Make it worthwhile
A Joint Hampshire Strategy for
Emotional Wellbeing and Mental Health
(Children and Young People)
A strategy prepared on behalf of
Hampshire’s Children’s Trust
2014 – 2017
Contents
Forward
Forward
3
What do we mean by Emotional Wellbeing and Mental Health?
4
What does good emotional wellbeing and mental health mean to children in Hampshire?
5
Our Vision and Priorities
6
Underlying Principles
7
Why do we need a strategy for emotional wellbeing and mental health?
8
Your Views
10
Children and Young People’s Priorities
11
Parent/carer views
11
Professional and other stakeholders’ views
12
National Context
13
Local Context
14
Local needs assessment
16
Future projections of need
18
Protective and Risk Factors for Emotional Wellbeing and Mental Health
18
Emotional Wellbeing and Mental Health Services in Hampshire
21
Specialist Child and Adolescent Mental Health Services (CAMHS)
22
Our Priorities
24
How will we deliver the strategy?
27
Children and young people with good mental health do better. They are
happier in their families; they learn better and do better at school; they
are able to enjoy friendships and new experiences. They are more likely
to grow up to enjoy healthy and fulfilling lives and to make a positive
contribution to society and to have good mental health as an adult.
Intervening early and positively makes a real
difference at every stage of the life course. We
know that giving children and their families the
right type of support in their earliest years can
help to avoid many of the costly and damaging
social problems in society. We are investing now to
save later.
Through the oversight of Hampshire’s Children’s
Trust and the successful delivery of the Hampshire
Children and Young People’s Plan over the last
eight years a wide range of organisations have
successfully come together to improve a wide
range of outcomes for children.
We believe that the emotional wellbeing and
mental health of children and young people is not
the exclusive business of experts but everyone’s
business, especially when it comes to promoting
good mental health and preventing ill health.
Raising awareness of the importance of good
mental health for children is a key part of our
strategy.
We will work to develop the capacity of our
children to be resilient and to maintain their
wellbeing. We know that children grow best in
families and supporting families is an important
part of the strategy.
However, there is increasing evidence that the
society we live in is not always good for the
mental health of our children. This strategy which
complements and sits alongside the Children
and Young People’s Plan is our response to the
increasing challenges faced by our children.
The continued reduction in resources means that
we need to work together even more closely to
be as efficient as possible. It isn’t always about
commissioning or developing new services, but
how we can reform and maximise the use of the
whole range of resources that we already have.
Over the past few months we have been
privileged to be able to listen to the views of
children and young people and their families and
to the professionals who work with them. Their
priorities are the basis of this strategy and have
helped us to set out clearly the changes that we
need to make to improve the mental health of
Hampshire’s children.
Thank you for working with us to improve
emotional wellbeing and mental health for all
Hampshire’s children and to ‘Make it Worthwhile’.
John Coughlan
on behalf of the
Hampshire Children’s Trust
2
3
What do we mean by Emotional
Wellbeing and Mental Health?
What does good emotional wellbeing and
mental health mean to children in Hampshire?
with a sense of connection with people, communities
and the wider environment.” It is increasingly used
alongside mental health, and is often favoured by
schools and others whose main contribution is around
prevention and health promotion.2
Many things affect children and young people’s
emotional wellbeing and mental health and so it is
unsurprising that there are many definitions.
Children and young people in Hampshire have told
us that good emotional wellbeing and mental health
means ‘feeling safe and secure’, ‘being satisfied with
life’ and ‘feeling worthwhile’.
These descriptions are useful, because they highlight
the fact that emotional wellbeing and mental health
are not about feeling happy all the time.
Mental health has been defined as: “A state of
wellbeing in which the individual realises his or her
own abilities, can cope with the normal stresses of
life, can work productively and fruitfully, and is able to
make a contribution to his or her community.”1
To help the reader throughout the strategy we have
used the terms ‘mental health’ to mean emotional
wellbeing and mental health and ‘children’ to mean
children and young people.
Children in Hampshire have told us that good mental health means:
being satisfied
feeling
with life
worthwhile
feeling safe
and secure
Emotional wellbeing has been defined as: “A positive
state of mind and body, feeling safe and able to cope,
The diagram below was produced by children who
attended the Youth Conference in May 2014, when they
were asked to talk about emotionally healthy schools.
Emotional
Peers
Support group
Spiritual room/
space
Training
Children
& Adults
It doesn’t mean:
No abuse
Music
Drama
Emotionally
Healthy
School
never crying or
Creative Arts
being angry
laughing a lot
being outgoing
and chatty
Art
Sports facilities
Visitors
Social spaces
1
4
2
Previous
experiences
Professionals
orld Health Organization. 2004. Promoting Mental Health: Concepts; emerging evidence; practice. Geneva: WHO.
W
As set out in two diagnostic manuals:
- World Health Organization. 2007. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines. Geneva: WHO.
