Promoting emotional wellbeing and responding to the mental health needs of children aged 0-18 Child and Adolescent Mental Health Services: the Essex CAMHS Strategy 2012-2014 CAMHS Strategy finalised 02-07-12 Page 1
Contents Section Context Page 1. Introduction and Vision 3 Purpose 3 Process 3 Our Vision 3 Implementation 3 The current range of Child and 4 Adolescent Mental Health Services in Essex 2. Our Service Principles 5 Developing a range of provision 5 Supporting emotional wellbeing in 5 the early years Facilitating a holistic and whole 5 family approach Developing the preventative and 6 early intervention role of universal services Enabling easy access 6 Promoting integrated, multiagency 6 partnership working Identifying, reaching out to and 7 prioritising Vulnerable Groups Embedding the systematic 7 involvement of children, young people and families Supporting and developing the 8 workforce 3. Outcomes Appendices 1 Key policy influences on the strategy 9 National research 9 Our needs 10 The views of children, young people, parents and other stakeholders 11 CAMHS Strategy finalised 02-07-12 Page 2
1. Introduction and Vision Purpose: This Child and Adolescent Mental Health Service (CAMHS) Strategy provides a clear agreed direction for the period April 2012 to March 2014 for promoting emotional wellbeing and responding to the mental health needs of children within Essex from conception to their 18 th birthday. It outlines the key principles, priorities and outcomes for service commissioning and delivery and for collaborative action across partners. Process This Strategy has been developed through a partnership approach so that partners share the vision, commitment and responsibility for efficient and effective commissioning and delivery of services to meet the emotional health and wellbeing needs of children and young people aged 0-18 within Essex. It was developed by the CAMHS Joint Commissioning Committee and CAMHS Stakeholder Partnership on behalf of the Essex Children s Joint Strategic Commissioning Group. These groups ensure an integrated coordinated approach to the commissioning and delivery of CAMHS services across partners and Tiers of provision. It will be reviewed regularly with progress reporting to the Essex Children s Strategic Joint Commissioning Group and partner organisations. It was informed by consultation with children, young people and partners and by current policies, a needs assessment and a review of good practice. A summary of the conclusions of these influences is included as Appendix 1. Our vision is to improve the emotional health and wellbeing of Essex children and young people from conception to their 18 th birthday and hence, their educational and social life chances by ensuring the delivery of high quality services that use evidence based effective interventions which respond to individual needs. Implementation This Strategy sets out the key principles, priorities and outcomes that underpin our activity across Essex to enable us to achieve the vision. This Strategy informs our commissioning and delivery of services. In line with the Strategy, our approach is to commission a mix of provision so that a range of different types of services are available to respond to all levels of emotional wellbeing and mental health need. We also want to facilitate access to the most appropriate service by implementing a gateway to screen and direct referrals. The current range of provision is illustrated in the diagram on the following page. The principles and outcomes set out in this Strategy will underpin the review of provision and our planning for the recommissioning options of provision that we will be undertaking during summer 2012. Hence, the details of the provision may change in the future. This Strategy also informs the collaborative activity across the Partnership. The Partnership develops an annual action plan which identifies activities to be undertaken during the year to respond to key issues. Although service details, levels of resource available and annual actions will change, the principles and vision described in this Strategy will continue as the framework for our approach over the next three years. CAMHS Strategy finalised 02-07-12 Page 3
The current range of Child and Adolescent Mental Health Services in Essex NB This will be adapted for each quadrant to give details of specific services in each quadrant. North Essex Foundation Partnership Trust and South Healthy Schools PHSE Class discussions and school cultures which value and support emotional health SEAL Learning, Attendance, Behaviour and Safeguarding Panels in schools Inter school cooperation via BAPs to place children in good schools Anti-bullying policies and activities Peer and learning mentors Support for parents to build attachment with their babies eg baby massage Language and communication activities Social skills development Midwifery services Health visiting support Circle groups Nurture groups Pyramid Trust Counselling incl by voluntary sector organisations Specialist mental health health visiting support Tier 1 provision by and in universal settings such as children s centres, early years settings, schools and youth ECC CAMHs Tier 2 individual counselling brief family work groupwork consultation to carers and professionals Court reports Tier 2 provision by a range of providers to respond to children and young people Essex Partnership Trust individual therapies family therapies diagnosis medication group therapies teaching consultation Tier 3 specialist mental health care for those with a complex and or enduring Tier 4 MH crisis assessment, home treatment, inpatient and specialist residential provision for children and young people with complex, prolonged or critical emotional health needs Single gateway phone access to direct referrals to appropriate tier and provision. North Essex Partnership Foundation NHS Trust Longview in-patient ward South Essex Partnership Trust Poplar in patient ward North East London MHPFT Brookside in-patient ward Private hospitals and out of county placements CAMHS Strategy finalised 02-07-12 Page 4
