Surrey Emotional Wellbeing and Mental Health Services for Children and Young People Needs Assessment Refresh

Transcription

1 Surrey Emotional Wellbeing and Mental Health Services for Children and Young People Needs Assessment Refresh January 2014 Updated April 2014 Authors: Tina Fenwick Commissioning Projects Officer, Children s Social Services and Wellbeing Commissioning Julie Nelson Public Health Lead 1

2 Executive summary Emotional Wellbeing and Mental Health Needs Assessment refresh Version 13 April 2014 Introduction This document is a refresh of the 2009 Surrey Child and Adolescent Mental Health Services (CAMHS) Healthcare Needs Assessment (2009 CAMHS HNA). The aim was to refresh the information on need, identify gaps and to develop recommendations based on the findings. The estimate of the total number of children and young people living in Surrey has increased from 268,500 to 276,000 between 2009 and Based on population data and population projections the areas of Surrey with the greatest requirement for health services for children and young people will continue to be Elmbridge, Reigate and Banstead, Guildford and Waverley. Woking has the highest percentage of children from minority ethnic groups in Surrey, and has a higher percentage of children from these groups than England, the South East and Surrey. The numbers of children with Fixed Term Exclusions had been reducing but is now beginning to increase again. The number of children excluded for persistent disruptive behaviour remains high although this category is broad and covers a range of behaviours and potential needs. The number of Fixed Term Exclusions at the primary age range is increasing as the needs of this cohort are becoming more complex. The ethnic group with the highest number of Fixed Term Exclusions is of children from Irish Traveller and Gypsy Roma Traveller communities. The number of children with English as a second language in Surrey has increased across all school phases with the highest numbers attending schools in Runnymede, Spelthorne and Woking. There is a need for a better understanding of the potential emotional wellbeing and mental health needs of children not in school. There is an estimated increase in the number of children with mental health disorders in Surrey from 5,884 in 2009 to 6,014 in 2012 based on an increase in the population estimates. Children with medical conditions have a higher incidence of mental illnesses that the average child population. Children with disabilities are more vulnerable to emotional wellbeing and mental health issues and their specific needs in this area are not always recognised in their own right. A holistic approach is emphasised to ensure consideration is given alongside their physical needs. Recognition of emotional wellbeing and mental health and associated services will form part of the local offer as part of the SEN reforms under the Children and Families Care Bill (2013) % of children nationally live with a parent who has a mental health disorder. Data is not available on the number of children living with parents with a mental health problem in Surrey. The number of women in Surrey who are suffering from perinatal mental health problems is estimated to be between 900 and 2,000. Both poor parental mental health and poor parenting skills have been found to result in a 4-5 fold increased rate in onset of emotional/conduct disorder in childhood. The importance of a family focus approach is reinforced together with improved joint working between CAMHS and Adult Mental Health Services in order to ensure that the needs of children whose parents have mental health issues are identified and there are improvements in the transition from children to adult services and support for the post 18 cohort. The particular groups of children and young people who may be vulnerable to increased risk of emotional wellbeing and mental health issues include young parents; parent and young carers; lesbian, gay, bisexual and transgender young people; refugee and asylum seeking children; children from the Gypsy Roma Traveller community; children from BME communities; recently adopted young people; children witnessing domestic abuse, children in low income families and those living in military families. 2

3 The estimated number of children living in low income households in Surrey is over 21,200, an increase of 3,000 since The local authority with the largest proportion of children living in low income households is Spelthorne.. 3

4 Recommendations 2014 Emotional Wellbeing and Mental Health Needs Assessment refresh Version 13 April The Targeted Mental Health in Schools (TaMHS) approach will include support for specific disengaged schools and offer more attachment training. Consideration should also be given to extending the TAMHS approach into Further Education colleges 2. Explore and increase the provision of early help and support for emotional wellbeing and mental health to children aged two and a half to five and for primary age children 3. School staff, with support from the multi-agency e-safety sub-group, need to be aware of the impact that cyberbullying can have on the emotional wellbeing and mental health of children and young people, particularly those from vulnerable groups 4. Services need to ensure support can be made more accessible to all families and communities, for example exploring the community based language programmes as a means of increasing access 5. Consider development of a designated CAMHS Gypsy Roma Traveller (GRT) liaison post to raise awareness of all professionals of the particular needs of children from the GRT community and to understand how access to services can be improved. 6. Increase the resilience of emotional wellbeing and mental health in families of children with autism and teenagers through targeted parenting programmes 7. Ensure the emotional wellbeing and mental health needs of children with disabilities/complex needs are recognised by all professionals as part of the holistic assessment and care planning arrangements. Similarly for those children who may not be statemented such as those with high functioning autism, attention deficit hyperactivity disorder or dyspraxia 8. Explore how services can best respond to meet the emotional wellbeing and mental health needs of children who are overweight or obese 9. Parent and young carers play a key role in improving the emotional wellbeing and mental health of those they care for and services need to routinely provide an assessment of their needs in order to support them to continue in their caring role. Services should consider how to embed carers champions within CAMHS service provision 10. In order to ensure continued emotional wellbeing and mental health there needs to be accessible, effective, 24/7 early support and information for children and young people and their families 11. Develop joint working between Adult Mental Health Services and CAMHS to deliver a family focused approach 12. Work with Adult Mental Health commissioners to ensure the mental health services pathway reflects the needs of young people post 18, in particular the pathway from CAMHS to Improving Access to Psychological Therapies (IAPT) to enable more effective signposting or support and information concerning self-help strategies for young people approaching adulthood, especially for the age group 13. Adult Mental Health services and CAMHS to be aware of and respond to the emotional wellbeing and mental health needs of the children of service users following discharge from the local armed forces community and to ensure that the Armed Forces are aware of the civilian emotional wellbeing and mental health service provision 14. Increase the capacity of the Parent Infant Mental Health service (PIMH) and You and Your Baby connecting service to enable greater early intervention and development of stronger more secure attachments. Work with Adult Mental Health Commissioners to develop a local dedicated perinatal service 15. Services need to better understand the emotional wellbeing and mental health needs of young people in Surrey who are lesbian, gay, bisexual or transgender and review the support and treatment available locally for young people who are gender questioning and considering gender variance 16. Develop more and ongoing support for prospective adopters and newly adoptive parents regarding the emotional wellbeing and mental health needs (including loss, trauma and attachments) of the children concerned and for the impact on the wider family to enable placements to be maintained 4

