“Minding the Gap” (Mental Health Provision for 16-25 Year Olds and Their Carers in County Durham)

“Minding the Gap” (Mental Health Provision for 16-25 Year Olds and their Carers in County Durham) Report of the Scrutiny Working Group Scrutiny Sub-Committee for Strong Healthy and Safe Communities Contents Section Subject Page One Foreword 3 Two Overview and Scrutiny: Background 4 to the Project and Terms of Reference Three Executive Summary and 6 Recommendations Four Mental Health Problems 14 Experienced by Vulnerable Young People: Some Definitions Five Who Does What? – How Services 19 are Delivered in County Durham Six Evidence 44 Seven What Young People and their Carers 67 Want Eight Conclusions 82 Nine Recommendations 95 Ten Membership of the Working Group 104 Appendix One Oral Evidence Taken 105 Appendix Two Written Evidence Submitted 106 Appendix Three Draft Action Plan 107 2 Section One - Foreword Most people will be affected by mental health problems during the course of their lives – either directly, or indirectly through their family and friends. Experiencing mental ill health can be frightening, leading to isolation and feelings of hopelessness. Unlike many other illnesses, it is not visible or always apparent and does not evoke the feelings of compassion or concern that those suffering from more visible illnesses often receive. For many, mental ill health is a temporary experience. With the care of family and friends, and medical support where required, most individuals can be helped through their difficulties. Some people, however, may need continuing assistance. The very word “mental” can be enough to stigmatise those who experience mental ill health. This applies particularly to younger people, where it is often an additional burden. Young adults not only have to confront mental ill health and the stigmatisation that goes with it - they are also at a stage in their development when they are leaving school; going to college or university; starting employment; beginning relationships; or looking for a home of their own. There has been tremendous progress in recent years in the development of services in the field of mental health, with much good practice evident. However, as services have evolved, there has been a growing recognition that young adults in the “transitional” age range of 16-25 years do not “fit” comfortably into either the children’s or adult mental health regimes. This transitional age group has different needs and a different “culture” not always best served by existing services. This Scrutiny project was undertaken because of casework issues involving a group of young people with mental health problems in Derwentside. The experiences of members of this group, when accessing health, education and social services, highlighted the lack of any real provision targeted at young people in the transitional age range. Given the complexity of the issues and the number of agencies involved, this has been a major scrutiny project. It could not have happened without the support of Members, Officers and all those who have given their time to come along and talk to us about their role in providing services. I would like to thank each and every one of those who participated in the project.. Effective scrutiny is about making a difference and driving up improvements in services. There have been some other studies, mainly national, looking at similar issues, but, as we heard during the course of the project, although well intentioned, these have resulted in little practical change. I hope that those involved in the delivery of services in County Durham will feel that the recommendations in this report will make a positive contribution and that they can be taken forward to “bridge the gap” in service provision. Councillor Edna Hunter Chairman of the Working Group 3 Section Two – Overview and Scrutiny, Background to the Project and Terms of Reference Overview and Scrutiny 2.1 Overview and Scrutiny is a new way of working for Councils and an important part of the Government's drive to modernise local government to ensure that we provide better public services by being responsive to stakeholders needs. 2.2 The Overview and Scrutiny process we have adopted in County Durham is based broadly on the lines of the parliamentary select committee model. The Executive (the Cabinet) is held to account for its decisions or assisted in policy formulation by Non-Executive Members (in the Overview and Scrutiny Committee and/or its Sub Committees). 2.3 Scrutiny Sub-Committees have been created for each of our corporate aims of Development of Lifelong Learning; Promoting Strong, Healthy and Safe Communities; Looking after the Environment; and Building a Strong Economy, together with a Sub-Committee for Corporate Management Issues (to examine matters that may affect the County Council as a whole), and a Sub-Committee for Health (in partnership with District Councils). 2.4 The Overview and Scrutiny Committee and its Sub-Committees: • Review and/or scrutinise decisions made or actions taken in connection with the discharge of any of the Council's functions; • Make reports and/or recommendations to the full Council and/or the Cabinet in connection with the discharge of any functions; • Consider any matter affecting the area or its inhabitants; and • Exercise the right to ask the Cabinet to think again about any decisions they have made (call-in). 2.5 Scrutiny Sub-Committees decide which areas they wish to examine and may look at particular areas in depth, as is the case in this particular study. To do this the Sub-Committees may appoint smaller Working Groups. 2.6 In looking at a particular issue, the Working Groups appointed by Scrutiny Sub-Committees will usually seek to establish the current position; seek help from experts and take evidence; listen to stakeholders; look at what is happening elsewhere; examine how we compare; produce a report with recommendations; and monitor progress of any agreed recommendations to ensure improvements are delivered. Background to the Project 2.7 The project was instituted by the Scrutiny Sub-Committee for Strong, Healthy and Safe Communities, following issues raised by the local Member, Councillor Mrs Edna Hunter, about mental health provision for young people aged 16-25 in the South Moor area of Stanley. The issues of appropriate 4 mental health provision for young people have also been highlighted nationally by charities such as YoungMinds and the Mental Health Foundation and in publications such as Community Care. 2.8 Following a presentation to Members in November 2002, it was agreed that a Working Group to examine the issues would be appointed. Terms of Reference 2.9 The Terms of Reference of the Working Group were agreed as follows: To review the level and adequacy of provision of support to 16-25 year olds with mental health problems in County Durham, with a view to considering: • How far it meets the needs of users of services and their carers • Whether it is timely and proportionate • Whether it is correctly targeted And to raise awareness of the issues and, if necessary, make recommendations for improvement. 5 Section Three – Executive Summary and Recommendations 3.1 There has been growing awareness in recent years that young people with mental health problems do not always receive services and support that are best suited to their needs. We chose to scrutinise services and support for young people aged 16-25 because this was the age range that appeared to be most affected by the way services were structured and delivered. 3.2 For many young people, young adulthood can be an exciting and exhilarating time, full of opportunities, with new found freedoms, new friends, career opportunities and so on. But for some young people, their experiences of this time in their lives can be starkly different, with the onset of mental health problems, social exclusion, isolation, loneliness, frustration, poverty and lack of opportunity. 3.3 The situation is not helped by the way in which services are structured to meet young people’s needs, which is often inconsistent. In most local authorities with Social Services functions, young people are treated within the Children’s regime until they reach 18 years of age (consistent with the Children’s Act). However, in the case of health service provision, many Child and Adolescent Mental Health Services (CAMHS) only go up to the age of 16, after which young people move in the adult mental health regime. 3.4 Geography and local custom and practice further complicate the issues. In some areas of the UK, CAMHS services are provided up to 18 or 19 years of age. Even within County Durham, there are differences. CAMHS provision in Easington, which is commissioned by Easington Primary Care Trust (PCT), goes up to 18 years of age. In the rest of County Durham, the CAMHS provision commissioned by the remaining County Durham PCTs covers young people up to 16 years of age. 3.5 Because young people in the age range 16-25 are at the upper limits of CAMHS provision and the lower threshold of adult provision, most services are not tailored to their particular needs. How young people move from CAMHS into adult services is also a major issue. Falling into the gap can have serious consequences and we heard from Dr Joe MacDonald, a consultant psychiatrist specialising in adolescent psychiatry, that young people could die in this gap. Our recommendations are an attempt to bridge the gap and to begin a debate locally about the issues. 3.6 Our report also contains a section about who does what in terms of support and services provided for young people with mental problems in County Durham. We were not able to discover during our investigation any readily available documents that provided an overview of how mental health provision was structured locally.

Load more