Minutes:
The Chairman welcomed James Postgate, Associate Director of Integrated Commissioning – SEL CCG (Bromley), Matthew Trainer, CEO – Oxleas, Lorraine Regan, Service Director (Bromley Directorate) – Oxleas, Sheena Gohal, Associate Director – CAMHS - Oxleas and Gill Allen, Director – Bromley Wellbeing Service for Children and Young People, to the meeting to provide an update on the current position of mental health resilience in the Borough.
The Associate Director of Integrated Commissioning advised Board Members that from a commissioning point of view, they had seen significant changes to services across the Borough. It was noted that mental health resilience was also an area of focus for the Mental Health and Wellbeing Strategy.
The CEO – Oxleas advised Board Members that, as a result of the COVID-19 pandemic, they were expecting to see a sustained increase in the demand for mental health services over the next six months. During the first wave, there had temporarily been a “drop-off”, however there had been a surge in demand during June and July 2020 – the demand for emergency support for those in mental health crisis was high, and remained so. It was noted that some patients would see Oxleas, as a specialist mental health provider, whilst others would access support through their GP, Bromley Healthcare or non-NHS interventions. It was important that in recognising the increased demand that not everything became medicalised – as with the issues of social isolation and loneliness discussed earlier, the Bromley community as a whole would be able to respond and help ensure people had the support required. There had also been an increase in the demand for secondary specialist services, from those already known to Oxleas who had become acutely unwell due to the pandemic, as well as new presentations. It was anticipated that this would increase further with the expected rise in unemployment and the economic impact of the pandemic, with some national benchmarking data predicting a 20-30% increase in demand for services over the next six to twelve months. As well as managing specialist services, thought needed to be given to those who were dependent on non-NHS services to help their recovery, and working in partnership with other departments such as social care and housing. It was emphasised that it would be a difficult winter period – some funding would be received, however this would not be sufficient to address the anticipated additional pressures on the service. Partnership working across the system would be particularly important this year.
The Service Director informed Board Members that services had continued to be provided throughout the pandemic. During the first wave of the pandemic, a number of services had moved on to digital platforms. On exiting the first wave they had worked to ensure that no patients had been excluded from receiving the support required due to their digital access. Face to face appointments had been offered throughout, however recently there had been a significant increase which had been affected by relapses in a number of patients well known to the service.
One of the most worrying trends was the number of young people presenting with a first episode of psychosis, and already being very unwell by this time. Work was therefore being undertaken with partners regarding how they could recognise this, and support and signpost these people into services much earlier. Staff were also mindful of the huge economic impact of the pandemic, and social stresses such as debt, housing and jobs, which could see patients relapse, and further increase the demand for services.
With regards to older adults mental health services, it was noted that this had been the patient group hardest to access face to face as many of them had been shielding or were anxious about leaving home. The team had been creative in providing support to these patient, and helping them access the care required and maintain contact.
It was noted that Oxleas would attend the February meeting of the Health and Wellbeing Board to provide further data, and the plans to take some of this work forward.
The Associate Director – CAMHS - Oxleas informed Board Members that the service was also seeing a higher level of acuity and demand. The CAMHS services had continued to be provided throughout the pandemic, but had moved to a hybrid model with a combination of virtual, telephone and face to face appointments. They had received a mixed response to these new ways of working, which had been helpful for some patients, but not all, and this would need to be taken into account going forward.
The service was seeing an increase in acute presentations, which during October 2020 were up 39% on the same period the previous year. These presentations were much more complex, and there were also significant safeguarding concerns which required partnership working with social care regarding how best they could provide support to these children. They had also seen an increase in cases of self-neglect, chronic depression, eating disorders and suicidal thoughts and intent. As well as an increase in crisis presentations, there had also been an increase in routine referrals – more were being accepted into CAMHS, which indicated a greater level of acuity.
With regards to winter pressures, it was anticipated that there would be a continued increase in demand on services. They would continue with recruitment, however it was hoped that by providing support to their crisis care pathway, it would free up some capacity to address some of the routine work undertaken in children’s services. Throughout the pandemic, they had sought feedback from children, young people, and their families – they had some good data, which would help inform future provision.
In response to a question, the Associate Director – CAMHS - Oxleas said that it was extremely important to think about the response to children’s mental health as part of a system. A huge amount of work was being undertaken across the Borough in relation to resilience, including the work with Bromley Wellbeing. Resilience was also a key element of some of the newly commissioned pathways in Bromley.