2. Our service principles and priorities Developing a range of provision We will ensure through our commissioning that there is a wide range of provision delivered by different organisations including the voluntary and community sector across different levels of need covering all four tiers of provision for emotional wellbeing and mental health: Tier 1: provided by practitioners who are not mental health specialists working in universal settings such as schools and early years settings, community venues and families own homes, offering general advice and support aimed at promoting emotional wellbeing and preventing mental illness. Tier 2: a service provided by specialist individual practitioners in primary and community settings including assessment, care and interventions for children and young people with emerging emotional health needs. Tier 3: a specialised multi-disciplinary service for more severe, complex or persistent mental health problems. Tier 4: essential tertiary level services for children and young people with the most serious problems, such as day units, highly specialised out-patient teams and in-patient units providing 24 hour nursing care. Supporting emotional wellbeing in the early years A child s experience in the first two years sets the foundation for the whole of life and the most crucial influence upon a child s emotional wellbeing and mental health is parenting influence within the first years of a child s life (see appendix 1). Hence, we will support the delivery of provision to parents with young children to help them develop positive attachments and promote their child s emotional wellbeing. This means ensuring CAMH services working closely with universal services notably maternity services, children s centres, early years settings and health visitors and we will commission specialist CAMH services to provide advice, support and consultancy to those universal services. We will also ensure training to improve understanding of infant mental health and ability to promote it is provided for the early years workforce. Facilitating a holistic and whole family approach Mental health often requires a specialist focus and sometimes a child or young person just needs support with their mental health. Often however, a child, young person or family has interlinked needs covering emotions, behaviour and relationships. Emotional distress is often expressed through difficult behaviour and CAMH services will be expected to recognise and respond to this. Children with communication difficulties and social needs often become emotionally distressed; emotionally distressed children often become isolated and withdrawn. Services need to take a holistic approach and work in partnership with other services to effectively address emotional and mental health needs. In addition, mental health needs are often affected by or result from wider family situations, relationships and experiences. Especially where an adult in the family has mental health needs, the child or young person s own emotional wellbeing is likely to be affected. Hence it is essential that services take an approach whereby they see the child s emotions and mental health as inextricably linked to relationships and experiences within the whole family. We will promote this awareness and require that services work in an integrated way recognising and responding to the links between emotions, behaviour and family relationships. We will also CAMHS Strategy finalised 02-07-12 Page 5
work closely with adult mental health services to ensure children whose parents have emotional or mental health problems are supported. continue to ensure a smooth and appropriate transition and integration between CAMHS and adult mental health services explore the potential for joint commissioning with adult commissioners for an all age service for those with emotional and mental health needs. Developing the preventative and early intervention role of universal services To ensure that emotional wellbeing is promoted and needs are addressed as early as possible to prevent them increasing in severity, we recognise, value and want to support and promote the crucial role that universal services such as schools, health, youth services and activity providers play in promoting self esteem, confidence and wellbeing; in addressing bullying and in identifying emotional distress and providing opportunities for children, young people and families to share their concerns and receive early support from peers and concerned adults. Early years settings, schools and health services have a key role in supporting the development of communication skills which aides emotional wellbeing. The times of transition from early years to reception classes and primary to secondary school are times when children are particularly vulnerable to emotional distress and schools will be encouraged to support vulnerable children and work closely with CAMHS when appropriate to respond to need. We will continue to provide advice, information and training to the universal workforce to help and support them with identifying and responding to emotional health needs. Enabling easy access Feedback from children, young people and families and partners highlights that they want more accessible, locally based services delivered within informal settings which children and young people choose and where they feel comfortable. Hence we will promote provision of accessible, flexible services available within a range of community and clinical based settings and also of outreach to ensure services take the initiative to identify and contact disadvantaged and vulnerable groups to deliver support rather than always expect those groups to contact services. Feedback also highlights the need for clear and easy referral routes. Therefore we will develop a single gateway to receive and screen and direct all referrals to the appropriate provision. This means children and families and referrers do not need to understand the details of criteria for the different services and tiers. Promoting integrated, multiagency partnership working Partnership working is essential for high quality service provision, to prevent children, young people and families from falling through potential gaps between different services, to provide consistent, joined up support where need is identified and to ensure resources are used effectively. We will ensure an effective partnership approach by: Promoting and requiring integrated working within and between each tier of provision. We will expect CAMHS to liaise with schools and other universal services to ensure good communication and joint working. Developing integrated pathways that cover all tiers of service. Ensuring CAMHS continue to be a key partner in Multi-Agency Allocation Groups (MAAGs), ensuring collaborative and joined-up multi-agency services, coordinated by a lead professional. Continuing effective joint commissioning to ensure shared vision, commitment and responsibility between partners and joined-up resourcing. CAMHS Strategy finalised 02-07-12 Page 6
