Report ACH21-056

The Board considered a report providing an update on the Bromley Mental Health and Wellbeing Strategy 2020-25. The Chairman noted that the agenda item on ‘Children and Young People’s Mental Health’ had been incorporated into this update.

The Associate Director – Integrated Commissioning, NHS South East London CCG (Bromley) (“Associate Director – Integrated Commissioning”) informed Members that the Bromley Mental Health and Wellbeing Strategy (BMHWS) 2020-25 set out a five-year delivery plan to make improvements across mental health and wellbeing services in the borough. At the heart of the BMHWS were the voices of patients and service users who relied on good mental health services in Bromley. In the coming years, as the strategy was delivered with partners, no matter what area of mental health was involved, the Council and NHS were committed to ensuring that patients and service users were at the forefront of designing their own service offer in Bromley.

The BMHWS set out a joint vision to support communities and individuals to have improved mental health and wellbeing. The strategy set out an approach in which the Council and CCG would work together with partners to prevent children and adults reaching a crisis point through the provision of a strong prevention and early intervention offer. It also put in place a joint plan for the provision of a number of important services for people with mental health challenges, including good advice and information, talking therapies and counselling, employment and training schemes, mental health support in schools and supported housing. The BMHWS was led by the Bromley Mental Health and Wellbeing Partnership Board, which was made up of senior representation across Bromley mental health services. The specific actions for children and young people’s services were being taken forward by the CAMHS Partnership Board. The Council and CCG provided oversight to this work through the Integrated Commissioning Board (ICB) and there was also broader partnership ownership of the work through the One Bromley Executive.

With regards to children and young people’s mental health emergency and crisis cases, the BMHWS highlighted the need to develop stronger preventative and early intervention mental health and wellbeing services for children and young people in the borough. This priority was in part borne out of a recognition that the number of children and young people’s mental health emergency and crisis cases had been increasing, year on year, since 2013/14. This issue was an area of focus of the Health and Wellbeing Board and Bromley Safeguarding Children’s Partnership prior to the COVID-19 pandemic. A deep dive exercise looking at the children and young people attending A+E with mental health issues had been considered in detail by the Bromley Safeguarding Children’s Partnership and SEND Governance Board in September 2021. There had been a number of interesting correlations with regards to areas of the borough and certain schools, and work would be undertaken to provide additional support and monitoring.

Within the framework of the BMHWS, the following immediate actions in relation to children and young people’s emergency and crisis cases were being taken: a new joint approach around crisis cases between Bromley Y/Oxleas CAMHS, with links into education and other partners as needed; and work with the Bromley Safeguarding Partnership Board on the next steps. This work would continue to be highlighted to the Bromley Health and Wellbeing Board as part of broader updates on the BMHWS.

The Associate Director – Integrated Commissioning said that since September 2020 the numbers entering children and young people’s mental health services in Bromley had increased by 30%, which was a picture seen nationally. The children and young people were presenting with more challenging and complicated needs – they were staying in services longer and required more specialist support. It was noted that although they were looking to hire specialists, it had not been possible to recruit the full complement. It was highlighted that this cohort was limited, and a number of organisations were trying to recruit to these specialist post all at the same time. Waiting times for children and young people’s mental health services were rising and for the first time in Bromley the 18-week target was not being achieved. The average waiting time was 25-weeks, which was better than some neighbouring boroughs, and the lists were managed based on risk. The focus would be on prevention and working with children and young people before they reached a level of challenge.

A Member enquired how reduced waiting times could be achieved, particularly for children and young people’s mental health services. The Associate Director – Integrated Commissioning said that this was a huge challenge nationally. Not all children needed to access NHS services, and could be provided with support from elsewhere, such as the voluntary sector. However it was noted that this work was happening in other areas but waiting times had not been affected. Partners at Oxleas focussed on those presenting in crisis however there were lots at the other end of the spectrum that needed support in relation to loneliness and social isolation.

In response to questions, the Associate Director – Integrated Commissioning said that 48 primary and secondary schools in Bromley had taken part in the mental health support team (MHST) pilot. This was a long-term solution that helped ensure the resilience of Bromley schools to manage mental health challenges, in partnership with other mental health and wellbeing services. This support would shortly be rolled out to another group of schools, which would see the MHST delivered to 75% of the schools in Bromley. It was agreed that a list of the schools involved could be circulated to Board Members following the meeting. With regard to recruitment, the South East London CCG and NHS England were looking at the workforce and the development of a high-level strategy across the region. This would consider whether other practitioners could do more if a clinical-based approach did not need to be taken.

A Member highlighted the importance of the wider support infrastructure for the families of those suffering with their mental health. The Associate Director – Integrated Commissioning emphasised that Children’s Social Care provided support to families. It was intended that this support would be further increased during 2022/23 with the introduction of more joined-up services.

The Director of Children’s Social Care said that he was pleased to see that prevention and early intervention was front and centre in the strategy. Work would continue to build on the initiatives mentioned, with Wellbeing Champions being launched in schools and families signposted to Bromley Y and other voluntary organisations. With the support of the Anna Freud Centre, the ‘Your Choice’ initiative would also be launched and to build interventions at every level. The data indicated that there were clusters of particular issues in the 13–17-year-old age group, and discussions would take place with staff to target this cohort.

With regards to adult mental health, the Associate Director – Integrated Commissioning said that overall, it was considered that the 5-year Action Plan was on target. However they would not be complacent and were aware that not all services were perfect – key deliverable had been achieved during year one, but there were now significant challenges in terms of recovery following the impact of the COVID-19 pandemic. Plans included the introduction of more digital and online services for children, young people and adults – another big change would be the Adult Mental Health and Wellbeing Hub which would be fully open from January 2022.

A Member highlighted that the strategy stated that ‘BAME community groups are over-represented across all types of severe mental health needs’, however there was no mention of an Equality Impact Assessment (EIA) having been undertaken. The Associate Director – Integrated Commissioning said that this had been an area of concern – the presenting challenges were very different, and this needed to be looked into further. An EIA had been completed for the strategy but as the document was so large, it may not provide as much detail as the Member would like to see for each point. It was noted that the Adult Mental Health and Wellbeing Hub would have an Equalities Officer and part of the role of the new Bromley Y youth ambassadors would look at whether services represented the borough as a whole. There was more work to do in terms of talking with community and church leaders, and these conversations would continue going forward. The Assistant Director for Integrated Commissioning advised Members that the draft strategy had been presented to the Adult Care and Health Policy Development and Scrutiny Committee last year, and an EIA had been included. The Chairman suggested that updates on the strategy could be provided to the Board on an annual basis, with information included on the EIA’s undertaken. In response to a question from another Member, the Associate Director – Integrated Commissioning advised that a dashboard was in progress to monitor how mental health services were performing in relation to the strategy and could be reported on in the next update to the Board.

The Chairman noted that this was great work, which looked at a multi-disciplinary approach to prevention and early intervention. Councillor Diane Smith, Portfolio Holder for Adult Care and Health thanked the Associate Director – Integrated Commissioning for his work in creating the strategy. This was an important subject, and the work was on the right track, however there was still more to be done, particularly in relation to children and young people’s mental health services. It was agreed that updates on the strategy would be provided at future meeting of the Health and Wellbeing Board.

RESOLVED that the progress to deliver the Bromley Mental Health and Wellbeing Strategy (2020-25) be noted.