1. Youth Mental Health – setting up a
dedicated service in Norfolk
Dr Uju Ugochukwu (Consultant Adult Psychiatrist)
Dr Sarah Maxwell (Consultant Child & Adolescent Psychiatrist)
Norfolk and Suffolk NHS Foundation Trust

2. Acknowledgements
• Professor David Fowler
• Dr Jon Wilson
• Debbie White

3. Collaborations for Leadership in Applied
Health Research and Care For Cambridgeshire
and Peterborough (CLAHRC CP) Fellowship
• Quantitative mapping project
– Description of the characteristics of 14 – 25
year olds within the service
– Description of mental health services
available to young people in Norfolk
• Qualitative Study

4. www.slideshare.net

5. How did it all start?
• CAMHS perspective
• Problems with transfer to AMHS
• AMHS/EI perspective
• Young people with emerging disorders who are not
psychotic
• Central Norfolk EIT - Team C
– Service to young people with emerging disorders
– Mentioned as an example of good practice in SCIE:
http://www.scie.org.uk/publications/guides/guide44/pr
acticeexamples/norfolk.asp

6. Bridging the gap

7. Disease Incidence over Age

8. All Referrals - CAMHS and AMHS
September 2010 – August 2011 All Contacts – CAMHS and AMHS
800 September 2010 – August 2011
8000
700
7000
600
6000
500
5000
Referrals
Contacts
400
4000
300 3000
200 2000
100 1000
0 0
14 15 16 17 18 19 20 21 22 23 24 25
Age
Age
Ugochukwu O, Maxwell S et al, unpublished, funded by CLAHRC

9. Making use of opportunities
• New Chief Executive
– Visits to various teams (EI, Team C)
• Trust vision
• Cost Improvement Program
• Radical Pathway Redesign
– Pathway C
• Evidence base - EI

10. Clinicians who felt
that young people
Guiding team
were falling through
set the ball
the gaps
rolling
Influential
manager

11. Key people attended
• Commissioners, senior managers, senior clinicians
• Increased enthusiasm

12. Project Management
• Project Teams
• Stakeholders Group
• Youth Advisory Council

13. Community resources: Non- Education
statutory
e.g.
Statutory e.g. MIND, MAP PRU, Attendance
Health Youth Groups teams
Social Care
e.g.
Probation, TAD
S
Detection, Liaison and Supervision
SPOA: Norfolk Wellbeing services & CAMHS
(Includes IAPT)
Youth Mental Health Service
(Case Management, Assertive outreach, Liaison/Supervision)
CRHT / Intensive Support Team
Crisis Houses / Alternative to hospital
CAMHS Tier 4 / Adult In-patient

14. YMH Declaration 2011 - Principles
• Belief in young people and their potential
• Respect for all young people
• Protect young people’s right to participate in processes and
decisions that affect them
• Commitment to uncovering the strengths within young
people, their families and communities
• Respect for the right to recovery and social inclusion for all
young people
• Value the importance of personal, social, educational and
employment outcomes
• Provide accessible, youth-focused services and supports
when and where young people need them
• Respect for the rights of family and friends to participate and
feel fully involved

15. Buy in - stakeholder event in
October 2011
Engage with young
people, commissioners and other
agencies
Kevin Davis, Youngminds

17. What do our young people want?

18. Right information in the right way
• Accurate and up to date
information
– Leaflets, websites
• Staff qualifications
• Patient rights
• Confidentiality
Adapted from report “Creating the best mental health service” Kevin Davis, Youngminds.
Unpublished

19. Location and environment
The Junction, Lowestoft
• Public transport
• Not too close to family
• Should not be called a
“mental health service”
• Bright, airy, comfortable, saf
e
• “One-stop-shop”
Adapted from report “Creating the best mental health service” Kevin Davis, Youngminds.
Unpublished

20. Accessibility
• Flexible appointments
• Different ways of
getting help
– Self referral
• Quick assessments
• Avoid repeated
assessments
Adapted from report “Creating the best mental health service” Kevin Davis, Youngminds. Unpublished

21. Staff
• Honest and reliable
• Good knowledge base
• Experienced
• Caring and understanding
• “someone who makes you feel like a person
and not an illness”
Adapted from report “Creating the best mental health service” Kevin Davis, Youngminds
Unpublished

22. Young people’s involvement
• Youth Council
– Supported by Youngminds
– Vision statement
– Name for service
• Involvement in project teams and wider
steering group
• Interview panels

23. funded by CLAHRC

24. Focus of 12 month pilot
• 3 pilot sites
• 14 – 25 year olds with complex mental health
problems
– HoNOS Clusters 5 to 17
– CGAS score, 50 and below
• Caseload – 225 CAMHS and 75 AMHS
• Consultant cover will be provided by Adult
and Adolescent psychiatrists

25. Where are we now?
• Start date – April 2012
• Resources
– Staff recruitment
– Staff training and induction
• Partnership/case discussion forums meetings
• Website – one stop website

26. Aims of the pilot service
• Actively engage young people at highest risk of
developing enduring mental health difficulties
• Offering therapeutic optimism
• Provide a range of interventions –
medical, psychological, social, vocational, physical
health and family interventions
• Prevent admission where possible through risk
management with the IST / CRHT
• Ensure that the young person is linked into appropriate
community resources (education, youth groups etc.)
• Provide step up and step down support working in
collaboration with other statutory and non-statutory
agencies

27. Outcomes
• Waiting times for assessment
• Reduction in bed days
• Time use questionnaire
• Global Assessment of Function (GAF)
• Pathway to care
• Experience of service questionnaire

28. Research
• Prevention of long term social disability amongst
young people with emerging signs of severe
mental illness
– A pilot randomised controlled trial of social recovery cognitive
behaviour therapy for young people with emerging severe
mental illness.
(NIHR trials funded, UEA led with Manchester)
• Detection and intervention with young people at
high risk of social disabling severe mental illness
(Programme grant bid, UEA with Manchester & Birmingham)
•
Professor David Fowler, UEA

29. Challenges – NoNo
• Resistance from some clinicians
– Early engagement is vital
• Resources
– Time
– Cost improvement program
– Negotiating for staff from teams with stretched
resources
• Changing culture and mindset

30. Change Management Process
Communicate
Pull Together Develop the Produce Short-
Create a Sense for Empower Create a new
the Guiding Change Vision term Wins Don’t Let Up
of Urgency Understanding Others to Act Culture
Team & Strategy
& Buy-in
Adapted from www.slideshare.net

31. Summary
• Young people want to be an integral part
of the whole process
–Their feedback should make a difference
• Early engagement of carers, other
clinicians and the third sector is crucial
Overall an exciting process!