5 17. Further need for data regarding emotional wellbeing and mental health of children and young people: presenting at A&E with self harm and other emotional wellbeing and mental health related needs; children in GRT & BME communities; children affected by domestic abuse; unaccompanied asylum seeking children and young people; children not in school; children in military families; parents and young carers and better recording of emotional wellbeing and mental health on case management systems 5

6 Contents Page Executive Summary 2 Recommendations List of tables and figures 7 1 Introduction 10 2 Aim and objectives 10 3 Current Surrey CAMHS 11 4 Local need for CAMHS Demographics and population projections England, South east and Surrey population estimates Black and minority ethnic communities Education Schools in Surrey Fixed term exclusions English as a Second Language Young people not in education, employment or training Health Children with mental disorders in England, South East and Surrey Estimate of mental health conditions amongst BME Link between physical ill health and mental ill health Children with disabilities Children and young people with limiting illness Parents with mental health needs Suicide and self harm Mental health and obesity Children and young people who are vulnerable or at risk Unborn children Children in need (CIN) Young carers Lesbian Gay, Bisexual, Transgender and Questioning young people Children in poverty Number/estimates of refugees and asylum seekers in Surrey Homeless families Gypsies Roma and Travellers in Surrey Transition (preparation for adulthood) Young offenders Care leavers Adoption Children from Armed Forces families Looked After Children 66 Appendix 1 Further information and gap analysis by Expert group 68 Appendix 2 Recommendations in 2009 CAMHS HNA 73 Appendix 3 Glossary 76 Appendix 4 References 79 Appendix 5 Contacts 82 6

7 List of tables and figures Emotional Wellbeing and Mental Health Needs Assessment refresh Version 13 April 2014 Tables Page Table 1 Summary of services jointly commissioned by CCGs and Surrey County Council, Table 2 Estimated number of children under 19 years in England, South East and Surrey. Comparison between 2009 and Table 3 Estimated number of children under 19 years in Surrey by borough/district. Comparison between 2009 and Table 4 Population projections for children aged 0 19 years , England, South East and Surrey 15 Table 5 Population projections for children aged 0 19 years by 5 year age groups between , England, South East and Surrey 16 Table 6 Population projections for children aged 0 19 years , boroughs and districts 17 Table 7 Number of children in schools in Surrey by type, January Table 8 Number of schools in Surrey by school type and number on roll, Table 9 Number of children in schools across Surrey boroughs/districts, January Table 10 Number of Fixed Period Exclusions (FPE) and percentage of school population for schools in Surrey, 2009 to Table 11 Reasons for Fixed Term Exclusions in state-funded primary, secondary and special schools in Surrey in 2009/10 and 2011/12 26 Table 12 Comparison of percentage of pupils with EASL in Surrey by borough/district, Table 13 Comparison of percentage of pupils with EASL in Surrey by school type, Table 14 Young people aged years who are NEET in Surrey, 2008 to Table 15 Estimate of children and young people with specific conditions comparison of 2009 with 2012 estimates 32 Table 16 Estimates of children and young people with specific conditions per borough/district, comparison of 2007 (from CAMHS HNA, 2009) with Table 17 SEN national picture, 2008 to Table 18 Statemented national picture 35 Table 19 Age range and numbers of statemented children & young people January Table 20 Age of children and young people in Surrey with SEN statements, 2008 and Table 21 Total numbers of children (0-18 years) registered on the Surrey Children's Disability Register (SCDR), 2009 to Table 22 Different Disability categories used in Surrey 2009 and Table 23 Number of children and young people with SEN statements, maintained by Surrey, whose primary need is physical disability, 2009, 2012 and Table 24 Children aged 0 5 years with a limiting illness and level of limitation in England, South East and Surrey 39 Table 25 Children aged years with a limiting illness and level of limitation in England, South East and Surrey 39 Table 26 Children and young people in Surrey boroughs and districts aged 0-15 years with limiting illness 40 Table 27 Children and young people in Surrey boroughs and districts aged years with limiting illness 40 Table 28 Adults in Surrey with various mental health disorders, Table 29 Parents who are attending treatment for substance misuse, who live with their child or children, rate per 100,000 children aged 0-15 years in the area Parents who are attending treatment for alcohol, who live with their child or children, rate per 100,000 children aged 0-15 years in the area

