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Improving Mental Health Services for Young Adults: News & Updates

Today’s conference will focuses on improving mental health services for young adults, and supporting the transition from child and adolescent mental health services to adult services. Through national updates, practical case studies and new ways of working that move away from the tiered and stepped age based transition models, the conference will provide support to improve mental health services for young adults in your practice.

The day opens with an opening address of Young Adults Perspectives followed by a national update session providing insight in to improving mental health services for young adults through ensuring timely preparation started within child and adolescent services, actively managing and co-ordinating transfers between child and adolescent and adult services, ensuring continuous developmentally appropriate support from adult services and commissioning tools, support and looking forward.

Dr Clare Lamb, Consultant Child and Adolescent Psychiatrist, Conwy & Denbighshire NHS Trust & Policy Lead, Royal College of Psychiatrists, Wales delivered a presentation on Improving Mental Health Services for young adults and discuss:

  • improving mental health services for young adults
  • ensuring timely preparation started within child and adolescent services
  • actively managing and co-ordinating transfers between child and adolescent and adult services
  • ensuring continuous developmentally appropriate support from adult services
  • commissioning tools, support and looking forward

Dr Clare Lamb Full Presentation

In her presentation Dr Clare Lamb stated: 

“Adolescence to adulthood – there is a steep rise in the onset of serious mental disorders (psychosis, eating disorders, and mood disorders)”

“Transition is a process and transfer is an event – and I think we need to work with young people and plan how we transition and when we transfer”

“50% of adult conditions present before 14 yrs, 75% by 18 yrs old”

“CAMHS should provide for children & young people in difficult circumstances, at risk of mental disorder, with diagnosable mental disorder, with functional impairment which might not reach diagnostic criteria for disorder”

“Mutual misperceptions contribute to pre-exciting ideological, practical and structural barriers between CAMHS and AMHS”

“The views of young people and families/carers - value flexible, non-stigmatising community based services appropriate to their age, find change in service philosophy from CAMHS to AMHS confusing, express concern re lack of services for specific groups (ADHD, ASD, emerging personality disorders)”

Transition form children’s to adult service NICE published in February 2016 – recommendations were published in conjunction with SCIE (Social Care Institute for Excellence).

“NICE took in to account – Development changes, continuity of care, young people with multiple needs, staff skills and coordination between services”

Involve young people and their carers in service design, delivery and evaluation related to transition by

  • co‑producing transition policies and strategies with them
  • planning, co‑producing and piloting materials and tools
  • asking them if the services helped them achieve agreed outcomes
  • feeding back to them about the effect of their involvement

“Person-centred approach – Tailored process adjusted to each individual’s needs, Mental Capacity, treating the young person as an equal partner in the process”

“Transition planning - a named worker (e.g. nurse, social care practitioner) that the young person trusts

Link child & adult services. Support min. 6 months before & 6 months after transfer. Timing & review - start planning early with developmentally appropriate transition planning, involve the young person & family/carer, build independence via Peer-support groups, mentoring, networking”

“Support before transfer – ensuring the young person has a named worker, contingency plan for consistent transition, personal folder for young people (with information about what did work and didn’t work, hopes for the future – this is something that a young person makes with you and not just about the stats) and information about service availability”

“Support after transfer – follow up the young person in 6 months and if disengagement, pursue re-referral.”

Dr Clare Lamb Presentation Abstract:

The transition from childhood through adolescence to adulthood is a crucial stage of social, personal and emotional development. The majority of adults with mental illness first experience mental symptoms prior to age 24 years. The different professional cultures of CAMHS and adult mental health have contributed to differences in theory and practice and eligibility thresholds for access by young people. Services have been described as “weakest at the point of highest need”. Studies have elicited the concerns of young people, parents and carers and what they want from services. There is broad acceptance of the need to define service models, frameworks and interventions to improve mental health services for young people. This presentation will outline the new NICE Guideline recommendations on ‘Transition from Children’s to Adult Services’, other relevant policy and guidance, and some approaches to improving the way we work at the CAMHS/Adult interface.

Dr Clare Lamb Biography:

Clare leads the North Wales regional Tier 4 CAMHS “Kite” team, providing an alternative to hospital admission for 12 to 18 year olds. Prior to this she established the Wirral 16 to 19 team, a community youth mental health team that bridged child and adult services in Merseyside. She has a special interest in early onset psychosis, youth mental health services and the interface between Child and Adult services. 