Promoting an integrated multi-agency approach to workforce learning and development across Essex. Developing understanding of the range of provision so that all practitioners working with children and young people understand the contribution that they and their organisation can make to psychological wellbeing and mental health and know how to identify and respond to a potential need. Identifying, reaching out to and prioritising Vulnerable Groups Services are open to all those with mental health needs and services will prioritise by the level of mental health need. However the following groups are particularly disadvantaged and often have a number of complex and interrelated needs and vulnerabilities and hence they will receive focused attention to help address inequalities. These groups are: Children who are in Care or Leaving Care, regardless of placement and including unaccompanied minor asylum seekers.. Children subject to a Child Protection Plan or a Section 47 enquiry or in need. Children with learning difficulties, disabilities and developmental conditions such as autism. Children with palliative care needs. Children affected by their own or family drug, alcohol and substance misuse. Children affected by domestic abuse. We will ensure through our commissioning and delivery that: Services respond flexibly and creatively and engage with and meet the needs of those who are reluctant to access or have difficulty in accessing services. We will expect that commissioned providers offer outreach and deliver in local venues. Services are proactive in implementing approaches and the Partnership undertakes collaborative actions to ensure equality of access and appropriate and accessible provision so that children and young people from black and minority ethnic groups, children and young people with any disability and children and young people who are gay, lesbian, bi-sexual or transgender receive support when needed. An Equality Impact Assessment for this Strategy and associated activity has been completed and will be regularly reviewed. Embedding the systematic involvement of children, young people and families We will promote and require the ongoing systematic involvement of children, young people and families in all commissioning and delivery by: Ensuring a holistic needs assessment is undertaken for all children and young people whose mental health needs cannot be met within a universal setting and working with the child or young person and their family to develop a personalised care plan. Providing all children and young people who receive additional support with a regular review of progress to determine whether additional services are required and to agree the level of support. At Tiers 3 and 4, this will be the Care Programme Approach. Ensuring the involvement of children, young people and families in the planning, review and implementation of commissioning and delivery activities. Both Tier 3 providers in Essex have young people s advisory and consultation groups within which they discuss service delivery issues. School Councils, the Young Essex Assembly, healthy schools audit and monitoring visits, voluntary organisation user groups, the Children in Care Council and a variety of parent groups, such as those in children s centres and for parents with disabled children are established forums that will be consulted with regularly so that plans for commissioning and service delivery reflect the views of children, young people and parents. CAMHS Strategy finalised 02-07-12 Page 7
Supporting and developing the workforce Effective early intervention and prevention relies upon the competencies and capacity of staff working in universal settings with children and young people to promote and support good emotional wellbeing and mental health and to recognise and respond to early signs of need. We will enable provision of training and support to practitioners within universal settings to raise awareness and knowledge of: The importance of good emotional health and well-being. How to recognise early signs of need and how to respond to this, including how to complete a needs assessment through CAF and, where required, refer to an appropriate service. We will ensure that the CAMHS workforce is appropriately trained and encompasses a balanced skill mix to deliver high quality services in all four tiers. All staff will be supported to maintain their professional registration and develop the necessary skills and competencies to work collaboratively with partners, assess needs, deliver effective interventions tailored to individual need and engage with and respond effectively to all children, young people and their families especially those who have difficulty accessing services. We will continue to facilitate the delivery of mental health support and training to the universal children s workforce so they can identify and respond to emerging mental health needs, this includes including publicising appropriate online training packages. We will also commission for the provision of consultancy, advice and support to staff in universal settings by specialist CAMHS providers. 