- American Psychiatric Association. 2000. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Arlington: APA.
5
Our Vision and Priorities
Underlying Principles
We want all children in Hampshire to enjoy good emotional
wellbeing and mental health.
This strategy has been developed in partnership with children and young
people, parents/carers, representatives from health, education, social
care, the voluntary sector, schools and early years settings. These are the
principles that have been agreed and that underpin the strategy:
We will build on the work that is already going on across Hampshire, coordinated through the Children and
Young People’s Plan, to promote good mental health in children and build their resilience, especially for those who
are at higher risk of developing mental health problems. Where children and their families need support in relation
to mental health, we believe this should be focused on delivering long lasting improvements in mental health. We
recognise that this is not the responsibility of any one organisation and that families are fundamentally important
in the development of good mental health for their children.
We want all children in Hampshire to enjoy good
emotional wellbeing and mental health
Emotional
Wellbeing and
Mental Health
in Hampshire
is Everyone’s
Business.
Earlier
recognition and
intervention for
mental health
problems in
children.
Improve
information and
advice available
for children,
young people,
families and
professionals
with regard
to emotional
wellbeing and
mental health.
Ensure all
children, young
people and
families have
access to timely,
evidenced based,
high quality
specialist mental
health support,
when it is
needed.
l take a life-course approach; this means
considering a child’s journey from before birth
into adulthood
l focus on promoting mental health as well as
ensuring we have high quality treatment services
l the views of children should inform the
development of the strategy and of services
l make sure that we meet the needs of vulnerable
groups of children and their families
l ensure that all the interventions and services we
provide, either directly or through commissioned
services, are based on the best available evidence
and are high quality, safe and good value for
money
l ensure that everyone works together to improve
mental health of children in Hampshire; this means
people in different organisations and sectors
working together
l make sure that the work we do will help to
reduce health inequalities; this means reducing
the preventable and unfair differences in health
experienced by different groups of people in our
community
l improve access to services; this means removing
barriers and making it easier for everyone who
needs a service to access one
6
7
Why do we need a strategy for emotional
wellbeing and mental health?
Children who are resilient – they can
‘bounce back’ and recover quickly from
difficulties - are able
to adapt and thrive
even if they experience
significant risks or
trauma in their lives and
they are more likely to
have good mental and
physical health.
‘Health is the basis for a
good quality of life and
mental health is of overriding
importance in this’
Article 24 of the United Nations convention
on the Rights of the Child.
‘Three-quarters of adult mental
disorders are in evidence by the
age of 21, but three quarters of
children and young people with these
disorders are not detected or treated.’5
The most recent UNICEF study [2013] placed the
UK at number 16 out of 29 of the world’s richest
countries in a league table of child wellbeing.
‘What happens during
the(se) early years (starting
in the womb) has lifelong
effects on many aspects
of health and well-being –
from obesity, heart disease
and mental health, to
educational achievement
and economic status.’3
Most children grow up mentally healthy, but surveys suggest that
more children and young people have problems with their mental
health today than 30 years ago6. This is probably because of changes
in the way we live now and how that affects the experience of
growing up. It is estimated that at any one time one in ten children
aged between 5 and 16 years in England has a clinically diagnosable
mental health problem and one in seven has less severe problems7.
There is no evidence that mental health problems in
children are becoming less common. In its 2014 report
‘Health for the World’s Adolescents’ the World Health
Organisation highlights mental health in adolescents
as an emerging public health priority. It describes how
‘effective interventions during adolescence protect
public health investments in early child development’
and that ‘adolescence offers an opportunity to rectify
problems that have arisen during the first decade’.
Mental health is influenced by many factors and is
strongly associated with the wider environment in
which children live. Some groups of children such
as looked after children, children from black and
other ethnic minority groups, lesbian, gay, bisexual or
transgender (LGBT) young people, young offenders,
young carers, refugees or asylum seekers, children
from gypsy and traveller communities, children from
service families are more likely to experience poorer
mental health than others.
It is vital that we identify and support
these children as we know that effective
early intervention can help prevent the
development of ill health and disability in
adult life8.
The Cost of Poor
Mental Health
Delivering the priorities set out in this
strategy will help us to do this.
In addition to the human and social costs, poor mental
health has an economic cost. The costs of emotional,
conduct and hyperkinetic disorders among children
aged 5–15 years in the UK are estimated to be £1.58
billion every year.9
Good mental health is associated with
positive life outcomes and is essential for
children to ‘develop
their potential, work
productively and creatively, build strong
and positive relationships with others, and
contribute to their community’.4
‘Fair Society, Healthy Lives’ (The Marmot Review).
