Liverpool’s CAMHS Partnership

Lisa NolanProgramme Delivery Manager

(Children and Maternity)Liverpool CCG

Lisa.nolan@liverpoolccg.nhs.uk

• Needs led• Family centred• Multi-agency – range of providers• Provides continuum of care with targeted support• Engaging, Involving and inclusive• Jointly commissioned• Strong

How did we get here?

Liverpool’s CAMHS Partnership

The journey

Alder hey community

mental health teams

Com

preh

ensi

ve C

AM

HS

In-patient provision

2+1 service,

Alder hey

Pre-2003

Providers:

Alder hey Foundation Trust – Community Mental health teamsRegional units

Commissioners:

Liverpool Health Authority

Outcomes:

Not monitored or reported

Tier 2

CAMHS tier 3 community teams,

YPAS counselling

‘Mad, Bad or Misunderstood’,

YPAS Support Service

Working Together

BEST

AS Pathway

Regional In-patient Units:

CABI

SLD team

HAVEN

2003-2006

Providers:

Alder Hey (many teams)VCS:YPAS Regional units

Commissioners:

Liverpool PCTLiverpool City Council

Outcomes:

Dev. of choiceLess stigmatising provisionNew ways of workingMore community based provisionJoint and partnership workingEmerging performance monitoring processPolicy driven

Tier 2

CAMHS tier 3 community teams,

YPAS counselling

Training and MH Promotion: ‘Mad, Bad or Misunderstood’, Healthy schools Partnership, Mental health promotion

YPAS Support Service

Working Together

ADHD Foundation

BEST

YOS mental health provision

AS Pathway

Regional In-patient Units:

CABI

Regional Home Based Treatment

Participation team, MYA

Banardos Young Carers & ‘Keeping the Family in Mind’

CAMHS LAC

CAMHS 16-18 team

SLD team

HAVEN

2007-2010

TAMHS, MYA

Providers:

Alder Hey (many teams)VCS:YPAS, PSS, Barnardos, MYARegional units and HBT

Commissioners:

Liverpool PCTLiverpool City CouncilSocial Care

Outcomes:

Dev. of choiceLess stigmatising provisionNew ways of workingMore community based provisionJoint and partnership working -participationThinking familyImproved performance monitoring processPolicy driven

PublicMenta

lHealthSelf-care,WebsiteMentalHealthpromotion

PublicMenta

lHealthSelf-care,WebsiteMentalHealthpromotion

Training:MBMInside Out, Master classMental healthfirst aidSpecific training

Consultation& support:Telephone,individual, group

Training:MBMInside Out, Master classMental healthfirst aidSpecific training

Consultation& support:Telephone,individual, group

C&YP&Families

C&YP&Families

Universal

services

Universal

services

Single Point of Access

Triage (multi-agency)

Alder Hey(Primary Mental Health Service,

Specialist CAMHS)

Alder Hey(Primary Mental Health Service,

Specialist CAMHS)

Mersey Care 16 plus

Mersey Care 16 plus

AHCFT 0-16 years

Out of Hours Psychiatry

AHCFT 0-16 years

Out of Hours Psychiatry

Other services (signposted)

Other services (signposted)

Tier 4YPC

(14-18), CHEDS

Tier 4YPC

(14-18), CHEDS

Tier 4Dewi Jones

Unit(0-14)

Tier 4Dewi Jones

Unit(0-14)

Tier 4OAT

(Independent Sector)

Tier 4OAT

(Independent Sector)

care aims methodology

Comprehensive CAMHS Pathways 2010-2013

Voluntary Sector CAMHS(YPAS, ADHDF, PSS,

Banardos YC)

Voluntary Sector CAMHS(YPAS, ADHDF, PSS,

Banardos YC)

Provider:voluntary CAMHS and c&yp

Provider:Voluntary CAMHSStatutory CAMHS

Providers:

Alder Hey(2 teams with SPA) VCS:YPAS, PSS, Barnardos, MYARegional units and HBT

Commissioners:

Liverpool PCT/CCG•Liverpool City Council•Schools•Social Care

Outcomes:

Dev. of choiceLess stigmatising provisionNew ways of workingMore community based provisionJoint and partnership working - participationThinking familyRobust performance monitoring process

•Single point of accessMulti-agency triage and workingMore accessible informationConsultation and training accessible to frontline provision

Liverpool’s CAMHS Partnership

Performance Monitoring:•Activity – CAMHS returns/National data set/national benchmarking•Outcomes – CAMHS returns/ CORC•Quality – CAMHS Returns/ Contract visits

Liverpool’s CAMHS PartnershipSo What??