3. Outcomes The following are the outcomes we are seeking through the commissioning and delivery of CAMH services and collaborative actions in line with the principles outlined above: Children, young people and parents/carers have improved emotional wellbeing, mental health, self esteem and confidence and are emotionally resilient. Parents and carers have the skills to recognise, manage and respond to their children s emotional needs. Children, young people and families and referrers know about and influence services and have easy access to services with quick response of appropriate interventions and individually focused support with respect for privacy and dignity. Children, young people and families have confidence in services and their needs are met through interventions by trained practitioners who feel supported through access to consultancy and advice and do what they say they will do. Children, young people and families experience effective transition between services without discriminatory, professional, organisation or location barriers getting in the way. Fewer children and young people experience stigma and discrimination through improved public awareness and understanding of mental health. Indicators and performance measures to assess achievement towards these outcomes have been developed and data is collected including through contract monitoring and reported and analysed quarterly and annually at LCCDBs and at the CAMHS Joint Commissioning Committee and CAMHS Stakeholder Partnership to assess progress. CAMHS Strategy finalised 02-07-12 Page 8
Appendix 1 Key policy influences on the strategy National research highlights that good emotional and mental health is fundamental to the quality of life and productivity of individuals, families, communities and nations. Positive mental health is associated with enhanced psychosocial functioning; improved learning; increased participation in community life; reduced risk-taking behaviour; improved physical health; reduced mortality and reduced health inequality. 1 Poor emotional well-being and mental health can lead to negative outcomes for children, including educational failure, family disruption, poverty, disability and offending. These often lead to poor outcomes in adulthood, such as low earnings, lower employment levels and relationship problems which can also affect the next generation. Half of lifetime mental illness arises by the age of fourteen and widespread research has shown that early intervention and preventative strategies are effective and crucial to improve the emotional wellbeing and mental health of populations. Resilience to poor psychological health can be developed at individual, family and community levels and interventions are most effective when they take a holistic, family centred approach. Research highlights that a child s experience in the first two years sets the foundation for the whole of life making a compelling case for investment in the early years. The most crucial influence upon a child s emotional wellbeing and mental health is parenting influence within the first years of a child s life. Maternal health during pregnancy affects the health and development of the unborn child; stress is associated with increased risk of child behavioural problems whilst alcohol, tobacco and drug use increase the likelihood of a wide range of poor outcomes that include long-term neurological and cognitive emotional development problems. 2 Early attachment and bonding between parents/carers and their babies is vital for a child s cognitive development. A lack of appropriate stimulation in the early years can result in language delay whilst inappropriate child-rearing practices may lead to emotional or behavioural disorders. 3 There is a strong correlation between communication difficulties and low self esteem and mental health and as approximately 50% of children in socially disadvantaged areas have significant language delay on entry to schools, supporting language and communication in the early years is important 4. Universal services must be able to identify need at the earliest point and provide early effective evidence based support to parents, children and families. Research has also shown that quick assessment and early intervention by the appropriate tier of service can help ensure an issue is treated successfully. For eating disorders, for example, this requires treatment as soon as possible by a range of professionals at Tier 3 rather than Tier 2. Our strategy has also been shaped by the following key points identified in the 2008 independent national CAMHS review. Everybody needs to recognise and act upon the contribution they make to supporting children s mental health and psychological well-being and to recognise the contribution others make. For parents/carers, this means helping them to understand the importance of psychological wellbeing in their child s life, and what they can do to promote this. 1 Royal College of Psychiatrists (2010), Position Statement PS4/2010 2 Royal College of Psychiatrists (2010); C4EO (2010), Grasping the nettle: early intervention for children, families and communities 3 Department of Education and Skills (2008), Sure Start Children s Centres Practice Guidance 4 Grasping the Nettle C4EO CAMHS Strategy finalised 02-07-12 Page 9
Local areas have to understand the needs of their children, young people and families at population and individual level and engage effectively with them in developing approaches to meet those needs. For parents/carers, children and young people, this means being listened to, knowing what is available and being able to access help quickly in places they choose. The whole of the children s workforce needs to be appropriately trained in identifying and supporting emotional wellbeing and mental health and, with the wider community, needs to be well informed. For practitioners, this means having access to sound evidence and knowledge on improving outcomes and sufficient knowledge, training and support to promote psychological wellbeing and to identify early indicators of difficulty. For parents, carers, children and young people this means having confidence that the people supporting them understand mental health and psychological wellbeing and know what works best. The main policy influence has been the 2011 mental health strategy No Health Without Mental Health. We aim to achieve the outcomes and objectives outlined therein, including: Promoting better wellbeing and good mental health for children, young people and families, ensuring