Foresight report 2008
5
Chief Medical Officer report 2012
6
Young Minds
3
4
8
5
15
£1.58
billion
Mental health and behaviour in schools – departmental advice for school staff. Department for
Education. June 2014
8
Early Intervention: The Next Steps, Graham Allen MP (2011)
9
Chief Medical Officer’s (CMO) Annual Report 2012: Our Children Deserve Better: Prevention Pays
7
9
Your Views
We wanted the views of children and of people
interested in the mental health of children to
be at the centre of this strategy. We asked an
independent charitable organisation to seek
these views using questionnaires and by talking
with groups of people.
The chart below shows who responded. We were very pleased
that over half of the responses were from children and young
people themselves.
We received
1,647
responses
to the
questionnaires.
Children and Young
People’s Priorities
We asked children to tell us about their
main priorities for services. They told us
that they want people to:
Overall children wanted to make
sure that whatever we do we:
Make it
WORTHWHILE
l Communicate with them well
l Be inviting
l Have a sense of humour
l Be trustworthy and available
and they want to:
l Be involved in decisions that involve them
l Be treated as an individual
A
Children and
young people
Parent/carer views
B
Parents and
carers
C
Professionals
10
The most commonly reported difficulties were anxiety,
depression, autism and self-harm. The majority of
parents/carers told us that they would choose to seek
support from their GP if their child was having mental
health difficulties, with the next choice being their
child’s school or college. Most parents/carers would
choose to have support provided by a specialist
mental health service, closely followed by voluntary
sector organisations. Just over half of parents/carers
who had experience of accessing emotional wellbeing
and mental health services for the first time for
their children felt that the service had improved
their child’s emotional wellbeing. Where an
additional service was accessed, this increased
to two-thirds. Parents/carers felt that
there were gaps in services for children
suffering from ‘low-level’ mental health
difficulties, including the need for more
access to counselling services, support
with attachment difficulties and transition.
Parents/carers felt that their children
generally had to wait too long to
access services.
11
Professional and other stakeholders’ views
Professionals had experience of referring to a wide
range of support agencies, about a third of which
were to the Specialist Child and Adolescent Mental
Health Service. There was a mixed response when
professionals were asked to comment upon how easy
it was to make a referral, with half saying it was easy
and half saying it was difficult. Some raised concerns
about the capacity of specialist services to meet
current demand. It was reported that it was easy to
refer into other emotional wellbeing services, although
professionals identified that there are some gaps in
the availability of appropriate services. Generally
professionals reported that services were in accessible
locations and had convenient appointment times.
They identified a need for better communication
and information for both professionals and families
about both specialist and non- specialist services.
They wanted more information about the best way to
support those children with mental health needs who
do not require a specialist mental health service, to
help ensure that their health does not get worse.
‘What do I think?’ Survey
Each year Hampshire County Council provides children in school with the
opportunity to say what they think about a variety of issues through the ‘What do
I think?’ survey. The last survey was conducted in 2013 and over 16,000 responses
from children aged 5-14 were received.
The results of the survey have helped us to understand how supported those children who
responded feel when they are in school if someone is being unkind to them or if they need to talk about
their feelings.
Children told us that mostly they enjoy being at school. While most of the younger children
always have an adult in school to talk to who will do something if someone is being
unkind only a third of older children thought that they had an adult who
could do something. A third of children did not think that there
was anyone in their school that they could talk to
about their feelings.
National Context
A number of national strategies and guidance documents have been
considered when developing this strategy. A summary of each of these
documents is provided in the needs analysis.
l Every Child Matters (2003)
l National CAMHS Review (2008)
l Promoting the health and wellbeing of looked
after children, Department of Health (2009)
l Fair Society, Healthy Lives; The Marmot Review (2010)
l Healthy People, Healthy Lives: Our Strategy for
Public Health in England (2010)
l Getting it right for children and young people – a
review by Sir Ian Kennedy (2010)
l Confident Communities, Brighter Futures (2010)
l The Importance of Teaching, Department for
Education (2010)
l No Health Without Mental Health; a crossgovernment mental health outcomes strategy for
people of all ages (2011)
l The Mandate: a mandate from the government
to the NHS Commissioning Board: April 2013 to
March 2015
l Early Intervention: The Next Steps Graham Allen
MP (2011)
l The Health Visitor Implementation Plan 2011-15 –
‘A Call to Action’
l The Munro Review of Child Protection: Final
Report, A child-centred system (2011)
l Closing the Gap: Priorities for essential change in
mental health (2014)
l Children and Young People’s Health Outcomes
Framework report (2012)
l From a Distance - Looked after children living away
from home, Ofsted (2014)
l Chief Medical Officer’s (CMO) Annual Report 2012:
Our Children Deserve Better: Prevention Pays
l Health visiting and School Nurse Programme:
Supporting implementation of the new service
offer: Promoting emotional wellbeing and positive
mental health of children and young people,
Department of Health (2014)
l How healthy behaviour supports children’s
wellbeing (2013) – Public Health England
l National Institute for Health and Care Excellence
guidance
l Promoting the quality of life of looked-after
children and young people’ 2010/ PH No 28
l Quality standard for the health and wellbeing
of looked-after children and young peopleQS31/ 2013
l Social and emotional wellbeing in primary
education (PH 12)
l Social and emotional wellbeing in secondary
education (PH 20)
l Social and emotional wellbeing – early years (PH 40)
12
13
Local Context
Hampshire Children and Young People’s Plan 2012-2015 is the overarching
strategy for children in Hampshire. It sets the direction and priorities for
services for children, and families in the county. The plan has the following
priorities and is underpinned by the United Nations Convention on the
Rights of the Child:
l Addressing the incidence and reducing impact of poverty on the
achievement and life chances of children and young people.
