Croydon Joint Strategic Needs Assessment 2012/13:Emotional health and well‐being of
children and young people aged 0‐18
Emerging findings
Kate Naish: Public Health Strategic Lead – Young People
Why this JSNA Deep Dive was chosen?
• Tackling mental health problems early in life can improve a wide range of outcomes.
• Locally ‐high level of need and set to increase.• Key priority for Croydon, particularly CFP and Be
Healthy Task Group.
• Limited funding/capacity within specialist services, so review of local commissioning urgently needed.
• Widely recognised greater focus and prioritisation needed on early intervention which is cost effective
and improves quality of life.
Aim of the JSNA –Deep Dive• A population approach with respect to children and
young people aged 0‐18 years of age.• Estimate & identify level/type of mental health need
amongst this age group in Croydon, including vulnerable groups.
• Include consideration of perinatal
mental health of pregnant women and new mothers.
• Consider national/local policy drivers and associated evidence base used to inform local service
improvements.• Review current CAMHS service provision and suggest
opportunities for improvement and increased early intervention.
• Inform future commissioning and local strategy development.
Proposed Deep Dive Framework:• Introduction: background, policy context and
evidence base • Needs Analysis: estimated need; trend analysis
and projections, need amongst vulnerable groups of CYP; perinatal
mental health
• Local services: universal and specialist• Transition Issues – CAMHS to AMHS • Views of stakeholders• Investment in child and adolescent mental
health• Recommendations
Key Facts and figures• 1 in 10 children aged 5‐16 years has a clinically
diagnosable mental health problem.
• At any one time 1.2‐1.3 million children have a diagnosable mental health condition.
• Half of those with lifetime mental health illness first experience symptoms by 14 yrs old and three‐quarters
before mid‐20s.
• Rates of disorder rise steeply in middle to late adolescence.
• Although effective treatments are available only around 25% of those that need such treatment, receive
it.
Croydon’s growing population
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
Num
ber
Age band
Croydon 2001
Croydon 2011
Croydon 2021(projected)
Prevalence Estimates• Table 1: Estimated children with number of disorders (2012)
• Table 2: Estimated number of children/young people who may experience mental health problems appropriate to a response from CAMHS (2012)
Croydon Percentage NumbersConduct Disorders 5.8% 3263Emotional Disorders 3.7% 2082Being Hyperactive 1.5% 844Less Common disorders 1.3% 731
Croydon Percentage NumbersTier 1 15% 13427Tier 2 7.0% 6266Tier 3 1.85% 1656Tier 4 0.075% 67
Projected need: 2012‐21
Tiered ‐
Service Models
Stakeholders involved to support the emotional health and well‐being of children and young people
JSNA Data Sources
Epidemiology/Quantitative Needs Assessment- National/Local picture;- Comparison with other London boroughs;- Types of emotional health disorders being presented- Variation based on age/gender/ethnicity/distinct types of young people (e.g.
LAC; young offenders; disabled young people inc. LDD and ADHD, ASD etc)- Info from other local sources:
Primary care data;Education: schools data (inc. SEN)A & E Data Social Care Data Croydon Community Health Services DataCAF and FEP DataYOS dataPerinatal Mental Health data
JSNA Data SourcesService information and analysis
- Locally commissioned services (e.g. Croydon Drop –In; Off the Record, SLAM Specialist CAMHS services etc).
- Service data analysis
no of referrals (age/gender etc)
annual trend analysis
waiting lists times
demand vs. capacity (unmet need)
- Other services offered by other non‐commissioned organisations
GP Data• For the period 2007/8‐2011/12, the largest numbers
of specific mental health disorders diagnosed amongst children and young people aged 0‐18 were
in descending order
‐
Other autistic spectrum disorder;
‐
Disorder of speech and language development;
‐
Attention deficit disorder;
‐
Anxiety disorder;
‐
Childhood conduct disorder
• Those disorders with the highest incidence rates per 1000 per year included: ‐Asperger
syndrome; other
disorder of psychological development and learning disability.