a good start in life and addressing the social determinants of mental ill-health. Supporting those with mental health problems to have a good quality of life, by identifying and intervening early, ensuring care and support respond to the needs of individuals, offering age appropriate information, care and interventions, working with the whole family and providing high quality care and treatment and 24 hour access to provision. Offering children, young people and families access to timely, evidence based interventions and individually focused support with respect for privacy and dignity and listening to and involving users and carers. Ensuring appropriate, effective transition between services without discriminatory, professional, organisation or location barriers getting in the way. Ensuring fewer children and young people experience stigma and discrimination by improving public awareness and understanding of mental health. Our needs There are some 332,900 children and young people within Essex aged 0-19. National evidence shows that approximately 10% will have emotional and behavioural issues which can be supported by universal services. In Essex this equates to some 33,000 children and young people. Data on provision at this level by the voluntary and community sector, schools and early years settings, children s centres and health teams is not collected or collated at a County wide level so we are unable to identify how much of this estimated need is currently met. The evidence also shows that 10% of children, some 30,000 in Essex, will have an emerging or diagnosable mental health problem which would require intervention from Tiers 2, 3 or 4 services. Data on the numbers in this group receiving individual intervention from the commissioned services provided by local community organisations, ECC or the mental health trusts is collected and given below. As well as direct work with individuals, Tier 2 and 3 services also provide advice, support and consultation to schools, other professionals and carers such as foster carers and residential staff to support them with responding to the emotional health needs of children and young people. Additional numbers will benefit from this. Data on provision of consultation is not consistently collected. We have taken 2010-11 as the baseline; hence figures are from that year. CAMHS Strategy finalised 02-07-12 Page 10
Group All children & young people With learning difficulties & disabilities, developmental disorders & in residential schools Children in short stay schools Children on a protection plan Number in Essex 332,900 11,000 Predicted number with mental health needs Individuals helped by community Tier 2 services in 2010-11 10% (33,000) 24,338 36% (3,960) 700 100% Not known Not known 750 Not known Children looked after 1,400 45% (630) Not known Individuals directly helped by ECC Tier 2 in 2010-11 Individuals directly helped by Tier 3 & 4 in 2010-11 2,745 4,458 84 (SEN statement) 123 142 Not known Not currently collected Not currently collected 136 112 There is unmet need, especially as the trend has been for an increase in more severe mental health problems in recent years. For example the number with eating disorders in North Essex increased from 47 in 2005 to 109 in 2008 and has been increasing since, reflecting a national trend. Also there are growing numbers of referrals for sexualised and other complex behaviours associated with emotional problems. A key challenge is to more effectively and efficiently meet more need in the context of reducing resources. The views of children, young people, parents and other stakeholders 78 children and young people gave views as part of the CAMHS Tier 2 consultation in March 2012. Their views were similar to those from an Essex CAMHS Needs Assessment conducted in 2005. Both found that young people want mental health services that offer: More general easy access to non statutory organisations and therapies such as counselling. Somewhere to go that is young person friendly, for example a drop in centre/one stop shop. To be able to talk to someone they can trust and feel at ease with. To be able to talk to and get help from other young people who have been in their situation. To be able to get help outside of office hours and particularly at weekend nights. More outreach support in educational institutions such as schools and colleges. To see someone when they are admitted to A&E who understands their experiences and needs and who treats them with respect and care. Easily accessible information and advice, informational websites for young people, advertisements for support groups, leaflets and posters on services, and more help lines. Additional points made in response to specific questions in the 2012 consultation were: The most popular time for appointments is the afternoon before 17.00 or morning (09.00 12.00) followed by early evening (17.30 19.30). There was little support for weekends or early mornings. Parents/family are the most important people to help support young people with emotional or mental health difficulties (26 responses), specialist staff (26 responses) and other CAMHS Strategy finalised 02-07-12 Page 11
CAMHS staff could help by listening so children and young people can talk about their problems. Easier access to services, including the ability to self refer and more information about services and how to make a complaint are necessary. It is important to raise awareness about mental health issues to reduce stigma and to encourage young people to talk about any issues. Very few young people expressed a preference for either separate or integrated CAMH services. Concerns about an integrated service were: less specialisation, loss of resource, longer waiting lists and some needs not being met. One fifth saw a single point of contact as important One fifth thought having a single child and adult service would ensure better transition; however a third thought it would not be sufficiently child focused. 