l Securing children and young people’s physical, spiritual, social,
emotional and mental health, promoting healthy lifestyles and reducing
inequalities.
l Providing opportunities to learn, within and beyond the school day, that
raise children and young people’s aspirations, encourage excellence and
enable them to enjoy and achieve beyond their expectations.
The Hampshire Joint Strategic Needs Assessment (JSNA)
Children and Young People’s chapter pulls together a
wide range of information to describe the current and
future health and wellbeing needs of Hampshire children
and associated inequalities. The 2013 JSNA made some
recommendations to improve mental health in children in
the following areas:
Promoting maternal mental health
Ensure that the health visiting contract continues to
include the responsibility to identify mothers at risk or
in early stages of postnatal depression, and then offer
appropriate support and treatment.
Promoting positive parenting
l Helping children and young people to be safe and feel safe.
l Promoting vocational, leisure and recreational activities that provide
opportunities for children and young people to experience success and
make a positive contribution.
The Hampshire Health and Wellbeing Strategy has been developed by
Hampshire’s Health and Wellbeing Board and sets out four areas where the
Board will focus to improve the health of people living in Hampshire:
Starting well
So every child can thrive
Living well
Empowering people to live healthier lives
Ageing well
Supporting people to remain independent, have
choice, control and timely access to high quality
services
Healthier
Communities
Enable access to evidence based parenting programmes
for those at highest risk.
Ensuring access to mental health services
Enable access to effective services to diagnose and treat
conduct disorders in childhood, especially amongst first
time entrants to the youth justice system.
Ensure that child and adolescent mental health services
meet the breadth of need of our young people and are
readily accessible to them and are non-stigmatising.
Looked after children
Ensure there is adequate support for young people
leaving care, particularly transition to adult services.
Helping communities to be strong and support those
who may need extra help
This strategy supports the overall objectives of the Children and Young
People’s Plan, the Health and Wellbeing Strategy and the recommendations
of the Joint Strategic Needs Assessment. It complements other existing
Hampshire strategies and work streams where the importance of mental
health for children is recognised including: Hampshire Adult Mental Health
Needs Assessment 2013, Domestic Violence Strategy, Autism Strategy for
children, the Hampshire Local Offer and the Clinical Commissioning Groups’
strategic and operating plans.
14
15
Local needs assessment
Among children with learning
disabilities 36%13 are likely to
have a mental health disorder.
They are much more likely
than others to live in poverty,
to have few friends and
to have associated long
term health problems such
as epilepsy and sensory
impairment. All these factors are positively associated with
mental health problems. We estimate that there are 1,560
children with learning difficulties in Hampshire who have a
mental health problem.14
36%
Adults in general have been shown to have low
awareness of mental health in children. A UK survey12
found that almost four in ten adults did not know the
signs and symptoms that they should look out for to
assess children’s mental health. The same proportion
of men surveyed believed that many children diagnosed
with a mental illness were just showing bad behaviour.
It is very likely that adults in Hampshire will show similar
low awareness and that there is a need to improve
understanding about mental health in children locally.
Rates of mental health problems increase as children
become teenagers and are higher in boys compared
to girls. The commonest disorders are conduct and
emotional disorders (anxiety and depression). Conduct
disorders are more common in boys while emotional
disorders are more common in girls. We estimate that
in Hampshire there are 10,700 children with conduct
disorders, 6,950 with emotional disorders and 2,785
with hyperkinetic disorders.
These estimates are based on a survey of child and
adolescent mental health that took place 10 years ago.
While this is the best evidence that we have it is far
from ideal to inform the planning of services. Childhood
has changed in the last ten years particularly with the
dramatic broadening of the scope and increase in
exposure of children to media in all its forms.
There are many benefits of media such as
opportunities to stay connected with friends through
social media, educational uses and e-health. However,
increasingly it is recognised that there are potential
negative impacts on children’s mental health
including problem internet use, the sexualisation and
exploitation of children and cyberbullying.