Clare is a member of the Welsh Government Task Group for Transitions from CAMHS to Adult Services, and a member of the National Steering Group for First Episode Psychosis in Wales. She was a member of the NICE Guidance Development Group for Transition from Children’s to Adult Services (2016) and the 2014 NHS England ‘Transition and Youth Mental Health’ work stream. She has published on alternatives to hospital admission, workforce and capacity in CAMHS, mental health information for young people/parents, and models of youth mental health service at the transition from CAMHS to Adult Services. Clare is Policy Lead for the Royal College of Psychiatrists in Wales.

Barbara Rayment, Director, Youth Access discussed:

  • the role of voluntary sector Youth information, Advice and Counselling Services in improving mental health services for young adults
  • the value of an integrated approach to young adults mental health and wellbeing
  • partnership working between YIACS, CAMHS and AMHS
  • commissioning to support transition and integration

Barbara Rayment Full Presentation

In her presentation Barbara stated:

YIACS – are very much focused around on being a young peoples service and are young person-centred,   designed around young people key features include: Open to a wide age range; typically 13-25,  Self-referral, ‘Drop-ins’ = key way in, Holistic approach, meeting multiple needs, Multi-disciplinary teams, Free, independent and confidential,  Social/developmental model (vs. medical model), Distinctive approach drawing on youth work, advice work and counselling traditions.

“YIACS – is an integrated health and wellbeing model”

“A range of interventions ‘under one roof’ – common interventions: Counselling and other therapies, Advice work, youth work, health clinics, social work, group work, advocacy and community education”

The benefits of this model include:

  • Open access  - open to all
  • Reduce fear and stigma
  • Young People with multiple issues
  • Offer Young People choice of service and approach
  • Tackle gaps and inaccessibility of statutory services – age, thresholds/waiting lists
  • Opportunity for cross referrals (mainly from NHS into VCS)

“These services are really meeting a real leave of significant and getting young people the level of service they need”

“Every day social welfare legal problems are key determinants of young mental health problems. Mental health problems are event more common where multiple legal problems are reported – so having an advice service can be a real support for these problems”

Why commission YIACS?

  • Accessible/trusted by young people - engage vulnerable YP
  • Integrated approach; addressing multiple needs
  • Tackle transitions ‘cliff-edge’
  • Early intervention
  • Achieve excellent outcomes
  • (Very) Cost-effective
  • Choice – complementing statutory provision

“The challenges of integration – resistance to change, competing interests of commissioners, reduction in LA funding, risk aversion (fallout from decommissioning), lack of knowledge and trust in VCS and protectionism.”

“The enablers of integration – high level backing/leadership for service remodelling – focused on service users, focused on early action, joint on early action, joint focus on shared outcomes, an integrated commissioning hub/team, a lead commissioner with the will and tenacity to drive change, good and effective communication with and involvement of service users, as well as interested providers, focus on evidence-base and cost-effectiveness, willingness to give up some control and using the VCS and creating a level playing between different sectors”

Barbara Rayment Presentation Abstract

There is long-standing and well-documented evidence about the gaps and problems faced by young adults in accessing appropriate mental health support, but few effective models responding to their needs.

Barbara’s presentation focused on the role of voluntary sector Youth Information, Advice and Counselling Services (YIACS) in providing effective mental health services for young adults. The session  demonstrated the value of YIACS’ integrated approach to young adults’ mental health and wellbeing and point to how good partnership working between YIACS, CAMHS, AMHS and other services can better meet the needs of this group. Also highlighted the need for better commissioning arrangements to support transition and integration of services.

Barbara Rayment Biography:

Barbara Rayment is Director of Youth Access, the national membership association for young people’s advice, counselling and support services. She has over 35 years’ experience of working in and championing services for young people.  This includes working in and managing frontline services, as well as undertaking training, writing good practice guides and engagement in policy work.

Over the years, she has been a member of various national forums and committees and a number of Government advisory and working groups. She was a member of the DH Children and Young People’s Mental Health and Well-Being Taskforce; was actively involved in NHSE’s Children and Young People’s Improving Access to Psychological Therapies (CYP IAPT) programme and remains on various government mental health policy groups. A past Chair of the Children and Young People’s Mental Health Coalition, Barbara remains an active member.