•Reduction in specialist CAMHS referrals by 21% form 11/12 to 12/13•90% of those accessing services showing improvement in mental health (CORC)•90% high satisfaction with services (CORC)•Increase year on year of universal staff accessing training

Liverpool’s CAMHS Partnership• All providers using CORC measures• VCS all quality assured• Built local workforce• Strong equalities agenda• Strong participation agenda• Focus on early identification and

prevention

Liverpool’s CAMHS PartnershipWhy VCS?

•Less stigmatising•Less medical•More Flexible•Innovative and creative•Skills of workforce •Added value•Community based•Engaging and involving•Asset based

Liverpool’s CAMHS PartnershipChallenges:

•Professional hierarchy•Funding •Restructure

WHAT NEXT?

Liverpool’s CAMHS Partnership

Need:•Approx. 100,000 c&yp•Liverpool is 1 of the most deprived cities in UK •High proportion of LAC, young cares, c&yp with disabilities, BME communities and refugee and asylum seekers

High risk factors therefore mental health problems likely to be high

Main presenting problems:- Emotional disorders, behavioural

and self harmAdverse Childhood Experiences: - physical, emotional, sexual abuse,

domestic violence, household substance misuse, household mental illness, parental separation and divorce, parent in prison

Main referrers:- Education, child health services,

GPL4, L8 and L6 postcodes account for

27% of referrals

Tier Number

1 12828 (15%)

2 5986 (7%)

3 1582 (1.85%)

4 64 (0.075%)

Future Challenges:

•Integrated commissioning – funding

•Integrated care – culture, personalities

•Changing NHS – relationship management

•Economic climate and social determinants

GAPS:•Transition – CAMHS to AMHS and Tier 3-4 pathway•Early years and maternal mental health•Neuro-developmental problems (ASD and ADHD)•Mental health promotion •In balance in access – too many at specialist level•In balance in funding and therefore delivery – more focus on specialist than early intervention•Integration at commissioning level

Future Opportunities:

• Integrated commissioning and care• CCG and LCC priorities • Liverpool’s children and young peoples/whole family

agenda• Public health changes• IAPT (Improved Access to Psychological therapies) • Mental health promotion and FYI developments

(participation)• Training menu• Transition • Research opportunities• Neuro-developmental pathway• Datasets

Working Together to ensure mental health and emotional wellbeing is

‘Everybodies Business’

Joint commissionersRange – VCS, independent and statutory-partnership

UNCRC

2014-2017 strategy:

Improved mental health of Children & Young People

[& their Families]

Reduction in Mild to Moderate

Distress

Reduction in the development of Moderate

To Serve distress

Increased Identification of C&YP with

early indicators of distress and risks

Improved Environments so that Children,

Young People & families can Thrive

Liverpool CAMHSOutcomes Strategic Map and Pathway

Reduction in life long distress

Delivery- public mental health, early intervention, targetedContracts – LCCFunding- LCC/CCG/social care/schools (pooled budget)Performance managed – LCC

MYA- MHP, training and engagement

Barnardos YC and KFIM

PSS – refugee and asylum seekers therapeutic support

YPAS – therapeutic/counselling and support service

ADHD Foundation

Alder Hey – Early intervention (PMHS) and LAC/CIN

Alder Hey - Specialist CAMHS

In-patient care – Dewi Jones (alder hey) and YPC (CWP) and OATS

Delivery – specialistContracts– CCGFunding- CCGPerformance managed – CCG

Delivery – In-Patient (regional)Contracts– Spec CommFunding- CCG top slicePerformance managed – Spec Comm

Key:

Outcomes:•Improved mental health of children, young people and their families•Improved environments so that children, young people and families can thrive•Increased Identification of children and young people with early indicators of distress and risk•Reduction in mild to moderate distress•Reduction in the development of moderate to severe distress•Reduction in life long distress

Liverpool’s CAMHS Partnership