8 Table 30 Estimated prevalence of peri-natal mental health illnesses in Surrey using the Prevalence and Benchmarking from NICE tool (NICE, 2007) 43 Table 31 Number of deaths by suicide in UK ; years of age 44 Table 32 Recommendations from NICE Managing overweight and obesity among children and young people: lifestyle weight management services (2013) 45 Table 33 Number of unborn children in Surrey as of by Children in Need (CIN) and Child Protection (CP) 47 Table 34 Number of unborn children open to Surrey County Council Children s Services, 2012/13 47 Table 35 Number of CYP subject to a CPP in Surrey as of Table 36 Number of Children in South East England on Child Protection Plan comparison 2009 with Table 37 Number of children subject to a Surrey CPP by category of abuse as of Table 38 Estimated Young Carers in Surrey by borough and district, Table 39 Percentage of Surrey children living in poverty aged under 16 years, trend data Table 40 Percentage of children (under 16 years) living in workless families, trend data Table 41 Unaccompanied asylum seeking children (UASC) in Surrey under the age of 18 years as at 18 November 2013 (non-validated figures) 57 Table 42 Number of UASC in Surrey by area, Table 43 Families with children in Bed and Breakfast accommodation for more than 6 weeks, excluding those pending review, by local authority as of 31 December Table 44 Mental Health Core Asset scores Apr 2012 to Mar Table 45 Numbers of Care leavers in Surrey, October Table 46 Rate of LAC per 10,000 of the 0-17 population 67 Figures Figure 1 Estimated percentage change in population in England, South East and Surrey, comparison between 2009 and Figure 2 Estimated number of children under 19 years in Surrey by borough/district. Comparison between 2009 and Figure 3 Percentage change in population projections between 2015 and 2025, England, South East and Surrey 16 Figure 4 Population projections for children in boroughs and districts aged 0 4 years, 2015 to Figure 5 Population projections for children in boroughs and districts aged 5 9 years, 2015 to Figure 6 Population projections for children in boroughs and districts aged years, 2015 to Figure 7 Population projections for children in boroughs and districts aged years, 2015 to Figure 8 Percentage of children aged 0 15 years in ethnic groups, Figure 9 Percentage of children aged 0 15 years in ethnic groups excluding White British group, Figure 10 Fixed Term Exclusions 2009/10, 2010/11, 2011/12 25 Figure 11 Percentage of children with the highest percentage Fixed Term Exclusions in Surrey by ethnic group 25 Figure 12 Difference in the range of languages spoken in Surrey expressed as a percentage, variance 2008 to Figure 13 Pupils with statements in Surrey, 2009 to Figure 14 Surrey Children s Disability Register, Figure 15 Hospital admissions for self harm for people under 18, 2006 to Figure 16 Map of Surrey IMD 2010 rankings at Lower Super Output Areas by Surrey 54 8

9 deciles Figure 17 Percentage of children living in income deprived households, Figure 18 Percentage of children under 16 years of age in Surrey living in poverty, Figure 19 Percentage of children (under 16 years) living in workless families, trend data

10 1. Introduction Emotional Wellbeing and Mental Health Needs Assessment refresh Version 13 April 2014 This document is a refresh of the 2009 Surrey Child and Adolescent Mental Health Services Healthcare Needs Assessment (2009 CAMHS HNA). It provides up to date information on issues requested by the CAMHS Commissioning group. It is envisaged that a full CAMHS HNA will be undertaken in the near future. Please read this document in conjunction with the 2009 CAMHS HNA. The Government s Mental Health action plan Closing the Gap: Priorities for essential change in mental health was published on 21 st January and is a key document for the future development of mental health services. 2. Aim and objectives The aims and objectives of the 2009 CAMHS HNA were: Aim To review the Child and Adolescent Mental Health Services available to residents of Surrey Objectives To identify and address National Guidance on CAMHS To assess the current evidence base for prevention and treatment of mental health problems in children and adolescences To undertake an epidemiology needs assessment to identify the needs of the population and vulnerable groups in Surrey To detail current provision and usage of CAMHS for Surrey residents To compare the available service provision with the estimated needs to identify gaps in the current service To undertake a corporate needs assessment to gather views of all stakeholders (including children, young people and families/carers), and identify strengths, weaknesses and gaps in current service provision To make recommendations about gaps and improvements required in CAMHS. The aim of this CAMHS HNA refresh is to update specific information in the previous CAMHS HNA as requested by CAMHS Commissioning group 10

