Steps taken in Bradford have resulted in all young people being seen within 11 weeks - the national guideline is 18 weeks - and urgent referrals occur within 24 hours. Here's how they do it.
Some young people are facing waiting times of up to 18 months to get the help they need, as highlighted in the recent Care Quality Commission (CQC) review on the quality of young people’s mental health care in England.
"To improve access and experience we have introduced evening clinics for children and families. This has been a huge success with families and staff, offering greater flexibility and enabling children and families to access support without it impacting upon school or work."
The review found nearly 40 percent of specialist child and adolescent services in England needed improvement.
Around half of all mental health illnesses begin by the age of 14. Preventing and identifying mental health issues as early as possible is crucial to effective treatment and recovery.
At Bradford Care Trust, we are bucking the trend, with a maximum wait of 11 weeks for routine referrals, and within 24 hours or sooner for urgent referrals. The national wait guideline is 18 weeks. We work as part of a formal West Yorkshire and Harrogate, Health and Care Partnership.
1) Specialist teams - including teams dedicated only to working with children in care and children with eating disorders
By setting up specialist teams within Child and Adolescent Mental Health Services (CAMHS) and designing new treatment pathways to enable children and young people to access services at an earlier stage, we’ve reduced wait times. We aim to ensure that every young person, who needs mental health support, gets effective treatment which is tailored to meet their needs, whether it be urgent crisis support or help to manage life’s ups and downs such as low mood, stress or anxiety.
For example we set up a specialist eating disorder team so those in need of support can be seen quickly and be offered specialist intervention. We also have a psychological therapy team working with children with mental health difficulties who are looked after [in care] or adopted. With the majority of referrals that come into CAMHS, that don’t fall within those categories, we have assessment clinics to establish which service will be best for those struggling with their mental health. To improve access and experience we have introduced evening clinics for children and families. This has been a huge success with families and staff, offering greater flexibility and enabling children and families to access support without it impacting upon school or work.
2) Discreet, residential safer space
Just over a year ago the Care Trust, working in partnership with charity Creative Support and Bradford Council, opened a through-the-night urgent mental health service which provides vulnerable young people with a homely and welcoming overnight place to visit in emotional distress. The safer space location is in a residential area and is kept discreet following feedback from young people who helped to decide how the service would look and what should be in it. It’s open 365 days a year from 10pm to 10am and can be accessed through the Trust’s First Response urgent mental health crisis service.
"We’ve had great feedback from parents who have felt reassured since the service opened. It means those in crisis can avoid going to A&E and can get the most appropriate support."
Our safer space comments book lists a series of positive feedback from those that have benefited from the service. For example *Gemma, aged 14, valued having a safer space to go to when she was in emotional distress following a breakdown of a family relationship. Gemma’s comments read: “It made a real difference having somewhere to go to, where I felt listened to. Getting things off my chest allowed me to feel calmer, more relaxed and I was able to get a good night’s sleep.”
3) Holistic support and partnerships
Other initiatives that we’re running to enhance mental health support include Youth in Mind, which is run in partnership with all children and young people’s agencies in Bradford, Airedale, Wharfedale and Craven involved in supporting emotional wellbeing. A new buddying scheme, which pairs a young person up with a mental health trained youth worker whilst waiting for CAMHS support, has come out of the initiative.
We’ve had feedback from participants who have credited their buddy and the scheme with helping them to manage their low moods and anxiety, enabling them to leave the house and socialise with more confidence; something they were unable to do before taking part in the programme.
The 12-week holistic wellbeing initiative provides additional support which includes a range of online tools for young people to access which allows them to track their own progress and learn how to cope better in future times of crisis. The overarching aim of the Youth in Mind service is to help people keep their mental health on track before a crisis escalates.
Since 2001 we’ve been working in partnership with school nurses across the district to offer advice and consultation - and timely and appropriate help to every young person. We also actively work across Bradford in partnership with all agencies and are part of a wider multi-agency approach in the district to support young people’s mental health and emotional wellbeing. This work is part of the West Yorkshire and Harrogate, Health and Care Partnership.
Children and young people who require an inpatient bed will also be able to get the care they need closer to home, making it easier for their family and carers to visit, when a new £13 million child and adolescent mental health unit is built in Leeds. Collectively the Mental Health Collaborative trusts are all committed to reduce out of area placements for young people.
We want to continue to help those most vulnerable before they become seriously unwell through early intervention and prevention services. Whether it’s a teenager with an eating disorder or a young person whose life has been overshadowed by mental health difficulties such as depression and anxiety, we’re committed to ensuring those who experience mental health issues are offered caring support and are left feeling better-equipped with the right techniques to manage their mental health in the future.
4) Showing how to boost moods
We offer WRAP groups – wellness recovery action planning – a peer-led recovery group programme that is young person friendly and is delivered through Barnardo’s in partnership with the Care Trust and the Youth service to help children and young people gain the skills they need to manage the ups and downs in their mental health. It’s been really successful. Young people have completed their WRAP and then trained to become WRAP facilitators using their own lived experience to help others.
We were probably one of the first to pioneer WRAP in the UK for young people, even though it was already established for adults. It’s not a complicated therapy; it’s about helping people to get in touch with the resources they have themselves to turn their lives around. For example using a wellness tool, these are the things that we do every day that keep us well and make us feel better that we often take for granted. It’s just reminding people of all the things that they can do, from going out and doing some enjoyable exercise, to snuggling up under a blanket with a good book. It’s about the things that boost your mood. Young people love it; it’s been really positively evaluated and has made such a difference to their emotional wellbeing.
5) Teacher support
We’ve also been doing lots of work on breaking down the stigma of mental health and getting it talked about in schools through our Mental Health Champions in Schools project. Our primary mental health workers are working alongside educational psychologists to create a network of champions across the schools in Bradford.
Over 60 schools have signed up to the project where senior members of teaching staff are offered additional training about emotional health and wellbeing. This includes six weekly specialist advice and consultation sessions delivered by our primary mental health workers who guide on how to provide teaching and assemblies on emotional wellbeing. We’re equipping both teachers and young people with knowledge and skills about mental health and wellbeing, how to talk about it, and what can help. They feel increasingly more comfortable accessing help and are looking at mental health as something not to be ashamed of.
As all these services and initiative become more embedded and established we will continue to see those wait times come down, enabling people to access the right treatment with rapid access to diagnosis and specialist treatment.
Nicola Lees is Chief Executive, Bradford District Care NHS Foundation Trust and the Chief Executive Mental Health Lead for the West Yorkshire and Harrogate Health and Care Partnership.