We know that socio economic disadvantage is a risk
factor for poor mental health and expect that the
highest areas of need for children’s mental health will
The Lancet, Mental health and wellbeing in children and adolescents Volume 383,
Issue 9924, Page 1183, 5 April 2014
12
16
be in the most deprived areas of Hampshire. These
are in Havant, Gosport and Rushmoor with pockets
of deprivation in the New Forest, Eastleigh, Romsey,
Andover and Basingstoke.
The current economic downturn can be expected
to have an adverse effect on the mental health of
some children and families. We do not know the
extent of this health impact which will depend on
the effectiveness of both national and local policies
to safeguard and support the mental health of our
population.
Young Offenders have at least three times the rate of mental
health problems compared to the general population, although
this is probably an underestimate and local data shows that
almost half of young people in contact with the Hampshire YOT
were known to mental health services. The most common
disorders are similar to those in the general population conduct, emotional and attention deficit disorders. They are 18
times more likely to attempt suicide.
Some groups of children are more likely to experience
mental health problems.
1,015 1,130
2008
2013
Looked after children are at five to six times
increased risk of developing mental health
problems than their peers and at four to five
times greater risk of self-harm. Hampshire has a
rising trend in the numbers of reported looked
after children from 1,015 in 2008 to 1,130 in
2013, mirroring the trend across England. We
estimate that 500 of these children will have a
mental disorder, the majority of which will be
conduct disorders.
Children of Armed Forces Personnel – Hampshire has a
greater range of armed Forces than any other county
in the UK. In 2012 there were 5,649 children of service
personnel on the Hampshire school roll. Evidence suggests
that the impact of parental deployment and constant
mobility on the family dynamic can lead to increased
mental health problems in some children.
Self-harm is very common among young people and
is more common in girls than boys. Some children
find it helps them manage intense emotional pain if
they harm themselves, for example through cutting or
burning. They may not wish to take their own life. In
the UK rates of deliberate self-harm appear to be rising
among young people, especially amongst girls and are
higher than anywhere else in Europe. Self-harming
behaviour occurs in over 1 in 4 young people with an
emotional disorder, e.g. anxiety, depression or phobia,
and 1 in 5 young people with a conduct disorder.
13
14
3,300
CARERS
Although children in Hampshire generally enjoy good mental health we
estimate that at any one time about 18,000 of those aged 5-16 will have a
diagnosable mental health problem.
7,604
2001
2011
YEARS
Young Carers become vulnerable
and at increased risk of mental
health problems when the level of
care giving and responsibility to the
person in need of care becomes
excessive or inappropriate for that
child. The number of young carers
reported in Hampshire has doubled
since the 2001 census, from 3,300
carers aged 0-24 years in 2001
to 7,604 in 2011. We know that
many of these young people will
need special support from services
such as school nursing to help them
maintain good mental health.
5,649
In 2012/13, rates of hospital admissions in Hampshire
for children admitted to hospital for self-harm were
higher than the England average. We need to look
more closely at these findings to understand the
reasons and the actions we need to take.
Hospital admissions for children with mental health
conditions in Hampshire are falling but have been
consistently above the England rate and those of similar
local authorities since 2012. Work is continuing to
understand if these higher rates are due to a higher
rate of mental illness, or are a reflection of the way our
local services are designed.
Emerson, E. and Hatton, C. (2004) Estimating current need/demand for supports for adults with learning disabilities in England. Institute for Health Research, Lancaster University, Lancaster
Public Health England Learning Disabilities Profile 2013
17
Future projections of need
By 2020 we predict that there will be 9,640 more children living in Hampshire. The recent rise in births,
continuous housing development and inward migration are all contributing to the increase. This is likely to
continue and we should consider these projections as ‘lower end of the range’ estimates.
The indications are that we will continue to see an increase in the number of children with mental health
conditions in Hampshire due to the following factors:
l it is unlikely that mental health problems will become less common. This means that we can expect an
increase in the number of children with mental health needs simply from the population increase
The Dynamic Model of Wellbeing
The four protective factors
are influenced by population
characteristics, wider
determinants and the core
economy. All of which
are influenced by
levels equity and
social justice.
l evidence suggests that mental health conditions in children in Hampshire, in
common with the rest of England, are underdiagnosed. The increased national
and local focus on children’s mental health and the drive for parity
with physical health may lead to more children being identified with
mental health problems. At the same time there will be increased
opportunities for prevention and early intervention which could reduce
some of the need for specialist mental health interventions
l trend data suggest that we will continue to see an increase in the
number of vulnerable children in Hampshire who are at significantly
increased risk of mental health disorders, for example looked after children
and children with learning disabilities
l the long term impact of lifestyle behaviours which increase the risk of poor
mental health such as obesity, physical inactivity and substance misuse is
more difficult to predict. While we have had some success in influencing
risky behaviours in children it is unlikely that we will see a dramatic reduction
over the next few years and that these behaviours will continue to affect the
mental health of children.