11 3. Current Surrey CAMHS services Table 1 Summary of services jointly commissioned by CCGs and SCC, 2013 Primary Mental Health Service A targeted service providing a combination of direct therapeutic timelimited intervention to children and young people with mild to moderate mental health problems and their families, consultation, training, joint working with universal services and community CAMHS teams. Including interventions with young offenders/those at risk of offending, children who are looked after, children in need preventing them becoming accommodated, children with learning disabilities and those placed in pupil referral units (PRU) and behavioural, emotional and social difficulties (BESD) schools to prevent or minimise escalation of need and referral to specialist services CAMHS Extended Hours Service CAMHS Weekend Assessment Service Parent Infant Mental Health Service (PIMH) You and Your Baby connecting Service Children in Care (3Cs) Targeted Clinical Service Sexual Trauma Assessment Recovery and Support (STARS) CAMHS Community Nurses for schools Aim of service is to prevent children from being accommodated and work with families at high risk of (mental health and) family breakdown Weekend assessment provision for children and young people presenting at Accident and Emergency (A & E) 9-5 Monday to Friday weekends and Bank Holidays Service aim is to promote positive, secure early attachments between babies and their parents where a mental health vulnerability or risk has been identified Aim of service is to support and offer intervention for young mothers in care or care leavers to promote positive, secure early attachments between babies Service aim is to provide a single referral and care pathway for Looked After Children (LAC) with significant mental health and emotional difficulties or displaying signs of emerging complex emotional and psychological difficulties and mental health needs. The service is for 0-18 year olds and includes training; advice and consultation to LAC teams and residential teams & fostering teams; assessment and treatment of complex or high risk cases; therapeutic intervention; transition planning to adult service and therapeutic support groups for foster carers To deliver targeted family interventions providing direct therapeutic work with children and young people with mild to moderate mental health problems and their families within Community CAMHS To provide a therapeutic and support resource for children, young people and their parents/carers who have been affected by sexual abuse, using a trauma focused approach, which aims to eliminate or reduce symptoms specific to sexual trauma. To deliver mental health interventions to children and young people with mild to moderate mental health problems and to support the school nursing teams offering consultation and advice in a school setting and contributing to the delivery of the TaMHS approach Everybody s Business training for professionals in universal services To deliver mental health awareness training for professionals and volunteers working in universal services to build capacity and develop skills and confidence to support early intervention and appropriate referrals to targeted and specialist CAMHS Source: Children Schools and Families Directorate, Surrey County Council (SCC),

12 4. Local need for CAMHS The local need for CAMHS depends on the prevalence of mental health problems and disorders in the local community; to estimate this we can use local population figures and projections, national figures, local data about those with risk factors for mental health problems and current service use. 4.1 Demographics and population projections England, South east, Surrey, district and borough level population estimates The 2009 CAMHS HNA included 2008 demographic data. Comparison between 2008 and 2012 data is not possible because the age categories have altered i.e in 2008 has been changed to years. It is possible to compare 2009 and 2012 data. The estimate of the total number of children and young people living in Surrey has increased from 268,500 to 276,000, an estimated increase of 7,500 in a three year period. This is an estimated 2.8% rise in number of children during this period which is greater than the England estimated increase of 1.3% and the South East estimated increase of 2.0%. Surrey shows a similar pattern in terms of increase in estimated populations for the younger age groups of 0 4 years and 5 9 years and a decrease in the estimated populations for the older age groups of years and years as for England and the South East. However there is a slightly larger percentage increase in Surrey for the 0 4 year age group and smaller percentage decreases in the two older age categories than for England and the South East. The boroughs of Guildford and Runnymede have seen the greatest increases during this period and both have an estimated increase in the number of children and young people of over 5%. Only Surrey Heath has an estimated decrease in the total number of children but this is small at less than 1%. All boroughs and districts show an increase in children 0 4 years in particular Runnymede and Woking, both with an estimated increase of over 10%. Spelthorne and Woking have an estimated increase of over 10% for children aged 5-9 years. In the years age group ten boroughs and districts have had an estimated decrease or no change; only Guildford has an estimated increase, which is of 1.4%. Eight boroughs and districts show an estimated decrease or no change for the years age group. The highest is Woking with an estimated decrease of 8.9%. Guildford has the highest estimated increase of 4.7%. 12

13 Estimated percentage change in population Emotional Wellbeing and Mental Health Needs Assessment refresh Version 13 April 2014 Table 2 - Estimated number of children under 19 years in England, South East and Surrey, comparison between 2009 and 2012 Numbers in thousands Region 0-19 years 0-19 years % change 0-4 years 0-4 years % change 5-9 years 5-9 years % change years years % change England 12, , , , , , , , , , South East 2, , Surrey Source: Office for National Statistics (ONS), 2013 accessed from Surrey-i Figure 1 - Estimated percentage change in population in England, South East and Surrey, comparison between 2009 and years years % change years 0-4 years 5-9 years years England South East Surrey -4-6 Age groups Source: ONS, 2013 accessed from Surrey-i

