Tag: child and adolescent mental health services

CAMH-Crisis2

Crisis care for children and young people with mental health problems: national mapping, models of delivery, sustainability and experience is a new project funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research (HSDR) Programme, which my colleague Clare Bennett and I are jointly leading. The wider team includes Martin Elliott, Leanne Sawle, Aled Jones, Steven Pryjmachuk, Claire Fraser, Euan Hails, Iain McMillan, Nicola Evans, Mair Elliott, Rachael Vaughan and Aneta Taylor.

Our study builds on the now-completed Crisis responses for children and young people: an evidence synthesis of service organisation, effectiveness and experiences, led by Nicola Evans, about which I most recently wrote a post here. It also has a clear connection to the Developing a model for high quality service design for children and young people with common mental health problems project led by Steven Pryjmachuk, with which it shares aspects of study design.

Our new CAMH-Crisis2 study began in November 2022, and a summary of what we’re doing is here:

There has been a sharp and worrying increase in mental health problems experienced by children and young people. Prior to the pandemic, one in eight 5-19 year olds in England had a probable mental disorder. In 2020, amongst 5-16 year olds this figure had risen to one in six. Amongst those with a mental health difficulty, almost half of older teenagers and a quarter of 11-16 year olds report having self-harmed or attempted suicide. Extreme psychosocial distress, with or without self-harm, is often referred to as a ‘crisis’. Services for young people in crisis are a UK priority, and provision is expanding in the NHS, social care and educational settings. However, despite this and the appearance of national standards very little research into crisis services for young people has been undertaken. We therefore do not know what crisis responses currently exist, who uses services, or what works best for children and young people and their families.

Against this background this project will answer the question, ‘How are mental health crisis responses for children and young people up to the age of 25 sustained, experienced and integrated within their local systems of services’? We will work with a group of young people who advise on research, some of whom have used crisis services, to address the following three objectives:

  1. To describe and map NHS, local authority, education and third sector approaches to the implementation and organisation of crisis care for children and young people across England and Wales.
  2. To identify eight contrasting case studies in which to evaluate how crisis services have developed and are currently organised, sustained, experienced and integrated within the context of their local systems of services.
  3. To compare and contrast these services in the context of the available international evidence, drawing out and disseminating clear implications for the design and delivery of future crisis responses for children and young people and their families.

To help us answer our research question and to meet our objectives we will make use of normalisation process theory. This supports studies into what helps, and what hinders, the implementation and sustainability of new approaches to care.

We will meet our first objective using a survey, creating a detailed record of crisis responses across England and Wales and how they are organised, implemented and used. To meet our second objective, from this detailed record we will identify eight contrasting services selected for variety in terms of: geographic and socioeconomic setting (England/Wales, urban/rural, and relative affluence/poverty); populations served (including ethnic diversity); and service configuration (including third sector and/or social care involvement). Treating each as a case study, we will conduct interviews with children and young people and family members who have used the service. We will also interview commissioners, managers and practitioners, including those providing a crisis response and those working in other parts of the local system. We will gather operational policies and related documents, and data on how each service is used and by whom. In our analysis we will focus on understanding how each crisis service is provided, experienced, implemented and sustained. To meet our final objective we will compare and contrast each case study, and use our synthesised findings to advance the available international evidence for best practice in service provision. We will close by drawing clear, actionable, lessons for the future commissioning and provision of high-quality crisis responses which are sensitive to the support and access needs of a diverse range of children and young people receiving care from a range of services.

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Nominal group technique

Time this morning for a quick post drawing attention to this new paper published in Research Involvement and Engagement reporting on our use of the nominal group technique in the now-completed RiSC study.

In this project we were interested in risk, broadly defined, for young people in inpatient mental health settings. We used a two-stage evidence synthesis, convening a stakeholder group midway through to guide us in our focus. This new article gives the detail on the process we used when the group met.

As it happens, the stakeholder meeting was a pivotal event in the life of this study, during which we were directed to find evidence on a whole range of risks which are very rarely considered in mental health services. Examples include the risks of losing contact with education, family and friends. The next step in this programme of research is a KESS2 PhD studentship which will bring to the surface all the things that child and adolescent mental health practitioners do to help young people in hospital to keep in touch. In the meantime, anyone wanting to know more about the RiSC study (should their appetite have been whetted following a read of this new article) might want to follow this link for our main findings paper and this link for our accessible summary.

Risk for children and young people in mental health hospital

Over the last year or two I’ve used this blog to publicise information about the RiSC study, an evidence synthesis into ‘risk’ for young people in mental health hospital. We’ve now produced an accessible summary, outlining what we did in this project and what we found. For a copy, click the front cover of the summary reproduced below:

Risk in inpatient child and adolescent mental health services

This week our full report from the RiSC study, An evidence synthesis of risk identification, assessment and management for young people using tier 4 inpatient child and adolescent mental health services, has been published in Health Services and Delivery Research. This is in gold open access form, and is free to download and read.

Here’s our plain English summary:

In our two-part study we brought together evidence in the area of risk for young people admitted to mental health hospital. First, we searched two electronic databases, finding 124 articles. Most were concerned with clinical risks, such as the risks of suicide. Using diagrams we grouped these articles together under a number of themes.

