BOND – WORKING WITH THE WHOLE SYSTEM

Elaine Willis, Kevin Ford, FPM

10th September 2013

London

BOND (Better Outcomes, New Delivery) is a two

year project funded by Department for Education

that aims to increase the capacity of voluntary and

community organisations to provide early

intervention mental health support services for

children and young people.

The Government’s Mental Health Strategy emphasises the crucial importance of early intervention in tackling emerging emotional and mental health problems for children and young people.

Intervening early has been shown to achieve improved outcomes for children, families and wider society such as increased learning and educational attainment, better physical health, improved long term mental health and reduced health and social care costs.

Voluntary and community organisations have an important role to play in providing effective, high quality early intervention services as they are local, flexible, trusted, informal and friendly.

THE CONTEXT FOR BOND

50% adults with lifetime mental health problems experience symptoms before 14 years of age.

75% adults with lifetime mental health problems experience symptoms before their mid 20s.

Fewer than 50% were treated appropriately at the time.

(Taken from Mental Health Strategy 2011 DH)

Why early intervention in CYP’s mental health?

• Some people are more at risk due to individual, family and social factors – knowing this can help target resources

• Early intervention can be protective (protecting those with risk factors against developing problems later on) or it can be remedial or therapeutic (improving the situation for those in the early stages of problems)

• There are instances where early intervention acts as a screening for those who will need more sustained or intensive interventions later.

Why intervene early in CYP’s mental health?

• Around 1 in 12 young people self harm (Mental Health Foundation, 2006) and around 25,000 are admitted to hospital every year due to the severity of their injuries (Fox & Hawton, 2004) with a 68% increase in the last 10 years

• 1 in 10 children experience problems severe and enduring enough to meet the criteria for a disorder (ONS 2004)

• In an average classroom:• 10 young people will have witnessed their parents separate• 8 will have experienced physical violence, sexual abuse or neglect• 1 will have experienced death of a parent• 7 will have been bullied (Faulkner, 2011)

What is normal?

Tier 1 - provides treatment for less severe mental health conditions, such as mild depression, while also offering an assessment service for children and young people who would benefit from referral to more specialist services.

Tier 2 - provides assessment and interventions for children and young people with more severe or complex health care needs, such as severe depression.

Tier 3 - provides services for children and young people with severe, complex and persistent mental health conditions, such as obsessive compulsive disorder (OCD), bipolar disorder, and schizophrenia

Tier 4 - provides specialist services for children and young people with the most serious problems

Mental health services for cyp in England are organised in a four tier system

Levels of competition in CYP mental health provider market

Tier 4: Inpatient Care

Infrequent competition amongst larger MH provider trusts

Some variety of providers More frequent tendering + increasing competition (usually LAs, NHS)

Numerous providers + commissioners Large + small organisations More VCS Less clinical governance Smaller contracts Frequent tendering

Tier 3: Clinical/ medical care (diagnosis/ medication)

Tier 3/2 interface: Primary MH services LAC, YOS, other targeted CAMHS

Tier 2/1 interface: ‘Generic’ School + community based e.g. counselling + IAG services Related services e.g. drop-in, youth support, family support

Limited contestability Increasing levels of competiti

on

Where does the VCS fit in?

Mental health expertise

Service ‘tiers’ 1 4

Access

School Counselling

Activity

based

Mediation

Young Carers

D.V.

Drop in

Mental Health Services

• Publications & resources

• Pilot programme

• National Strand Master classes

• Commissioning support programme

• Sustainability – collaborative models

• ACE-V

• Workforce Development

• Work with schools as commissioners

BOND’S AREAS OF WORK

Schools….

Greater autonomy, devolved funding….• How are they shaping up as

‘commissioners’?• What helps and hinders?

Buy inexpert capacity

Workwith or refer to external services

Build internal capacity

What schools do

Counselling

Family support

Additional assessments

X-SchoolInc. support

roles

Internal ‘case’ management

Knowledge and Expertise/training

Other services e.g. CAMHS, H&SC, VCS

External processes e.g. CAF

Activities

School concerns - ‘Hooks’

• Increasing MH needs (more accurately described as emotional and social difficulties that manifest in behaviour issues)

• Dissatisfaction with stat services/thresholds• A very few pupils taking up a lot of staff time• Impact of parenting and difficulty in engaging or

knowing how to work with parents effectively • Closing the gap; behaviour and attendance –

underlying problems

Schools as commissioners - challenges

• Language of ‘mental health’ • Lack of understanding of link between MH and

academic attainment• Knowing which schools are interested• No one ‘model’ of intervention or what good looks

like• Lack of systematic info on needs e.g. young carers,

bereavement, family problems• Schools may lack confidence, knowledge and skills

to commission; not see it as their role; not know what is out there

Persuaded by

• What other schools are doing• References from schools/trusted colleagues• Speed of response to problem• Price and added value• Flexibility and integration in school• Examples of good practice & cases• Experience of results! E.g. improved behaviour

What schools want help with;

• Examples of good practice/ideas• To be able to find services which can work in

schools – particularly for individuals• Efficiency through joint commissioning (although

many still dependent on LA to facilitate this)• Big interest in HOW schools can work with

emotional difficulties effectively - ‘sub statutory services threshold pupils’

• How to build in effective processes, systems, approaches to school inc. roles, staff skills, etc

What do schools do now for ‘support’?

• No school reported using any national guidance • Schools did not see themselves as commissioners • Structures within schools did not allow for a

commissioning approach – silo approaches and lack of budget overview in relation to vulnerable pupils

• Special schools often buy in professionals and integrate in to school workforce – much to learn from re BESD

• Little linkage between research evidence and practice – more evolved in response to

• New relationships between commissioners and providers – different and better understanding of each others’ roles and requirements

• New ways of working together – more collaboration and dialogue

• Some new (or safeguarded) money to VCS: £225,000 additional investment in Tees Valley from LA, CCGs & NHS Tees; new money to VCS in Cumbria and Cambridgeshire

• Greater involvement of schools; raised awareness in schools of commissioning questions

Impact of BOND – lasting change

• Leadership development for school commissioners - Commissioning for emotional and mental health’ for Head teachers and Early Years leads, in collaboration with National College for teaching and Leadership

• Active role of CVS and CVAs in developing the roles of VCS as providers – e.g. Middlesbrough Voluntary Development Agency (CVS) supporting development of a VCSO consortium to provide universal, flexible, responsive early intervention services

Impact of BOND – lasting change

What is the role of the CVS or infrastructure body? Bring people together within interest areas eg young people or

mental health and across interest areas Help develop market readiness – build the capacity of vcs to

respond to the needs in schools and of commissioning Work with commissioners to show how vcs can be engaged Break down the `us’ and `them’ – promote open dialogue Support consortium to develop and respond Be proactive with key vcs organisations to develop local

strategies and approaches

Supporting development: CYP, VCS providers & Commissioners

GETTING IN TOUCHWebsite: www.youngminds.org.uk/bond

Email: bond@youngminds.org.uk

Telephone: 020 7089 5050