Responding to the rapidly changing landscape for children’s mental and emotional health

A radical approach to improving mental health for young people in West Sussex has proved successful in suicide prevention, Cara Davis told an audience in a seminar at the COMPASS Jobs Fair in London.

Ms Davis, Service Manager in West Sussex County Council’s Children’s and Emotional Health Team said that nationally, COVID-19 and lockdowns took a severe toll on children’s mental health.

She said that West Sussex reflects the national picture, “we know that current need completely outstrips the resources we have. Over the last year, from 2021-22, there have been there have been over 1,000 additional referrals to CAMHs.”

In West Sussex, between May 2021 and March 2022, eight young people are believed to have died by suicide, three of them as part of a cluster in one borough.

“I don’t want to diminish their individual experiences, but we saw some themes following these tragic events: domestic abuse was definitely one issue, as well as experiences of loss -- so moves from schools, moves from areas where they had lived. Young people within the LGBTQ+ community were disproportionality effected, and then there was the impact of covid and lockdown. Young people were sharing between themselves the anxiety of returning to school after months off.

“In West Sussex we are currently waiting 20-22 months for an autism assessment; it is 8-12 weeks for an initial assessment with CAMHs; it can be another 12 weeks to begin treatment. For young people who have experienced trauma, the wait can be as long as a year.”

“Typically, children’s social care does not deal with mental health: previously if you came to social care with a mental health issue, we would refer you over to health. That does not work now because of the resource issues and current overwhelm and high need within the system. We need to consider what is happening within a young person’s life to be having thoughts of suicide. Now it has become a safeguarding issue.”

The county’s response was to launch Operation Warren, a multi-agency initiative bringing together West Sussex County Council, Police, CAMHs, Sussex Partnership NHS Foundation Trust, and Public Health. It developed into two programmes: an immediate in-school response and multi-agency triage.

The in-school response meant that when a child had died, educational psychologists, social workers and safeguarding leads went into the school on the first working day to support children and staff, and to support communication with parents and the wider school community.

From day two, further support was brought in to help schools identify vulnerable and impacted pupils.

Ms Davis shared a case study where one school identified 8 young people aged 13-14 years old who were sharing suicidal ideation. Initially they were in two separate groups, who linked through Snapchat & Whatsapp.

All had some involvement with CAMHs historically or currently. Two of the young people had shared they had gone to bridges to attempt suicide. Some had gone to A&E as a result of overdoses.

Immediate action included calls to parents from CAMHs to safety plan for them that day; CAMHs offered initial assessments to children not previously working with them. Those open to children’s services were contacted by their social workers for safety plans; others were referred to the county’s Integrated Front Door service, through which anyone can refer a child where they are concerned they are experiencing harm.

Meetings were held at least once a week to look at broader issues including family support, extended networks and the response to funerals and memorials.

“One school identified 26 more children as being at risk in a scoping task,” Ms Davis said. “We put in training and early help teams to support schools.

“We gave support to the wider network partners and developed a culture that mental health is everyone’s business.

“We also realised that our usual approach to young people and social media is to be very restrictive. We’d tell young people to get off Snapchat but their natural response to that is to stop talking to us, social media helps young people to connect and we need to embrace this positively. The co-operational and strategic elements meant that we were thinking about other young people in the area. We identified risk areas such as car parks and bridges and could risk-assess these.

“Previously communication had been very adult-focussed so we thought about whether a 13-year-old would read the messages there and see them as offering help to them.”

Multi-agency triage identified risk, and supported referrals to a variety of services, as well as providing direct support and intervention in school teams.

Daily triage meetings held with 13 secondary schools in West Sussex, chaired by managers within children’s social care and supported by police, CAMHs, schools, MASH (Multi-Agency Safeguarding Hub) nurses, Early Help and additional partners.

Ms Davis said results so far had been good: “Since March 2022, there have been no further suspected suicides of young people in West Sussex. We have had overwhelmingly positive feedback from schools and have identified three groups of young people at risk of suicide clusters. Working relationships between the various agencies have improved.”

Schools involved in Operation Warren were the top three referring young people to CAMHs – “if they know how to use the service, the schools will make use of it.” The initiative has won a national award for patient safety.

Operation Warren ended in July 2022. During that time, hundreds of children had been identified as potentially at risk, and discussed in triage. Feedback from schools have been overwhelmingly positive.

For the future, Ms Davis concluded, discussions and an imaginative approach to sourcing funds mean there is an ongoing commitment from partner agencies, for the 2022/23 term, to the development of the Multi Agency Mental Health Education Triage (MAMHET) being. Five additional schools have been added to the triage.

The Children’s Mental and Emotional Wellbeing team managers will organise and chair the triage. All minutes and episodes recorded on children’s social care database and shared with network for their information.

Additionally, she said West Sussex County Council are developing training programs to support young people around the Mental Health Act, Eating Disorders, Neurodiversity, Emotional Regulation and Children in Crisis.

“Alongside adult and mental health social care leaders we have developed training around the MH Act 1983, which will include support around social workers role for children and young people detained and S117 Aftercare planning. This is due to go live in the autumn term 2022.

“We will be delivering three psycho educational workshops around emotional health to ASYE students.”