Children and Young People’s Mental Health: Promoting Integration and Early Intervention

1. Integration of physical and mental
health services for young people
Dr Lesley French
Clinical Director
Children & Young People’s Directorate
Manchester Conference 08 December 2016

2. Challenges to integrated health care for young people
2
From The Winter’s Tale by William Shakespeare
I would that there were no age between ten and twenty-three
That youth would sleep out the rest
For there is nothing in between but getting wenches with child,
wronging the ancientry
stealing and fighting.

3. What we know
3
• Around 80% of those patients with chronic medical conditions,
often starting in childhood have associated mental health co-
morbidity.
• 75% of adults with MH problems age of onset <24 years
• Some estimates 1:8 adult physical health patients receive
evidence-based mental health treatment
• Extensive evidence that mental health plays a key role in pain
management, recovery and quality of life
• Extensive evidence that physical health strategies improve
outcomes for mental health conditions such as depression

4. Why is it so difficult
4
• Biggest barrier is service organisation
• Current commissioning structures in the NHS
• Financial pressures more acute than ever
• Health economic arguments of life-time savings in services do
not bring immediate solutions to cash-strapped NHS and Local
Authority providers
• In children’s services multiple agencies can be involved with
children with complex needs, each providing good care but
multiple contacts for the family to manage

5. What good looks like
5
• For real integration of physical and mental health services?
• An unrelenting focus on outcome changing care
• A champion –led culture shift to holistic care
• Cross-disciplinary training (more diversity per professional)
• Use of care managers/care co-ordinators as specialists
• Co-ordinated records and systems
• A total population focus at commissioning level
• A respectful co-ordination of co-located interdisciplinary clinical
services (Kathol et al, 2010)

6. Triangulation of Outcomes
6
“Are CYP
receiving
our services
improving?”
Service User
Satisfaction & QoL
(CHI-ESQ, Friends &
Family Test)
Goals Based
Outcome
Measure
Physical/Mental
Health Measure
(RCADS, CGAS)

7. Integration of Physical and Mental Health in Practice
7
• Three boroughs, three sets of commissioning arrangements and
a range of local priorities for one health provider
• A re-furbishment of one building has prompted a re-think about
co-location of physical and mental health services for children
across two boroughs
• Health visiting, school nursing, children with complex disabilities
and child with mental health needs (CAMHS)
• Existing practice should be transformed by proximity of teams
• Culture change embedded

8. Local examples
8
• Integrated neuro-developmental service
- psychiatry, psychology paediatrics and SaLT
• Dietetics and CAMHS – working with obesity
• Sickle cell physical health and emotional care
• Physiotherapy joint clinics with orthopaedic hospital surgeons
• Community health & well-being services in schools
• Physical health clinics for adolescents with complex MH needs
• Working with LA to ensure disabled access in local parks
• Diabetes community nursing and clinical psychology provision

9. Why integration matters
9
• Broad agreement in the literature that for children & young
people co-ordinated and integrated care the best offer
• All our efforts at whatever point of contact for the young person
should be to enhance the social and emotional competence of
young people
• Schools can be seen as a de facto mental and physical health
system
• A single point of access for children which is non-stigmatising
• Secondary school age children should be a key focus for public
health programmes given the evidence of vulnerability

10. The developmental arguments
10
• Young people ( 12 – 24) are developmentally emerging adults
• The stage in which most mental health disorders emerge
• A high rate of self-harm – and suicide a leading cause of death
• A strong relationship between poor mental health and other
health and developmental concerns & educational outcomes
• Global estimates 1 :4 YP will suffer one mental disorder
• Poverty and social disadvantage strongly associated
• Protective factors include a sense of connection and social
support, parents and friends who model health behaviours

11. Mind the Gap
11
• Most MH care for YP delivered in outpatient community settings
• Sometimes housed within adult services
• Access to mental health poor especially for late adolescence
early adulthood – the most at risk period
• If physical health good unlikely to have relationship with GP or
any other health worker able to connect to a wider system
• Often diagnostically confusing and need multi-disciplinary cross-
service support along with excellent engagement skills
• A substantial gap still exists for rapid and effective service
responses at the time of greatest mental health need for YP

12. Implications for policy and practice
12
• Disseminate health-based interventions for young people
through co-located health sites and schools
• Stigma of mental health limits access to the traditional offer
• Integrate MH intervention into general health interventions
• Physical health practitioners trained to deliver treatments such
as CBT and evidence-based counselling when treating children
with chronic health disorders
• A single young people-friendly site under one clinical
management structure -primary and tertiary care

13. Thank you
lesley.french1@nhs.net