A & E Attendances
Post‐Natal Depression: FHNA
SLAM CAMHS Specialist Services
Age-specific rate of referral per 1000 (3-year rate), by CAMHS team, Croydon 2009/10-2011/12
0
2
4
6
8
10
12
14
16
0-4 years 5-10 years 11-16 years 17-18 years
Age groups
Rate
per
1,0
00
Croydon ADHD Croydon Adolescent Service
Croydon Children's Team Croydon Early Intervention Team
Croydon - Looked after Children's Team Croydon Youth Offending
SLAM CAMHS Specialist Services
Numbers of patients seen by team, Croydon 2008/09 - 2011/12
0
100
200
300
400
500
600
700
800
2008/09 2009/10 2010/11 2011/12
Num
ber
of p
atie
nts
seen
Croydon Adolescent Service Croydon ADHDCroydon Children's Team Croydon Early Intervention TeamCroydon - Looked after Children's Team Croydon Youth Offending
Croydon Drop‐InActivity by Age groups, Croydon 2009/10 - 2011/12
0%
10%
20%
30%
40%
50%
2009/10 2010/11 2011/12
Age groups
Per
cent
age
11 - 12 yrs 13 - 15 yrs 16 - 19 yrs 20 - 25 yrs Unknown
Off the Record
Completed assessments by age groups, Croydon 2008/09-2011/12
0%10%20%30%40%50%
< 14 years 14 to 18years
19 to 21years
22 to 24years
25+ years
Perc
enta
ge
2008/09 2009/10 2010/11 2011/12
Consultation:
• Consultation undertaken with wide range of children and young people, including vulnerable
groups
• Additional consultation undertaken with Croydon social workers and SLAM CAMHS practitioners.
• Wider stakeholder event held 19th
September to consult multi‐agency partners across LA, NHS,
voluntary sector, schools/colleges, parents and carers
Consultation Groups
• BME young people
• LAC (indigenous and UASC)• Young people accessing Croydon Drop‐In and
Talkbus
Outreach services
• Young carers• Young offenders• Croydon Youth Council• Wider stakeholders and parents and carers
Consultation: CYP initial analysis
• High levels of stigma regarding emotional health and well‐being and as a result considerable fear about
accessing services.• Majority of those consulted had been personally
affected or knew someone affected with a mental health issue
• Young people cited that greater awareness and information is needed in relation to emotional health
and well being, as well as information about general mental health disorders.
• Support and support found to be generally good for those who have received it
• Greater provision of support services is needed in schools and colleges.
Consultation: CYP initial analysis• Need to improve awareness and advertising of local
services, particularly counselling services• Mental health issues not routinely discussed with
parents and carers and peers are generally the people, children and young people would initially
approach with their worries rather than other family members .
• Although many young people identified they would approach their GP for advice and support with a
mental health issue, few had found it easy to talk to their GP and felt that their concerns were not taken seriously.
• The need for young people to have someone to talk these worries through with, were a key priority
either for themselves or someone else they knew.
Emerging findings• Paucity and limited available data within certain
key services.• Lack of awareness of local services and
associated referral criteria.• Lengthy waiting times for certain specialist
CAMHS services (e.g. ASD and ADHD)• Greater need for early identification and
intervention for young people with mental health issues
• Greater focus on child and young people focused health promotion and education around
emotional health required within universal settings, particularly schools and colleges
Evolving recommendations
• Develop CAMHS minimum data set and improve local service based information
• Improve communication and awareness of the range of local CAMHS services at all Tiers and
within the statutory and voluntary sector
• Improve and increase awareness of CAMHS protocols and care pathways for referral, support
and early intervention
• Improve multi‐agency and partnership working around this area of priority
• Review and increase early intervention initiatives and support available at Tiers 1 and 2
• Address unacceptable waiting lists for specialist SLAM CAMHS services, through service review
and creative solution focused initiatives (e.g. ASD/ADHD shared care protocol)
• Increase provision and support available in schools, using a ‘whole school approach’
to
supporting pupils emotional well‐being and resilience
• Improve and increase available training and education to practitioners in universal services
• Improve identification and support of perinatal mental health difficulties by GPs
• Review local transition protocol in relation to joint working arrangements between CAMHS and
AMHS
• Increase and improve involvement of children, young people and their families and carers in
local planning and commissioning of services
• Develop a comprehensive children and young people’s emotional health and well‐being
strategy
for Croydon for 2013‐14 and beyond
Thank you!