Young people who had been inpatients in mental health hospital, carers, managers and professionals helped us prioritise the types of risk we should concentrate on in the second part of our study. Our top two priorities were the risks of dislocation and contagion. We used the word ‘dislocation’ to refer to the risks of being removed from normal life, of experiencing challenges to identity and of being stigmatised. We used it to refer to the risks to friendships and families, and to education. We used ‘contagion’ to refer to the risks of learning unhelpful behaviour and making unhelpful friendships.

We searched 17 databases and a large number of websites for evidence in these areas. We asked hospital staff to send us information on how they managed these risks and we searched journals and reference lists. We identified 40 items to include in our review and 20 policy and guidance documents. The quality of the studies varied. We grouped the evidence together under seven categories.

We found little evidence to guide practice. The risks of dislocation and contagion are important, but research is needed to inform how staff might identify, assess and manage them.

This has been an excellent project to work on: a great team, and some good engagement with young people and others with a shared interest in what we’ve been up to. Next up is an accessible summary, and some writing of articles. More to follow!

Taking Measure

Here in Wales we have the Mental Health Measure. This is a piece of legislation passed in 2010 and implemented in phases in 2012, and which is intended to improve the quality and timeliness of mental health services. Specifically, it provides for:

  • primary mental health care;
  • care and treatment planning and care coordination;
  • the right for an automatic reassessment of needs in secondary mental health services for people discharged within the previous three years;
  • advocacy in hospital.

This month the National Assembly for Wales Health and Social Care Committee has reported on its post-legislative scrutiny of the Measure. The Welsh Government has already committed to conduct a formal evaluation of the legislation through a duty to review, built in as the Measure passed into law. In pursuit of this an inception and an interim report have already appeared, with a final document due in 2016. With the Health and Social Care Committee’s report appearing this month it is clear that the Mental Health Measure is becoming seriously scrutinised.

When the Committee published its call for evidence last year the COCAPP research team submitted a response alerting Assembly Members to our ongoing study. It would have been ideal had we been able to report key findings, given that COCAPP is an examination of care planning and care coordination and is, therefore, of interest to anyone wanting to know how part 2 of the Measure (dealing with care and treatment planning) is being experienced. But the Health and Social Care Committee’s timescales and those of COCAPP were not aligned, meaning the best we could do was to draw attention to our project.

This month the Committee praises many aspects of the Measure but also makes ten recommendations. They address:

  1. meeting demands for primary mental health care, particularly in the case of children and young people;
  2. improving the collection of data to better support the evaluation of primary mental health services;
  3. taking action to improve the form, content and quality of care and treatment plans, with a view to increasing service user involvement and spreading best practice through training;
  4. making sure that rights to self-refer for reassessment are properly understood and communicated to all;
  5. improving staff awareness of service users’ eligibility for independent mental health advocacy in hospital;
  6. setting timescales for new task and finish groups reviewing the Measure, and setting out plans to respond to their recommendations;
  7. during evaluations of the legislation, consulting with as wide a range of people as possible using traditional and novel approaches;
  8. ensuring that information is available in a variety of formats, so that all groups of people are able to access this and to understand;
  9. following the publishing of new plans for the improvement of child and adolescent mental health services, making clear how these will be realised;
  10. carrying out a cost benefit analysis of the Measure.

Clearly, Assembly Members have detected evidence of an uneven pace in the development of primary mental health care across Wales, and are particularly concerned to make sure that the mental health needs of children and young people are properly identified and met in timely fashion. As a COCAPP-er, I am interested to read that the Committee thinks care and treatment planning for everyone can be improved, informed by examples of best practice and through investment in staff training. I also pick out the recommendations on improving service user collaboration, and estimating the costs and benefits of the Measure. These resonate, to me, with current concerns in Wales with prudent health care and co-production.

And as for COCAPP’s findings? Suffice to say our draft final report is now under review with the National Institute for Health Research (NIHR) Health Services and Delivery Research (HS&DR) Programme. More to follow in due course…

Welcome meeting for the RiSC project

Yesterday brought a there-and-back trip to Southampton, with esteemed colleagues Nicola Evans and Deborah Edwards, for an NIHR Health Services and Delivery Research Programme welcome meeting for our RiSC project. This was an opportunity to meet with other funded researchers (and very interesting they were, too) and to learn more about how the HS&DR Programme works with investigators over the lifetime of projects and beyond. We also had the chance to present our study, and to field questions from the floor.

On its website the HS&DR Programme says that it:

aims to produce rigorous and relevant evidence on the quality, access and organisation of health services, including costs and outcomes. The programme will enhance the strategic focus on research that matters to the NHS including research on implementation and a range of knowledge mobilisation initiatives. It will be keen to support ambitious evaluative research to improve health services.

And that it:

aims to support a range of types of research including evidence synthesis and primary research. This includes large scale studies of national importance. This means primary research projects which:

  • Address an issue of major strategic importance to the NHS, with the cost in line with the significance of the problem to be investigated
  • Are likely to lead to changes in practice that will have a significant impact on a large number of patients across the UK
  • Aim to fill a clear ‘evidence gap’, and are likely to generate new knowledge of direct relevance to the NHS
  • Have the potential for findings to be applied to other conditions or situations outside the immediate area of research
  • Bring together a team with strong expertise and track record across the full range of relevant disciplines
  • Will be carried out across more than one research site.

A search through the programme’s portfolio of projects turns up a raft of studies of national and international significance, including work (ongoing and completed) led by or involving nurses. Well worth a look, in my view…