14 Local authority Elmbridge Epsom and Ewell Guildford Mole Valley Reigate and Banstead Runnymede Spelthorne Surrey Heath Tandridge Waverley Woking ,000 4,500 7,800 4,500 8,700 4,500 5,600 5,100 4,700 7,300 6, ,800 4,900 8,400 4,700 9,500 5,000 6,100 5,100 4,900 7,400 7,400 % change ,400 4,300 7,200 4,800 8,000 4,100 5,000 5,100 4,700 7,200 5, ,900 4,500 7,900 4,800 8,400 4,400 5,500 5,300 4,900 7,600 6,300 % change ,300 4,600 7,400 5,400 8,200 4,100 5,400 5,500 5,400 7,600 5, ,400 4,600 7,500 5,200 8,100 4,000 5,100 5,400 5,100 7,600 5,600 % change ,400 4,600 8,500 5,100 7,900 5,200 5,400 5,400 5,200 7,800 5, ,200 4,700 8,900 5,100 7,800 5,400 5,300 5,200 5,100 8,000 5,100 % change ,100 18,000 30,900 19,800 32,800 17,900 21,400 21,100 20,000 29,900 23, ,300 18,700 32,700 19,800 33,800 18,800 22,000 21,000 20,000 30,600 24,400 % change Emotional Wellbeing and Mental Health Needs Assessment refresh Version 13 April 2014 Table 3 - Estimated number of children under 19 years in Surrey by borough/district, comparison between 2009 and 2012 Source: ONS, 2013 accessed from Surrey-i

15 Estimated population aged 0-19 years Emotional Wellbeing and Mental Health Needs Assessment refresh Version 13 April 2014 Figure 2 - Estimated number of children under 19 years in Surrey by borough/district, comparison between 2009 and Boroughs and districts Source: ONS, 2013 accessed from Surrey-i Population projections In Surrey the number of children between 0 19 years is due to rise during the period 2015 to 2025 from 282,700 to 306,200, an increase of 8.3%. This is lower than the projected rise for England of 9.1% during the same period. As the age range used for the most up to date projected population estimates is different to the age range given in the 2009 CAMHS HNA it is not possible to compare the projections. Table 4 Population projections for children aged 0 19 years , England, South East and Surrey Population in thousands Region 0 19 years 0 19 years % change England South East Surrey Source: Population Projections Unit, ONS. Crown copyright 2012 accessed from Surrey-i

16 Estimated percentage change in population projections Emotional Wellbeing and Mental Health Needs Assessment refresh Version 13 April 2014 Table 5 Population projections for children aged 0 19 years by 5 year age groups between , England, South East and Surrey (population in thousands) Region % % % % years years years years years years years years change change change change England South East Surrey Source: Population Projections Unit, ONS. Crown copyright 2012 accessed from Surrey-i Figure 3 Percentage change in population projections between 2015 and 2025, England, South East and Surrey England South east Surrey years 5-9 years years years -10 Age groups Source: Population Projections Unit, ONS. Crown copyright 2012 accessed from Surrey-i

17 Table 6 - Population projections for children aged 0 19 years , boroughs and districts Local authority % years years change 0-4 years 0-4 years % change Emotional Wellbeing and Mental Health Needs Assessment refresh Version 13 April years 0-5 years % change years years % change Elmbridge 33,800 35, ,500 8, ,600 9, ,100 9, ,600 7, Epsom and Ewell 19,400 22, ,200 5, ,100 5, ,600 6, ,500 5, Guildford 34,200 37, ,700 8, ,400 8, ,500 9, ,600 10, Mole Valley 19,900 21, ,900 4, ,200 5, ,000 5, ,800 5, Reigate and Banstead 35,000 39, ,900 9, ,400 10, ,300 10, ,400 8, Runnymede 19,800 21, ,300 5, ,800 5, ,200 5, ,500 6, Spelthorne 22,100 24, ,200 6, ,900 6, ,100 6, ,900 5, Surrey Heath 21,000 21, ,300 5, ,500 5, ,400 5, ,800 5, Tandridge 21,000 22, ,200 5, ,500 5, ,300 6, ,000 5, Waverley 32,300 34, ,800 7, ,300 8, ,200 9, ,000 9, Woking 24,300 27, ,400 7, ,800 7, ,300 6, ,800 5, Source: Population Projections Unit, ONS. Crown copyright 2012 accessed from Surrey-i years years % change 17

18 Estimated number of children per borough/district Estimated number of children per borough/district Emotional Wellbeing and Mental Health Needs Assessment refresh Version 13 April 2014 Figure 4 - Population projections for children in boroughs and districts aged 0 4 years, 2015 to Boroughs and districts Source: Population Projections Unit, ONS. Crown copyright 2012 accessed from Surrey-i Figure 5 - Population projections for children in boroughs and districts aged 5 9 years, 2015 to Boroughs and districts Source: Population Projections Unit, ONS. Crown copyright 2012 accessed from Surrey-i

