Community Forensic Child and Adolescent Mental Health Services in London and commissioning across England

Community Forensic Child and Adolescent Mental Health Services in London and commissioning across England

Community Forensic Child and Adolescent Mental Health Services in London and commissioning across England

Symposium103Heidi Hales, West London NHS Trust, United Kingdom; Abiha Bhatti, West London NHS Trust, United Kingdom; Emily Curtis, West London NHS Trust, United Kingdom; Andrew Nicols-Clarke, NHS England, United Kingdom

Room 4EThu 14:00 - 15:30

This workshop comprises of 4 presentations regarding Community Forensic Child and Adolescent Mental Health Services in England. Forensic Adolescent Mental Health Services provide assessment, care and support for young people who present with high risk behaviours, significant emotional and mental health difficulties and/or young offenders. In this symposium, we will discuss the development of our North West London Forensic CAMHS and discuss the characteristics of the patients referred to this service. We will consider in particular their sensory and OT needs and impact of cultural and racial differences. We will then place this in context of development of adolescent forensic mental health services commissioning across England.

Presentation 1: Unpacking the complex overlay of services commissioned in London to support young people at risk of violence
Background: Serious violence perpetrated by young people has been increasing in London. Young people are known to be victims of Child Criminal Exploitation by gangs run by adults, using young people to transport and sell drugs. This is causing much concern and has been high on the agenda of the London Assembly, Metropolitan Police, NHS England and Government. A Public Health Approach to knife crime is the favoured approach.

Services are being commissioned by different National and Local Government agencies to support young people to try to reduce this wave of violence in London. Our North West London FCAMHS service offers advice, consultation, assessments and coproduced interventions to professionals working with young people across 8 London Boroughs.

Presentation: We will produce a mapping of services for young people across several levels:

  • Within the individual 8 Boroughs in which our FCAMHS service works, such as the individual statutory agencies of CAMHS, social care, education, Youth Offending Services and smaller voluntary agencies.
  • Across several Boroughs as joined services, such as Speech and Language teams working across 2 or 3 boroughs and Hospital Trusts working across several boroughs.
  • Pan London services, such as the Metropolitan Police or voluntary sector agencies.Commissioning agencies include:
  • NHS England
  • MOPAC (the London Mayor’s Crime and Policing Commissioners)
  • Local Government
  • Charities

We will consider our FCAMHS referrals since the service started in August 2018 and consider the agencies with which we liaise to consider the needs of young people in London.

Discussion: One ex-gang member noted how the communication in local gangs is more effective than communication across different children’s agencies in London. We will discuss how to ensure that our services work effectively together.

Presentation 2: Community Forensic CAMHS in London

The North West London Forensic Child and Adolescent Mental Health Service (NWL FCAMHS) is a community-based service covering a population of approximately 2 million people.

Our FCAMHS service received 378 referrals between August 2018 and December 2021. Of these referrals, 138 (37.2%) young people were of a White ethnic background, 169 (45%) young people were of a Black and Minority Ethnic (BAME) background and 64 (17.3%) young people were of a dual heritage background. The disproportionate number of referrals received for young people of a BAME background relative to the demographics of the 8 London Boroughs our service covers poses the question as to the cause of this disproportionality.

In this workshop, we consider the following questions in an attempt to explore the complex relationship between the ethnic background of young people and disproportionate number of referrals received by our Forensic Child and Adolescent Mental Health Service:

  • Did the route of referral to our FCAMHS service differ for those from a White ethnic background compared to those from a BAME background?
  • Was there a difference in the number of other services involved in the young person’s care prior to their referral to our FCAMHS service based on their ethnic background?
  • Was placement of a young person in a secure or custodial setting more likely than a community or hospital based setting based on their ethnic background?
  • Was there a correlation between risk (on referral to FCAMHS, risk on discharge from FCAMHS and overall risk reduction) and ethnic background?

    Presentation 3: Sensory needs in the forensic CAMHS population – what are we doing to highlight and address these

    Background:
    There is currently little data on the percentage of young people in the criminal justice system in the UK with diagnoses of ASD, LD or sensory needs, however local observation puts it at at least double that of the general population, and data shows over 60% of young people in the criminal justice system have speech language and communication needs. This is a high need cohort, with low rates of assessment and intervention in place. As an Occupational Therapist (OT), new to the FCAMHS role, this was notable.

    This review aims to:

  • Assess the number of YP’s referred into FCAMHS with sensory needs
  • Highlight those with unmet sensory needs
  • Identify pathways for these YP’s to receive appropriate assessment
  • Offer assessment and treatment to those who can not access elsewhere.Method:
    A ‘moment in time’ caseload audit was used, from December 2021. The 48 young people that were active on the FCAMHS caseload were reviewed. The OT met with the case holders and enquired about any sensory needs mentioned on the initial referral or subsequently highlighted.

    Result and discussion:
    From the 48 cases reviewed, 17 had suspected sensory needs 35%, 12 (25%) also would benefit from Occupational therapy (sleep hygiene and routine, activity of daily living support, social skills). These results were subjective to the case holder/ OT discussion and identification, and real need is likely to be higher.

    This review has raised a number of questions and development opportunities. What are the needs we are seeing? What can be done to address them? What benefits will addressing them have on the young person. Future work needs to evaluate the impact of sensory intervention on reducing risk and increasing young people’s participation in pro social lifestyles and occupations.

Presentation 4: The National Community FCAMHS network in England
Background:
In 2018 NHS England commissioned 13 new Community Forensic Child and Adolescent Mental Health Service (Community FCAMHS) Teams, covering the whole of England. These are tertiary services accessible to all agencies (e.g. CAMHS, social services, YOTs, prisons, courts, solicitors, education, health commissioners etc.) within a region that may have contact with young people exhibiting high risk of harm to others or young people in the youth justice system who have mental health difficulties.

Presentation:
We will outline the National Community FCAMHS provision in England including:

  • Development of the Community FCAMHS service model.
  • How the service model has been implemented differently across the country based on local need.
  • How the 13 services work together and via the development of the National Community Forensic CAMHS Clinical Network.
  • Current national referral data and implications from the national evaluation.
  • Further planning around complex needs and integration of service framework.
Assessment and treatment of young and/or adolescent offenders
CAMHS, community, FCAMHS, services
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