Protective and Risk Factors for
Emotional Wellbeing and Mental Health
The dynamic model of Mental Health and Wellbeing15 identifies four core
groups of protective characteristics that have a positive influence on the
mental wellbeing of children and their communities:
l Enhancing Control: the extent to which individuals and communities have control over their lives has a
significant influence on mental health and overall health.
l Increasing resilience and community assets: resilience is the ability to ‘bounce back’ and do better
than expected in the face of adversity. Communities with high levels of assets are those where people know
and trust each other, do things together and reward kind actions.
l Participation: being involved in activities outside the home, such as cultural and leisure activities, as well
as volunteering, membership of clubs and groups.
Certain things (risk factors) make it more likely that children will experience poor
emotional wellbeing and mental health.
There is a complex interaction between these risk factors and protective factors.
Many children who are exposed to significant risk factors will thrive and develop
into confident and caring adults because they are resilient and have enough
protective factors to act as a counterbalance.
Understanding these factors is important so that we know how to promote
children’s mental health and support them to be resilient.
l Inclusion: The extent to which opportunities such as employment, education, leisure, financial resources
can be accessed. People with mental health problems are among the most socially excluded.
18
15
NMWIA Collaborative,2010
19
Protective and risk factors that influence children’s mental health16
Child
Family
School
Community/
Wider World
Protective Factors
Risk Factors
•
Being female (younger children)
•
Genetic influences
•
Biological resilience
•
•
Good communication, social and emotional skills
Specific developmental delay or
neuro-diversity
•
Good physical health and development
•
Physical illness/ disability
•
Secure attachment to parents or carers
•
Low IQ and learning disabilities
•
Outgoing temperament as an infant
•
Communication difficulties
•
Problem solving skills and a positive attitude
•
Difficult temperament
•Humour
•
Academic failure
•
Experiences of success and achievement
•
Low self esteem
•
Faith or spirituality
•
•
Capacity to reflect
Who have or are misusing substances,
such as alcohol and drugs
•
At least one good parent- child relationship ( or
one supportive adult)
•
Overt parental conflict, including
Domestic Violence
•
Family harmony and stability
•
•
Affection
•
Supportive and consistent parenting with firm
boundaries and limits
Family disharmony, instability and
break up ( including where children
are taken into care)
•
Harsh or inconsistent discipline
•
Support for education
•
Hostile or rejecting relationships
•
Absence of severe discord
•
•
Family involvement in activities /spending time as
a family
Failure to adapt to a child’s changing
needs
•
Physical, sexual and/or emotional
abuse
•
Parents/ carers with mental illness
•
Parental criminality, alcoholism or
personality disorder
•
Death and loss
•
Siblings with serious illness or disability
•
High morale school with positive policies for
behaviour, attitudes and anti- bullying
•
Whole school approach to promoting good
mental health
•
Sense of belonging and connectedness between
school and family
•
Positive peer influences
•
Academic achievement
•
•
•
•
•
Wider supportive network
Good housing
High standard of living
Participation in community networks
Strong cultural identity and pride/valued social
role
Opportunity for participation in a range of leisure
activities
•
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20
• Difficult school transition
•Bullying
•Discrimination
• Breakdown in or lack of positive
friendships
• Peer pressure
• Deviant peer influences
• Poor reading/low school attainment
• Poor pupil – teacher relationships
• Poor attendance
• Socioeconomic disadvantage
•Homelessness
•Discrimination
•Isolation
• Disaster, accidents, war or other
overwhelming events
• Other adverse events in childhood
Emotional Wellbeing and Mental Health
Services in Hampshire
There is a four-tier pathway of services in Hampshire
in line with national policy which places firm emphasis
on prevention and early intervention. ‘Universal
services’ which are accessible to everyone and early
interventions for groups of children and families who
need additional support are usually described as tiers
1 and 2. More specialist services, mainly provided
by the child and adolescent mental health services
[CAMHS] are described as tier 3 and highly ‘specialist
services’ which are available for those children and
young people with the most severe and complex needs
are at tier 4. The framework highlights how children
and young people’s needs can increase or decrease
over time and so they may need to access services in
different tiers at different times and how professionals
can work across ‘Tiers’.
From our consultation we know that the balance
between services in the tiers isn’t quite right for the
needs of Hampshire children and families and that we
need to work to change this.
Tier 4 Services generally referred to as specialist
services. In the context of mental health, these services
will generally be in-patient units, or highly specialised
multi-disciplinary community teams that will work
intensively with the child or young person to support
them within the community. Referrals will need to be
made through other professionals and there will be
eligibility criteria for access into the service.
Tier 3 Services generally referred to as community specialist services. These
are services which continue to be accessed from within the community
but services usually work in a multi-disciplinary environment due to the
complexity and severity of the needs of the child or young person and the
requirement to have input from specialists from a variety of professional
backgrounds. It is unlikely that services will offer self-referral and may need
to be referred into the service by another professional.
