with referrers, to reduce the number of inappropriate referrals received.

The Children and Young People’s Mental Health and Wellbeing Programme Board is currently developing a CAMHS service specification which includes a duty for all CAMHS teams to provide a contact for referrers to discuss referrals with.

Rec 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 Children and Young People’s Mental Health and Wellbeing Programme Board is currently developing a CAMHS service specification which includes clear standards around how services should engage with children and young people and their families. 

Rec 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 Children and Young People’s Mental Health and Wellbeing Programme Board is currently developing a CAMHS service specification which includes clear standards around how services should engage with children and young people and their families.

Rec 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 Children and Young People’s Mental Health and Wellbeing Programme Board is currently developing a CAMHS service specification which includes Boards making information as clear and accessible as possible.

Rec 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 Children and Young People’s Mental Health and Wellbeing Programme Board is currently developing a CAMHS service specification which includes Boards involving children, young people and their families in any decisions that are being made about their care and treatment. Additionally, that services should have appropriate re-engagement policies in place.

Rec 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 Minister for Mental Health wrote to all NHS Boards in July to seek assurance that information about crisis support should be published in an accessible way. We are currently carefully considering our next steps based on what we have heard.

Rec 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 a 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 Children and Young People’s Mental Health and Wellbeing Programme Board is currently developing a CAMHS service specification which includes Boards providing time for continuous professional development and training for those supporting children, young people and families mental health.

Rec 16

CAMHS teams should ensure all those who can refer into them have child-centred 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 Children and Young People’s Mental Health and Wellbeing Programme Board is currently developing a CAMHS service specification which includes Boards providing time for continuous professional development and training for those supporting children, young people and families mental health.

Rec 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 Children and Young People’s Mental Health and Wellbeing Programme Board is currently developing a CAMHS service specification which includes the importance of collaboration between services around referrals. Additionally that any assessments should take into consideration all information relating to the child or young person as outlined in the child’s plan.

Rec 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 resources such as the ALISS database.

The Minister for Mental Health wrote to all NHS Boards in July 2019 to seek assurance that Boards were providing information and advice to referrers about other support that is available in their area. We are currently carefully considering our next steps based on what we have heard.

Rec 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 Scottish Government agrees with this recommendation and we are currently developing our approach.

Rec 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.

This year our Programme for Government contained an action to develop community mental health and wellbeing services. These services will be put in place to support the mental health needs of children and young people, using an open access model that also allows self-referral. The services will include a variety of support services which could include peer support groups for parents. 

This service is being progressed though the Children and Young People’s Mental Health and Wellbeing Programme Board. In the coming months we will be announcing how we will fund and deliver these services.

Rec 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 behavioural problem.

The Children and Young People’s Mental Health and Wellbeing Programme Board is currently developing a CAMHS service specification which will include children and young people with complex needs and how services should best meet their needs.

Rec 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 Scottish Government agree with this recommendation and we are currently developing our approach.

Rec 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.

The Scottish Government is working with Information Services Division on a number of actions to improve the data that is collected regarding referrals to CAMHS.

Rec 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.

Information Services Division is part of a Sharing Intelligence for Health and Care Group which consists of the following seven national organisations:

  • Audit Scotland;
  • Care Inspectorate; 
  • Healthcare Improvement Scotland; 
  • Mental Welfare Commission for Scotland; 
  • NHS Education for Scotland; 
  • Public Health & Intelligence 
  • Scottish Public Services Ombudsman.

Rec 25

The Scottish Government should request Information Services Division 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.

The Scottish Government is working with Information Services Division on a number of actions to improve the data that is collected regarding referrals to CAMHS.

Rec 26

The Scottish Government should request Information Services Division 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.

The Scottish Government is working with Information Services Division on a number of actions to improve the data that is collected regarding referrals to CAMHS.

Rec 27

Information Services Division 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 NHS Boards to ensure consistency and comparability. This would include less use of ‘Other’ categories.

The Scottish Government is working with Information Services Division on a number of actions to improve the data that is collected regarding referrals to CAMHS.

Rec 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.

This year our Programme for Government contained an action to develop community mental health and wellbeing services. These services will be put in place to support the mental health needs of children and young people, using an open access model that also allows self-referral.

This service is being progressed though the Children and Young People’s Mental Health and Wellbeing Programme Board. In the coming months we will be announcing how we will fund and deliver these services.

Rec 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 Minister for Mental Health wrote to all NHS Boards in July 2019 to seek assurance that information about referral criteria should be published in an accessible way.

The Children and Young People’s Mental Health and Wellbeing Programme Board is currently developing a CAMHS service specification which will include Boards make sure that they have clear eligibility criteria and referral processes which are easily accessible. 

Contact

Email: MentalHealthStrategyandCoordinationUnit@gov.scot

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