19 Estimated number of children per borough/district Estimated number of children per borough/district Emotional Wellbeing and Mental Health Needs Assessment refresh Version 13 April 2014 Figure 6 - Population projections for children in boroughs and districts aged years, 2015 to Boroughs and districts Source: Population Projections Unit, ONS. Crown copyright 2012 accessed from Surrey-i Figure 7 - Population projections for children in boroughs and districts aged years, 2015 to Boroughs and districts Source: Population Projections Unit, ONS. Crown copyright 2012 accessed from Surrey-i Implications for CAMHS Based on population data the areas of Surrey with the greatest requirement for health services for children and young people will continue to be Elmbridge, Reigate and Banstead, Guildford and Waverley (Table 6). However, whilst population data is important in determining the requirement for services, further information in this Refresh regarding prevalence of risk factors for mental health disorders in these areas must be taken into account in conjunction with population data when planning service provision. 19

20 4.1.2 Black and minority ethnic (BME) communities Evidence provided in the 2009 CAMHS HNA showed that the prevalence and presentation of child and adolescent mental health disorders varies between ethnic groups and there was no consistent pattern across subgroups. The 2009 CAMHS HNA also provided evidence that: Children of Asian origin have a comparable or slightly lower rate of psychiatric disorder than Caucasian children There is a statistically significant bias in relation to the referral route to CAMHS and ethnicity of children. This results in lower referral rates from black and ethnic minorities compared with white peers The 2009 CAMHS HNA suggested that specialist training of interpreters and other staff is required for those dealing with families and young people whose first language is not English when delivering psychological treatments. The 2011 Census provides the most up to date data of percentage of children aged 0 15 years in ethnic groups at both national, county and borough and district level. It is not possible to compare the current data with the data in the 2009 CAMHS HNA as the groups differ. In the 2011 Census data, Woking and Epsom and Ewell have the highest percentage of children from minority ethnic groups in Surrey and Woking has a higher percentage of children from these groups that England, the South East and Surrey. Figure 8- Percentage of children aged 0 15 years in ethnic groups, 2011 Woking Waverley Tandridge Surrey Heath Spelthorne Runnymede Reigate and Banstead Mole Valley Guildford Epsom and Ewell Elmbridge Surrey South East England White British All other white groups Multiple ethnic groups Indian Pakistani All other Asian groups Black/African/Caribbean/ Black British Other ethnic group Percentage Source: Census 2011, ONS accessed from Surrey-i

21 Figure 9 - Percentage of children aged 0 15 years in ethnic groups excluding White British group, 2011 Woking Waverley Tandridge Surrey Heath Spelthorne Runnymede Reigate and Banstead Mole Valley Guildford Epsom and Ewell Elmbridge Surrey South East England All other white groups Multiple ethnic groups Indian Pakistani All other Asian groups Black/ African/ Caribbean/ Black British All other ethnic groups Percentage Source: Census 2011, ONS accessed from Surrey-i

22 4.2 Education Emotional Wellbeing and Mental Health Needs Assessment refresh Version 13 April Schools in Surrey The School Census 2013 gives an estimate of 184,250 children and young people in Surrey schools. This a rise of almost 45,000 compared with the figure of 140,364 in the 2009 CAMHS HNA. However the 2009 figures do not include independent schools. In 2013, 38,127 children are being educated in independent schools, if this number is subtracted from the total the number of children a figure of 146,123 is achieved which represents an increase of almost 6,000 pupils. 20.7% of Surrey children attend independent schools. The 2013 data provides information on the number of children attending a wider range of schools including academies and independent schools. There are currently six primary schools that are academies and 23 out of 53 secondary schools are academies Data for children at the primary stage is recorded differently than in 2009, there is no division for infant, junior, primary. The total number of schools at the primary stage has decreased from 308 to 300 but the number of children has shown a notable increase from 45,871 to 83,940. The number of children attending special schools has also increased from 1,860 to 2,341 and there are seven more special schools since According to the data available from the School Census, 2013 on Surrey-i the number of children attending pupil referral units is 56, which is considerably lower than the 2009 figure of 256. Concern has been expressed that the 2013 figure is incorrect. There has been a large decrease in number of children attending pupil referral units from 256 to 56. Table 7 - Number of children in schools in Surrey by type, January 2009 School type Number of schools Total number on roll % total Nursery Infant/First , Junior 51 16, Primary , Secondary 53 59, Special 23 1, Pupil referral unit Total , Source: SCC, January 2009 (2009 CAMHS HNA) Table 8 Number of schools in Surrey by school type and number on roll, 2013 School type Number of schools Total number on roll % of children on roll (STATE 22 % children on roll (ALL SCHOOLS) FUNDED ONLY) Nursery Primary , Secondary 53 59, Special 30 2, Pupil referral unit TOTAL STATE , FUNDED Independent , TOTAL ALL , SCHOOLS Source: School Census, 2013 accessed from Surrey-i