Tier 2 Services generally referred to as targeted services. These are services are generally
available to specific groups of children and young people, for example children with
disabilities, who may need some additional support. Self-referrals may still be possible but
there is likely to be a level of eligibility criteria applied. Interventions are usually delivered
in a single-disciplinary environment, who may access support from other services as
and when required. the types of services that may be available include, support groups,
counselling, outreach workers, consultations and assessments.
Tier 1 Services generally referred to as universal. These services are
generally available to all children and young people and service users can
make direct contact with them. These services include Schools, Children’s
Centres, Nurseries, GPs and Health Visitors.
Young Minds risk and resilience handouts
21
Specialist Child and Adolescent Mental
Health Services (CAMHS)
What do we need to do now in Hampshire?
We need to:
In 2010 the Child and Adolescent Mental Health Service contract for
Hampshire was awarded to one NHS organisation. Working with the
new service we have:
l Implemented a Hampshire wide intensive home
treatment service. This service provides intensive
community support for children and young people
with complex mental health difficulties, supporting
them in the community and reducing the need for
inpatient admissions.
l Re-structured all Child and Adolescent Mental Health
teams across Hampshire to provide a more equitable
access to mental health services.
l raise awareness of the importance of good
mental health in children amongst all those
who work with children.
l promote good mental health in children
by working across organisations to build
protective factors and reduce exposure to
the risks for poor mental health in children
wherever we can.
l invest in services to support children with
mental health needs at an earlier stage to
reduce the future social, health and economic
costs associated with poor mental health.
There is good evidence to show that these
actions can improve mental health in
children:
l Promoting the mental and physical health of
parents
l Improving parenting skills, particularly in
infancy and early childhood
l Building resilience in children and young
people
l Promoting good physical health in children
l Prevention of violence and abuse
l intervene earlier when a child has a mental
health problem before it becomes significant.
l Implemented the Choice and Partnership Approach
(CAPA) across Hampshire, which has increased the
focus on choice for the child or young person and
better management of capacity within the service.
l identify children and young people who are
at higher risk of mental health problems so
that we can ensure that they get the right
support.
l Decreased the number of missed appointments
where the child or young person did not attend their
appointment, which has enabled more time to be
spent with children and young people.
l continue to support Early Intervention policies
to build the social and emotional bedrock in
children aged 0-3 years.
l Introduced Hampshire wide referral criteria, which
have improved consistency in accessing the service.
l Successfully bid for the ‘Increasing Access to
Psychological Therapies (IAPT)’ Programme which
will enable staff to deliver more evidence based
interventions.
l Implemented a consistent approach to performance
reporting which has led to a better understanding of
the needs of children and young people accessing
the service.
22
23
Our Priorities
The following priority areas for action have been identified and take account of what children and their families
have told us. They are a good fit with and build on existing work.
1.0 Emotional Wellbeing and Mental Health in Hampshire is Everyone’s Business
There are many factors that influence good emotional wellbeing and mental health. We want everyone
to understand what these factors are, including the importance of physical health, and how they can help
to promote mental health in children and remove the stigma that is often associated with mental health
problems. We want to increase awareness and knowledge about mental health problems amongst people
working with children and young people and improve understanding of when it is necessary to seek specialist
support.
Key outcomes
How will we know we have made a
difference?
A greater awareness, amongst professionals who
work with children and young people, of why good
mental health is important and the factors that
influence it in children.
People working with children will report:
• a greater awareness of the factors that influence
mental health in children and young people
• a greater awareness of why good mental health is
important
• an increased confidence in having conversations
with children who have additional emotional
wellbeing and mental health needs
The importance of good mental health in
children and the influences on this continue to be
reflected in strategic plans, for example continued
prioritisation of investment in the Early Years and
action on maternal mental health.
• Actions for improving mental health in children are
included within multi-agency supported strategies.
Children and young people have the skills they need
to stay emotionally healthy.
• More children are resilient
• There is a reduction in the need for specialist
treatment and interventions
Key Actions
24
A
Develop a coordinated approach to enable everyone working with children, young people and their
families to undertake training so that they are more knowledgeable about emotional well being and
mental health and are better equipped to support them.
B
Increase the focus on promoting and improving children’s mental health at a strategic level across
organisations.
C
Embed the importance of good mental health in children across all partner agencies, including
health, education, children’s services, social care and third sector services.
D
Work with Early Years settings, Children's centres, voluntary organisations, schools and colleges so
that they can better support the mental health of children and young people, especially at times of
transition.
E
Encourage schools to adopt a whole school approach to promoting resilience and good mental
and physical health through the Hampshire Healthy Schools programme and/or the Young Minds
framework.