The Director – Bromley Wellbeing Service for Children and Young People informed Board Members that the service had seen a huge increase in referrals, from around 5 per day at the start of lockdown, to 20-30 per day. Increases were also being seen in schools and their face to face contact service. A whole school approach was being taken with partner agencies to provide support in all areas. They were also part of the Link, which looked at roles and responsibilities between healthcare and education, and was being rolled out across England by the CCGs.
Since March 2020, most of the Bromley Wellbeing services had been delivered remotely, which staff and teachers had adapted to extremely well, and feedback from young people and their families had been positive. However, some face to face contact was required, and this was still being provided. Some therapies were more amenable to remote working than others, and it was hoped that further face to face contact could be delivered from January 2021. They had been very aware of digital poverty, and mindful that some of these most vulnerable groups were struggling – they therefore ensured that they had access to IT and mental health services.
Due to the complexity of referrals, associated risk, and requirement of staff to manage safety calls there was an even greater need to liaise with partner agencies, such as social care. The Single Point of Access had been strengthened, and they were working closely with Oxleas - CAMHS to ensure young people were on the right care path, at the right time, and timely decisions were made. It was highlighted that wait times had been impacted due to the pandemic. They were managing to triage patients within 72 hours, and assess them within 4 weeks, however the wait time for intervention or treatment had moved from 4 to 10 weeks. With regards to workloads, as more conflict was being seen within families, cases were also being kept open longer.
During the pandemic, a website had been developed, “creating a door” into the Bromley Y and Oxleas - CAMHS services. They had worked hard to support their staff, and they had encouraged them to think about their own wellbeing. They had also considered the Black Lives Matter and the BAME agenda, undertaking outreach work into the community and ensuring that the same opportunities are provided. A survey had recently been sent out to all schools to gather feedback from young people – over 150 responses had been received, a summary of which could be provided to Board Members.
A Board Members noted that the information provided, particularly in relation to CAMHS was extremely enlightening. It was suggested that, with regards to conversations around resilience, the Bromley Children and Young People’s Forum could provide a captive audience and it also had a very active social media platform. The Associate Director – CAMHS - Oxleas and Director – Bromley Wellbeing Service for Children and Young People said they would welcome the opportunity to link with any forums. It was highlighted that the co-production of services ensured that the voices of children and young people were heard and sustained.
In response to a question, the CEO – Oxleas advised that the national Mental Health Investment Standard was an additional investment which had been mandated for mental services over the previous couple of years, to address issues such as access to psychological therapies and developing their community offer. This funding had been welcomed, and had been used as part of their transformation work – there had also been an announcement recently from the Treasury, advising that an additional £500m would be provided nationally to mental health services the following year, specifically related to the impact of COVID-19. Some additional funding had also been received for work around discharge from mental health units over the winter period. It was noted that in addition to the NHS receiving funding, it was important to ensure that social care, community and voluntary sector partners were able to “play their part”.
In response to a question regarding digital access, the Associate Director – CAMHS - Oxleas emphasised that this was an extremely important issue, to which they had given significant thought throughout the pandemic. It was noted that they had taken a person-centred approach, providing a range of options, and some specific pathways (such as the SEND pathway) which also provided access to digital technology. For those affected by IT poverty or connectivity issues, conversations with these families were taking place to establish the best method of intervention, and ensuring that there were no delays to assessment and treatment. Phone apps had also been developed, such as ‘Attend Anywhere’, which reduce the reliance on tablets and laptops. For the most vulnerable, and those for which there were social concerns, appointments were being provided face to face. Everything that was being provided was in collaboration with the individual family. The Director – Bromley Wellbeing Service for Children and Young People further advised that 49 schools had initially been involved in the mental health Trailblazer, and during the pandemic this had been extended to over 100 schools.
The Chairman noted that there were a number of programmes through which redundant phones and laptops could be donated, which could help address the issue of digital poverty. The Associate Director – CAMHS - Oxleas were linking with partners, including the Local Authority and Bromley Y to consider the best way to support the children and young people in their care. With regards to children in CAMHS services that were attending schools outside of the borough, work was undertaken with the local CAMHS services to ensure they had the required support and a smooth transition.
The CEO – Oxleas said it had been a difficult year, which had been tough on everyone’s mental health, and particularly so for those who were vulnerable. It would be a challenging winter, and it was the strengths of the partnership working across Bromley that would enable them to get through it.
The Chairman thanked James Postgate, Matthew Trainer, Lorraine Regan, Sheena Gohal and Gill Allen for attending the meeting to provide an update, which had highlighted the number of interlocking issues around the complexity of referrals.
RESOLVED that the update on mental health resilience be noted.