Committee
Health and Sport Committee 15 November 2016
15 Nov 2016 · S5 · Health and Sport Committee
Item of business
Mental Health
Jackie Irvine
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I highlight the disparities in referral data. I cannot with confidence say that one group refers better or more appropriately than other groups, but I certainly know that what has helped locally—colleagues have mentioned this—is education work with GPs and referrers to make clear to them what we can achieve in CAHMS or what social workers are looking for in that respect. What also helps is being clear about the other services that are available prior to tier 3 to ensure that people get referrals in early. That is the gist of my response, although I should point out that, as we have mentioned, the specific criteria for getting into CAHMS might vary. We want to eradicate that variation, because the criteria need to be standard across Scotland to ensure that families and professionals understand and are talking about the same thing. As for the mental health strategy, I go back to my earlier point that I—and certainly Social Work Scotland—want an emphasis on tiers 1 and 2. If those services are not there, some children will be escalated into CAHMS inappropriately, or they might have to wait so long that they do not get the service that they need when and for the length of time that they need it. That sort of thing is variable, and the variability comes down to funding. As we have discussed, such services are funded by the voluntary sector, and some CPPs put in money in various ways, but we are picking up a significant gap there. Aside from asking for extra money for CAHMS—notwithstanding the fact that demand for CAHMS has gone up, particularly in relation to autism spectrum disorder and ADHD, the assessments and diagnoses of which take some time and a lot of work—I want an emphasis on ensuring that every CPP has a view about what it has on the pathway all the way from what my colleague has helpfully termed tier zero, so that people understand how children are routed into the appropriate service at the appropriate point. In the main, we identify children quite early, but it is not unknown for a child to reach secondary school and to be struggling with a lot of the transition by mid-secondary school. That is when their mental health rapidly deteriorates. We need to strike a balance because, as we have discussed, if we focus on only one area, such as waiting times for CAHMS, we will miss out on doing a lot of the preventative work that we could be doing to keep children and young people from needing such services and, indeed, adult mental health services in the future. We need to take what could almost be called a spend-to-save approach.
In the same item of business
The Convener (Neil Findlay)
Lab
Good morning, everyone, and welcome to the 11th meeting in session 5 of the Health and Sport Committee. I ask everyone in the room to ensure that their mob...
Alex Cole-Hamilton (Edinburgh Western) (LD)
LD
Good morning, panel. Thank you very much for coming to see us today. Everyone in this room is aware that the mental health strategy expired at the end of l...
Jackie Irvine (Social Work Scotland)
In our submission, we make the point that looking at CAMHS in isolation will not solve the problem. We need to look at the continuum, from the lower-level ti...
Tracey Gillies (NHS Forth Valley)
It might be helpful for me to say something about NHS Forth Valley’s waiting times, because they were particularly low in the recent NHS Scotland Information...
Lorna Wiggin (NHS Tayside)
Looking at the whole-life continuum, I would like to see much more emphasis on how care pathways are provided from birth right through to adulthood; on build...
Alex Cole-Hamilton
LD
On my question about the lack of availability of tier 4 beds, in the summer, we put in a freedom of information request, and the numbers that came back on ki...
Lorna Wiggin
Currently, we have all 12 beds open in our facility, which serves the north. The issue is not always just to do with staff; it can be to do with the young pe...
Alex Cole-Hamilton
LD
But is there a gap? I accept what you have said, which certainly chimes with a lot of what we have heard about giving people care in the community, which is ...
Lorna Wiggin
Some of them will; some will need admission, so obviously we would seek a bed elsewhere for them that was suitable for their needs. Through work that we hav...
Jackie Irvine
On the point about trying to keep children and young people supported in the community, from my experience in greater Glasgow and Clyde, I think that managin...
Alison Johnstone (Lothian) (Green)
Green
Many submissions have highlighted the increasing number of referrals to CAMHS. Some people thought that that reflected growing need and were concerned about ...
Jackie Irvine
I cannot comment specifically on the position in West Lothian, but we recognise that some children who are referred to tier 3 of CAMHS could be dealt with ap...
Alison Johnstone
Green
In last week’s evidence session, the view was expressed that better training for teachers and so on would enable them to help young people instead of feeling...
Lorna Wiggin
I can tell you what happens in NHS Tayside. A referral could come through various routes—from a teacher, a general practitioner or a school nurse—and is cons...
Tracey Gillies
That matches our experience. We have done a lot of work with GPs and other primary healthcare services on our referral criteria to ensure that they are well ...
The Convener
Lab
Is that your experience as a practitioner, Barry?
Barry Syme (Association of Scottish Principal Educational Psychologists)
It depends on how people get into CAMHS. In Glasgow and other authorities, we try to follow getting it right for every child, with a multi-agency meeting. We...
Jackie Irvine
Another issue is the quality of the referral when it gets to CAMHS. If it has the most pertinent information, that quickly gives CAMHS a much clearer idea of...
Clare Haughey (Rutherglen) (SNP)
SNP
I want to move on from what we have been saying about referrals and expand the discussion a bit. At last week’s committee meeting, some of the panel, and som...
Lorna Wiggin
There is definitely variation across health boards in the referral criteria and even in the tiers at which patients will be seen. It would be advantageous to...
Clare Haughey
SNP
Does anyone else want to comment?
Barry Syme
I agree with Lorna Wiggin that there is variation, even across neighbouring authorities and health boards—we find that in Glasgow. My particular area in the ...
Clare Haughey
SNP
Would differences in referral criteria explain why there is such a variation in the rate of referrals to your services that are accepted? Are you getting lot...
Tracey Gillies
Some of the variation is more in the availability of what other support is available. I suppose that I would look at it more from a health perspective, altho...
Clare Haughey
SNP
What are the health boards doing to address the issues that you are picking up?
Tracey Gillies
We have put in place a way to ensure that we receive as much information as possible electronically and we work with our local authority and third sector col...
Lorna Wiggin
We use the information and the data that we get to create a dashboard for the service and for clinicians, which lets them look at themes. If we see that ther...
The Convener
Lab
You might have addressed this and I have not picked up on it, but what happens after a referral is rejected?
Lorna Wiggin
In Tayside, the referrer is contacted and told why the child or young person has not met the criteria and what other services would be more appropriate. Ther...
The Convener
Lab
Is that then tracked?