2.0 Earlier recognition and intervention for mental health problems in children
We know that earlier intervention of mental health difficulties improves the life chances and opportunities
for children. Parents and carers told us that there are gaps in services for children suffering from ‘low-level’
mental health difficulties. Professionals told us that they wanted more information about the best way to
support children with mental health needs who do not require a specialist mental health service to help ensure
that their health does not get worse. We will work across agencies to develop early intervention services for
children with mental health difficulties and to ensure that there is easy access from these services to more
specialist advice when needed. We will continue to work across agencies in the development of a multiagency early help response for children and young people who have additional needs, such as Looked After
Children.
Key outcomes
How will we know we have made a
difference?
Additional emotional wellbeing and mental health
needs are identified early.
• Reduction in the number of urgent referrals to
the specialist Child and Adolescent Mental Health
Service.
Services are provided at an earlier stage.
• An increase in the proportion of referrals being
received by the appropriate service first time.
• An increase in the proportion of appropriate
referrals to the Specialist Child and Adolescent
Mental Health Service.
The development of services have involved seeking
the views of and working with children and young
people.
• Children and young people have been consulted
over the development of services and their views
have been incorporated.
Key Actions
A
Review and implement improved ways of working between Early Help Hubs, being led by
Hampshire County Council, and the Specialist Child and Adolescent Mental Health Service to
ensure specialist mental health advice, guidance and support is available at an earlier stage.
B
Review currently commissioned Tier 1 and Tier 2 services, using the recently developed needs
analysis as a basis for decision making regarding future service provision. Specific areas for early
review include a review of parenting support across Hampshire, parent/carer health, management
of self-harm and targeting groups most at risk of developing mental health difficulties.
25
3.0 Improve information and advice available for children, young people, families and
professionals with regard to emotional wellbeing and mental health.
Through the consultation, we heard that families feel they need additional support, but often struggle to
receive the right support at the right time. This is because they do not know where to find information about
services that are right for them and how to access the support that is available. We will make it easier for
families to find out about services in Hampshire so that they can make informed choices about what type of
support they need and how to access it.
Key outcomes
How will we know we have made a
difference?
Parents/carers and professionals have access to
a variety of resources in one place in relation to
emotional wellbeing and mental health.
• Emotional Wellbeing and Mental Health resources
are available through the Early Help Hub, the
directory of services and the Local Offer.
Key Actions
A
How will we deliver the strategy?
A Strategic Group for Emotional Wellbeing and Mental Health (Children
and Young People) has been established to oversee the development and
implementation of the strategy.
The group will develop a detailed action plan setting
out the short, medium and long term actions needed
to deliver the priorities. The group will review progress
against the plan regularly and ensure that it is
delivered. The group is multi-agency and consists of
young people, and representatives from Parent/Carer
Groups, Children’s Services, Public health, Health,
Schools and the Voluntary Sector.
The strategy will be reviewed each year.
The structure below shows the governance
arrangements for the Strategic Group for Emotional
Wellbeing and Mental Health (Children and Young
People) and its links with overarching bodies.
Review the information, advice and guidance available to children, young people, families and
professionals and work with them to improve the quality and accessibility of such information and
improve the awareness of services that are available locally.
4.0 Ensure all children, young people and families have access to timely, evidenced based,
high quality specialist mental health support, when it is needed.
Children’s Trust
Board
Health and
Wellbeing Board
Specialist mental health services are needed for children with more complex and severe mental health needs.
Through the consultation, we heard that parents and carers felt that their children often had to wait too
long to access these services. Professionals identified a need for better information for both professionals and
families about specialist services and some were concerned about the capacity of specialist services.
Key outcomes
Children who require it, have timely access to
evidence based interventions.
How will we know we have made a
difference?
• Implementation of the IAPT Programme for
children as part of a specialist service.
Joint Child Health
Commissioning
Board
• Continue to monitor and improve waiting times
for the Child and Adolescent Mental Health
Service.
Looked After Children and other vulnerable groups
of children, who require support from specialist
services, have access to it in a timely way.
• All Looked After Children and other vulnerable
groups have timely access to specialist services.
Key Actions
26
A
Ensure that our Specialist Child and Adolescent Mental Health Service can meet the needs of the
increasing numbers of Looked After Children and other groups of vulnerable children in a timely
manner.
B
Continue with the implementation of the IAPT Programme and ensure that Routine Outcome
Measures are rolled out across the whole of the Hampshire Child and Adolescent Mental Health
Service.
Strategic Group
for Emotional
Wellbeing and
Mental Health
Child Health
Prevention &
Early Intervention
Delivery Group
27
This document is available in Braille, large
print, other languages or audio format on
request. To request an alternative format,
email [email protected],
call 01252 335154 or write to:
NHS North East Hampshire and Farnham
Clinical Commissioning Group
Fourth floor, Aldershot Centre for Health
Hospital Hill, Aldershot, Hampshire GU11 1AY
CS38697 – NHS Creative – September 2014