Dr Peter Hindley MBE, Chair, Faculty of Child and Adolescent Psychiatry, NHS England delivered a presentation on Moving forward: securing excellence in the mental health services for young adults of the future and discussed:

  • why do young adults need a different approach
  • new service models and developments for young adults
  • should we be moving away from tiers and transition points?
  • are we just moving the transition points?
  • how do we create a service that is “young adult friendly”?
  • early intervention: moving from reactive to proactive services

In his presentation Peter stated: 

“What do young people want?  - Easy access, Confidentiality, Online resources and services, Information about services, Non-stigmatising settings, Collaboration and choice,  and Involvement of parents and carers where appropriate”

“Developing and family oriented approach – is crucial”

“Try to look the expertise from CAMHS and Adults Mental services and think about a complementary way of working”

The models we have identified are:

  • Designated Liaison/Link Posts
  • Transition Clinics
  • Age specific generic Youth Mental Health (YMH) Services
  • Disorder Specific Services
  • Transition Mental Health Team for ‘Looked After Children’
  • Virtual Team
  • Multi-agency ‘One Stop Shops’ for Youth – like youth accesses
  • GP led multi-agency Primary Care Youth Clinics 

“We have tried to avoid using one particular model we have tried to get people to think about what models fit there particular areas”

“Designated Liaison/Link Posts – ½ clinicians, often community psychiatric nurses with expertise in working with young people. Carrying out assessments and some face to face work. Working jointly across both the adult mental health and CAMHS. Facilitate work with older young people.”

“Youth Mental Health Services – very strong participatory service, with young people involved in planning, developing and delivery of service. These are non-stigmatising, community settings, some are in multi agency one-stop shops. They have early intervention models. Emphaisis on effective engagement of young people who are showing functional impairment and signs of distress. Treat the range of mental disorder presenting in this age group.  Multidisciplinary team with a mix of expertise from both CAMHS and Adult Mental Health. Recovery model with a range of psychological and psychosocial interventions, in collaboration with third sector and other agencies, to promote positive psychosocial functioning.   Many linked to Early Intervention Service for Psychosis and in addition have good working relationships with their local Home Treatment and Crisis Resolution Teams as well as Social Services, Education, the local Youth Offending Team and Substance Misuse Service.”

“One of the problems for me in youth mental health service is inpatient care”

“Virtual team – is the team that brought around a young person. They are designated members from CAMHS and AMHS multidisciplinary teams, working together to provide a range of skills and expertise to help meet the developmental and mental health needs of older young people presenting to either service. No team base or fixed team constitution. Flexes according to demand”
“GP led multi-agency Primary Care Youth Clinics - Engagement of youth, early detection and intervention. Youth only setting provides walk in appointments in a non stigmatising setting, and a range of medical assessments and interventions. Physical health problems a(sexual health, skin complaints, substance misuse) alongside mental health problems. On-site youth worker and help and advice for housing and finance. Embedded mental health specialist  (CPN) and/or robust links to local specialist mental health teams”

“Models have improved the mental health services offered”

“By forging strong working links or formal partnership agreements with other agencies involved with young people.”

“Successful partnerships have been formed with non statutory and voluntary organisations as well as those from the statutory sector.”

Dr Peter Hindley Full Presentation

Future events of interest:

Improving Physical Health for People with Mental Health Conditions
Tuesday 5 July 2016 
Hallam Conference Centre, London

Psychological Therapies for Severe & Prolonged Mental Illness
Tuesday 5 July 2016 
Hallam Conference Centre, London

Eating Disorders: Developing a Gold Standard Service
Wednesday 6 July 2016 
Manchester Conference Centre, Manchester

Towards Zero Suicide: Preventing Suicide, Saving Lives
Thursday 15 September 2016 
ICO Conference Centre, London

Implementing the NICE Quality Standard for Domestic Violence & Improving the effectiveness of MARACs
Tuesday 20 September 2016 
Hallam Conference Centre, London

Sexual Abuse & Mental Health - Reducing the impact of abuse on mental health
Tuesday 20 September 2016 
Hallam Conference Centre, London

Delivering Excellence in Recovery Oriented Services in Mental Health
Tuesday 4 October 2016 
Hallam Conference Centre, London

Medically Unexplained Symptoms/Somatic Symptom Disorder
Friday 21 October 2016 
De Vere West One, London

Smoking Cessation in Mental Health
Friday 21 October 2016 
De Vere West One, London

21 June 2016


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