Issue - meetings

It was noted that the CAMHS local transformation programme was currently entering the fourth year of a five year agenda. A hub model using iTHRIVE principles has been developed for the main providers in order to seek to deliver earlier interventions. The service’s future direction was reinforced by the new NHS Long Term Plan with its emphasis on investment in areas such as prevention, early intervention in psychosis and eating disorder services. Funding for CAMHS is received on a borough-wide basis but some funding is top sliced in order to fund BHR-wide work e.g. a single point of access.

A steering group has been established to look at local need and come up with local solutions. In the past year, the transformation programme hasfunded work across a range of settings and services including the Early Help Service to increase perinatal mental health support, CAD team to deliver Five to Thrive and ELSA training, Youth Services to deliver the Go Girls programme, Havering Mind and AddUp charities to deliver parent support sessions and Children’s Services to develop the Adolescent Safeguarding Hub.

These programmes link to wider work which has included the funding of mental health first aid courses and suicide prevention training for school staff. School counselling was purchased by schools directly although officers were working with schools in order to map which Havering schools offered counselling and develop practical checklists for use by schools when appointing counselling services. It was suggested that the Council could coordinate joint purchasing of counselling services via its traded services. Officers would clarify which counselling services were currently available via traded services.

Healthwatch powers did not cover children’s issues but Healthwatch did wish to support this work. A Healthwatch report on mental health issues from another area could be shared with the Board for information.

The availability of IAPT services for children and young people was currently an issue at STP level and funding for services after year 5 of the transformation agenda was yet to be decided. The Council had also invested in mental health work within children’s services and wished to see children and families supported more in their own environment, rather than in clinics etc.

Training on suicide prevention and mental health first aid had been delivered by the Council’s Safeguarding and Workplace Wellbeing teams. The three-borough strategy on suicide prevention had been in place for one year and a lot of activity had taken place during this period at local, pan-London and national levels. Commissioning intentions for suicide prevention across BHR had been collated and published and work on discharge from in-patient settings was being led by NELFT. It was important for people with long-term conditions to have access to talking therapies. In addition, a ‘Good Thinking’ site had been commissioned across London with the aim of providing tools and resources to help tackle problems such as stress.

AThrive London programme had been established with improving the mental health and wellbeing of all Londoners. The Samaritans had also produced resources for use in schools.

Priority work included the arranging of an annual BHR summit and workshop on lessons learned from suicide. Public health officers also met with the coroner twice a year to discuss suicide inquests. Inquests into the suicides of Havering residents who died elsewhere would be undertaken by the coroner for that area although information could be gleaned from death registrations.

Work in progress this year covered areas such as training on suicide prevention, crisis response & places of safety and the provision of support to individuals in crisis. A review of the care of patients that self-harmed could be carried out at the BHR level of via the STP steering group. It was noted that self-harm was a very high risk factor for suicide and it was felt hat the impact of self-harming on A & E services should also be considered. The role of school counsellors was also important in preventing young people self-harming.

It was emphasised that there was now a wish to prioritise children’s autism needs, in addition to those of adults. A new Government strategy for autism was due at the end of 2019 and some work had been undertaken locally to get a better sense of what people with autism and their families were saying. Some services were highly regarded including post-diagnosis support for adults with learning disabilities and hospital staff being aware of patients with autism.

A draft strategy was being completed this week that would need sign up from all partners at a senior level. There were around 500 Havering residents with a primary autism diagnosis with a further 70 having a secondary diagnosis. Key issues for families included housing and unemployment and it was felt there should be an improved pathway between children’s and adults services. There was also a need to better signpost where help and support was available. An additional priority was to provide support to ensure people with autism could safely use public transport.

The Healthwatch representative felt it was important that children with autism received annual healthchecks and agreed that the CCG had improved greatly in this area. Work was also in progress with BHRUT to bring the skills of Trust staff with assisting people with autism etc out into the community.

The strategy covered large groups of people with varying needs and also looked at needs for supported housing. The families of people with autism wished to be more involved but it was felt more input was required from the Council and its partners. It was felt that the Council’s leisure provider and libraries could support work on dementia awareness and the action plan would include details of proposed work on raising autism awareness.

The Board discussed whether the Autism Partnership Board was the best place to take the strategy forward and it was agreed that Healthwatch Havering could be engaged to support consultation on the autism strategy.

The Board was advised that it was wished that local work on mental health transformation fitted with the national programmes for this area. The recently published NHS Long Term plan focussed on mental health and there was a need to explore the primary care model for people with moderate to severe mental health issues. The Long Term Plan aimed to provide better community support for mental health and the CCG was currently investing in perinatal mental health. Improving access to IAPT services was also a priority whilst work was also in progress on improving the access of rough sleepers to mental health support, support for people with gambling problems and for suicide reduction.

National must do actions for the CCG included meeting IAPT treatment targets although the increased recruitment this required could be difficult to achieve. Havering was not meeting its target for formal diagnosis of dementia and the estimate of numbers of people in Havering with dementia may not be accurate. It was noted that GPs were not allowed to diagnose dementia, this had to be done by a consultant.

The CCGs were working on ensuring that all patients with acute mental health issues received a full physical healthcheck. Out of area placements had increased recently and more people from outside Havering were also receiving treatment at local facilities. The CCGs had put investment into CAMHS and further investment was planned for 2019/20. A stakeholder workshop had been held on 28 February.

It was felt that a BHR-wide needs assessment exercise could assist with future planning for mental health and that a more coordinated approach to suicide prevention was also required. The Local Area Coordination model used in Thurrock had picked up a lot of issues that could lead to mental health problems such as debt, employment problems and housing issues. This gave a different way of working with communities and it was important that the aims of the mental health transformation programme fitted in with localities. Officers were also keen to work across BHR on substance misuse and mental health, as well as on homelessness issues.

The record of voting decisions is attached at appendix 3.