23 Table 9 - Number of children in schools across Surrey boroughs/districts, January 2009 Local authority Number of schools Total number on roll % total Elmbridge 34 13, Epsom and Ewell 26 11, Guildford 52 17, Mole Valley 34 10, Reigate and Banstead 44 17, Runnymede 32 9, Spelthorne 32 12, Surrey Heath 34 11, Tandridge 32 10, Waverley 50 14, Woking 32 11, Total , Source: SCC, 2009 (2009 CAMHS HNA) Number of schools in Surrey in 2014 is now 389 as although the number of children is increasing, schools have amalgamated. However, there are a potential number of free schools and new schools to be opened in the next two to three years Fixed Term Exclusions (FTEs) The impact of FTEs on emotional wellbeing and mental health of children and young people is that it can mask the underlying needs and issues. Barnardo s (2010) 1 states that for many, bad behaviour in school is a result of real difficulties outside school, such as bereavement, parental separation, drug misuse, stress of living in a deprived area and suggests that sending pupils home to chaotic families or risky neighbourhoods does nothing to improve their behaviour and exposes them to the risk of getting involved in antisocial behaviour and crime and that children at risk of exclusion need more adult supervision, not less. For some children, school provides routine, boundaries and stability that they do not have at home. The report also highlights that permanent exclusions have declined in recent years but that temporary, fixed term exclusions have increased with 1 in 20 secondary pupils being excluded and some missing as much as 9 weeks of school each year. Statutory guidance identifies a number of groups for whom the exclusion rate is consistently higher than average. This includes pupils with special educational needs (SEN), pupils eligible for free school meals, looked after children and pupils from certain ethnic groups. The groups with the highest national rates of exclusion are Gypsy Roma, Travellers (GRT) of Irish Heritage and Black Caribbeans. National picture Across all schools in England there were 363,280 FTEs in 2008/09 with 307,840 FTEs in secondary schools affecting 1 in 20 of the secondary school population. Persistent disruptive behaviour is the most prevalent official reason for school exclusion and the Barnardo's report asks how behaviour is allowed to become persistently disruptive without effective interventions at an earlier stage to help resolve problems. The reduction in permanent exclusions is partly as a result of a change in culture and practice within education with zero exclusions and managed moves alongside the recognition of the need for adequate, resourced alternative provision. 23

24 The report focuses on four models of intervention to restore at-risk young people to learning and work to improve behaviour, each costing less than a Pupil Referral Unit (PRU) place: The Shropshire Project unpicking the issues Palmersville Training choosing vocational alternatives The Late Intervention Service tracking down the hardest to reach Leeds Reach respite and reintegration The Shropshire Project approach focused on early interventions and preventive services for 5 18 year olds centred on family support work with primary objective to prevent school exclusions. There was a focus on emotional management as they found those most frequently referred had low self-esteem expressed through poor behaviour. The projects demonstrated that with the right intervention, understanding of the consequences of choices can have a positive impact on behaviour. Managing anger and understanding the consequences of actions are important skills for school and life in general. Local picture Department of Education (DfE) statutory guidance stresses the importance of early intervention in addressing the underlying causes of all disruptive behaviour. For students with SEN or disabilities, any intervention should include an assessment of whether appropriate provision is in place. Head teachers are advised to consider use of a multi agency approach for all students who demonstrate persistent disruptive behaviour and what extra support is needed e.g. support of Traveller Education services. Schools should avoid permanent exclusion of looked after children. Table 10 Number of Fixed Period Exclusions (FPE) and percentage of school population for schools in Surrey, 2009 to 2012 Year State-funded primary (1)(2) Number of FPE % school population (5) State-funded secondary (1)(3) Number of FPE % school population (5) Number of FPE Special (4) % school population (5) State-funded primary, state-funded secondary and special schools (1)(2)(3)(4) Number of FPE (6) % school population (5) 2009/ , , / , , / , , Source: Schools Census, 2009/10, 2010/11, 2011/12 The above table shows an increase of 2.6% in the number of FTE in state funded primary schools (1 & 2) in Surrey from 551 in 2009/10 to 778 in 2011/12. With state funded secondary schools (1 & 3) there was a reduction of 2.56% FTE from 2009/10 to 2011/12. However, for special schools (4) the number of FTE increased by 4.24% from 2009/10 to 2011/12. The overall number of FTE in state funded primary, secondary and special schools in Surrey reduced by 0.99% from 2009/10 to 2011/12. 24

25 Figure 10 Fixed Term Exclusions 2009/10, 2010/11, 2011/12 % of school population Fixed Term Exclusions 2009/ / / /12 Source: Schools Census, 2009/10, 2010/11, 2011/12 Years Figure 11 Percentage of children with the highest percentage Fixed Term Exclusions in Surrey by ethnic group % of school population FTE by ethnic group 2011/ / / /12 Source: School Census, 2009/10 and 2011/12 There are a wide range of ethnic groups in Surrey in the FTE data, but the numbers appear to be extremely low. The table above shows that the highest percentage of children with Fixed Term Exclusions by ethnic group is from the Irish Traveller and Gypsy Roma communities although this has reduced from 2009/10. There has been a small increase in the number of Fixed Term Exclusions from the other ethnic groups 25