42 parents/carers responded to the Tier 2 CAMHS on-line survey in March 2012 and parents views were also obtained in 2005. These showed: The need to develop a greater understanding of mental health issues. Raise awareness of what support is available (e.g. within schools). The need to encourage young people to talk about mental health issues. Easy access to services when needed. The need for consistent long term support. One key worker - you end up telling the same story to so many people. More effective services with staff treating them with respect and including them in the treatment. More long term parent groups. More information. Continuity of service around the transition age. Additional specific points from the 2012 survey (42 parents) were Concern about loss of funding/resources. The majority would go to their GP for help, 17 would go to school staff and 8 to CAMHS. 10 parents/carers would like direct access to support. The majority consider that schools are the best place for children and young people to see someone who could offer support, with home being the second best place, then other venues such as youth clubs. Most important is to have a place of the child s choice where they feel comfortable. There were mixed views about the time of appointments with the most popular being Saturday morning, Saturday afternoon or weekday early evenings. Views on having appointments during school hours were mixed. The majority consider that the most important people who can help support a child or young person with emotional or mental health problems are parents or family members, followed by specialist services, school staff and then GPs. Many gave no preference about having an integrated service for all levels of need. Many did not comment on having one service that works with both children and adults, but the few that did would prefer separate services. There was a preference to give views about the service via surveys/consultations, face-toface meetings, emails and a small number would prefer online contact. Parents/carers felt it was important for them to know how to make complaints but 28 CAMHS Strategy finalised 02-07-12 Page 12
Of the 87 primary and secondary Essex schools responding to the Audit Commission s 2009 national school survey, 41% rated local services as poor in meeting the mental health needs of children and young people and 19% rated services as good or excellent. This placed Essex in the lowest quartile nationally. Schools state that they want access to Tier 1 and non clinical Tier 2 provision in universal settings where it can be quickly accessed and linked to other provision. Since then much has developed and improved. Crisis and outreach services have developed; 24 hour access has been provided and a transition protocol has been developed. In the CAMHS Tier 2 consultation February/March 2012 five stakeholder workshops were held and individual and group responses were received (consisting of staff from early year settings, schools and colleges, GPs, ECC staff, the voluntary sector and CAMHS practitioners). Things that were identified as very important but not currently working well were: Supporting the whole family. *Partnership working (including advice and support for non-camhs staff in universal services). Having swift and easy access to CAMHS services. Clear referral processes. *Support for schools/colleges. Support for non-camhs practitioners in universal services. Communication/ Feeding back on interventions or outcomes and the location of services. More staff and resources. Things that were reported as working well were: Skills and experiences within Tier 2 staff. Joint/partnership working. Support for schools and colleges. Support available to parents/families. Having locally or community based services. Engaging with young people. *It should be noted that fewer respondents mentioned these areas as not working well than numbers indicating it is working well. The main thing identified as needed to improve access to help is having quicker and easier access to services (especially for schools and health professionals). Linked to this point is the need to have a better referral process and more staff/resources, plus improving advice and guidance on the referrals process. Support for non-camhs practitioners in universal services also needs to improve. Some respondents suggested improving the location of services. Four fifths of stakeholders (from all specialisms) say they would prefer an integrated service that covers all levels of emotional and mental health, with the main benefits being a better referral process (including referrals between tiers), better links/communication between tiers, and better partnership working. However, a fifth (mainly schools and ECC staff) would prefer separate services/a tiered service, with the main reason being the need to have specialist skills for different levels. CAMHS Strategy finalised 02-07-12 Page 13
The views on commissioning for an integrated service that works with both adults and children were more mixed. While half would prefer an integrated service, one in ten would prefer separate services and a third have mixed views. The main reason for preferring an integrated service is the support that can be provided to parents/families, plus improving transition. The main reason for not integrating adult and child services is seen as the need to keep a child specific focus. A large majority (80%) of the 14,000 pupils who completed the 2010 SHEU (School Health and Education Unit) survey, said they were happy about life, that their parents and family look out for them and that they have one or more good friends. However, nearly two out of ten said they often feel sad or tearful and three in ten said they worry a lot. 1% said that they have no friends. When they have worries about an issue, all pupils are most likely to share it with their parents first. However, whilst some primary pupils also share worries about school and friends with teachers, secondary pupils share these problems with friends or boyfriends/girlfriends. The percentage of pupils feeling afraid to go to school because of bullying, at least sometimes, has steadily fallen over the last four years. Most pupils felt their school deals well with bullying, but a sizable minority do not agree: 13% of primary and 22% of secondary pupils felt their school deals with bullying badly or not very well. CAMHS Strategy finalised 02-07-12 Page 14