26 Table 11- Reasons for Fixed Term Exclusions in state-funded primary, secondary and special schools in Surrey in 2009/10 and 2011/12 State funded schools FTE reason Secondary 2009/10 Secondary 2011/12 26 Primary, secondary and special schools 2009/10 Primary, secondary and special schools 2011/12 Physical assault , against a pupil Physical assault against an adult Verbal abuse/ threatening behaviour against a pupil Verbal abuse/ 1, ,439 1,072 threatening behaviour against an adult Bullying * Racist abuse Sexual misconduct Drug & alcohol related Damage Theft Persistent disruptive 1, ,686 1,288 behaviour Other 1, , Total 5,550 3,900 6,490 5,160 Source: School Census, 2009/10 and 2011/12 The above table shows an overall decrease in the total number of FTE in all Surrey state-funded schools from 6,490 in 2009/10 to 5,160 in 2011/12 (-1,330). The only reason category showing an increase is sexual misconduct from 35 in 2009/10 to 49 in 2011/12, an increase of 14 FTEs, with 11 in state-funded secondary schools. The remaining three are in primary and/or special schools. The highest numbers of exclusions are for verbal abuse/threatening behaviour against an adult 1,439 in 2009/10 reducing to 1,072 in 2011/12. In 2009/10, physical assault against a pupil 1,090 in 2009/10 reducing to 915 in 2011/12 and for persistent disruptive behaviour at 1,686 in 2009/10 reducing to 1,288 in 2011/12. The Persistent disruptive behaviour category is very broad and will encompass a range of issues but a crude analysis of the data suggests a need for further emotional management support, reflecting the Barnardo s report findings. *The bullying category in the above table indicates a decrease in FTE incidents relating to this from 88 in 2009/10 to 60 in 2011/12. However, this does not include cyber bullying which is on the increase although a relatively recent phenomenon. In extreme cases, cyber bullying has driven teenagers to suicide & research 2 from the Anti-Bullying Alliance suggests it is part of everyday life for more than half (55.2%) of all children and young people. The key themes of 2013 Anti-Bullying week include equipping young people to recognise cyber bullying, supporting professionals to develop youth-led anti-bullying initiatives and promoting positive use of technology. Caring professions need digital skills to be able to support young people effectively. Many experts highlight the need to build social skills, such as resilience, selfesteem and empathy. The Bullying Intervention Group runs an annual research called Cybersurvey 3. The findings included:

27 Particularly vulnerable groups identified included young carers, looked after young people, those with mental health issues or special educational needs. Young people in care may miss out on e-safety lessons, possibly joining a class mid way through the year or seeking intimacy in online relationships. Young carers are more likely to depend on the internet for their social life, while SEN pupils may need tailored e-safety training. Young people who self harm are especially high risk. Children are using technology at an increasingly younger age so support needs to start in primary school Research shows that 15 year olds are least likely to follow e-safety advice (with only 30% saying they do so) so they need extra support. Targeted Mental Health in Schools (TaMHS) Since April 2011, the TaMHS approach has been rolled out across Surrey. Of the 365 schools in Surrey, 209 (57%) schools engaged with the TaMHS approach from November 2011 to November Approximately 3000 staff across 146 Surrey schools have received or booked in to receive Mental Health Awareness training so far, delivered by primary mental health workers and CAMHS community nurses for schools. Groups of school staff were trained with a mean of 21 participants in each school. Evaluation is being undertaken by the Royal Holloway University of London. Interim evaluation has found that school staff were consistently satisfied with the mental health training they received. School staff felt significantly more competent across all areas of mental health awareness following their training. The most improved areas related to staff were: Understanding of their role in supporting children with emotional and behavioural difficulties Knowledge about the services that are in place in school to support young people s emotional health Understanding of the structure of CAMHS, feeling more able to make appropriate referrals to CAMHS Four main themes emerged from focus groups with schools engaged in the TaMHS approach including: Positive experience of the TaMHS training package Positive impact of TaMHS training on the understanding, confidence and skills of individual school staff Positive impact of TaMHS training on school functioning and the development of networks of support Positive impact of TaMHS training on outcomes for children. Future plans for TaMHS in include support to specific schools following a detailed analysis of unengaged schools, as the next phase of TaMHS. Some schools clearly have embedded systems in place and therefore do not need to prioritise TaMHS at this stage. Training continues to be delivered to schools and there are plans to deliver more attachment training to schools and ensure full implementation of the TaMHS approach by encouraging uptake of the consultation lines and primary mental health worker consultation sessions in schools. An Emotional Literacy Support Assistants (ELSA) Programme has been piloted in south east Surrey and has been successfully evaluated. Educational psychologists train teaching assistants to provide emotional literacy support programmes to help children to recognise, understand and manage their emotions and equips ELSAs to identify children needing extra support and plan and deliver individual and small group programmes. 82 ELSAs have been trained with a further programme being delivered in SE Surrey to develop the capacity in recognition of the impact of the pilot. The next area to receive the training will be SW Surrey in February - April 2014, followed by 27