Young Reporter goes behind the scenes at CCAMHS Isle of Wight

The 2020 - 2025 Isle of Wight NHS Trust strategy on Mental Health and Learning Disability services sets the target for services to "Aim to be innovative as we recruit new people and strengthen the service" .

Mr Hannam told me the service will continue to have a multidisciplinary team, with a richness brought by staff with different qualifications. Staff recruited include nurses, social workers, and occupational therapists. 

Staff culture in the building has been described as supportive, with a low turnover. The manager stated: "The staff we have are invested in wanting the best for the children and young people they work with, with enjoyment brought from seeing people move forward."

In respect to Project Fusion, which is an an programme of the Solent NHS services in Hampshire to merge the Island's community services with community services, mental health, and learning disability services from the mainland into a new trust, the Hampshire and Isle of Wight Healthcare NHS Foundation Trust, Mr Hannam believes this will bring a positive effect to the service, with an alignment of services occurring due to the similarities between the function of CCAMHS on the Island and the mainland, and he hopes it will open opportunities for staff training and development. 

In respect to the building, the service is looking at the estates department within the trust for support in making changes. A meeting was conducted between the service and a youth art organisation to create murals for the waiting room.

The service is aware they must strike a balance between appealing to young people and adolescents, noting that "the environment must be open to all".

The service has a desire not to overstimulate children, and as it was mentioned a lot of users have "neurodevelopmental issues."

The service aims to be as open and engaging as possible to service users.

The service will continue to recruit clinical psychologists, though it was noted that this is challenging nationwide, and their mainland partners have difficulties in this respect as well though recruitment of clinical psychologists into training programmes has expanded nationwide the service aims to benefit from this in the next few years.

Due to this the service has aimed to look at other types of therapy, such as employing cognitive behavioural therapists, family therapists, and systemic practitioners due to the shortfall in clinical psychologists, to ensure the "best availability for service users" to address the concerns raised by the CQC about the range of psychological therapies offered.

The CQC also raised concerns about the service's handling of verbal complaints, with Mr Hannam stating: "Our complaints process is robust, and any complaint goes into a system and is properly reviewed."

He went on to detail that the current process now supports the individual to make a complaint if needed, and the service will attempt to work with the individual to understand and explore the reasons behind the complaint.

A large emphasis was placed on adapting the process and listening to complaints from service users. The manager of the service reviews any complaints, however it was stressed that depending on the severity of the complaint, support from external agencies in conducting reviews will occur to reduce conflicts of interest.

He went on to say:

The Island is both in a unique and challenging place as the services work closely together, our referral meetings are joined by the Youth Trust and Mental Health Support Team to ensure the right support is given at the right time. We have access to more joint working than some mainland services, but the challenges take the form of the lack of access to all the provisions shared on the mainland.

The challenges raised about service provision were in relation to the lack of a dedicated mental health inpatient unit for children and young people that require high level support.

The service works hard to support children to remain on the Island if possible, and the service will support children and families throughout the process if they are moved off the Island.

He noted funding was provided by the commissioning board which allows the Mental Health Liaison within the Emergency Department to assess and support on the children's ward overnight and at the weekends, allowing any admitted child to be seen and assessed by a mental health practitioner without the need to wait for CCAMHS to come in on a Monday.

The need for continual openness, honesty and dialogue with youth forums was cited as a key part in what the service is doing to improve patient experience.

Most of the people in the service are older and may not be up to date on what children engage with and enjoy, so the need for open and honest feedback helps ensure the relevancy of the service.

A lot of the service's processes are around ensuring partner services have involvement, and how they can be expanded to bring the services together.

Mr Hannam noted that he is currently working with the Issoropia Foundation to provide joint run groups to support each other and deliver a wide range of services.

It was noted that with any policy change the service aims to gather feedback from service users, be it a current or former user, going on to say the service "values peer level feedback and understanding, as it helps us understand where they may be gaps or needed adaptations so a better service can be made", going on to add that "constant improvement and continual review is needed in order to ensure relevancy".

When asked about the service expansion he told me the service is constantly looking at expanding, noting the staff team has increased by 14 per cent over the last four years due to the increased funding, so naturally the services have been expanded.

He used the Eating Disorder Service as an example, with it going from one staff member to six, working to provide a "robust and supportive intervention."

When asked how the service responds to the lack of continuity when a service user is moved from team to team he told me that it is why the focus is on giving partner agencies further involvement with the process, but in respect to the different parts of the service the placement of the user is about the need of the child at the time.

He said: "It is not uncommon as you start to dig deeper into their challenges, there is a level of need that requires specialist intervention, so the right specialist is assigned."

He gave an example of a child starting off with the community team, but as they begin to develop an eating disorder this is recognised and they get supported under the specialist team.

It was noted that for the child the lack of continuity is directly addressed with joint discussions between the child, their new team, and their old worker.

Ensuring that the service user is introduced and a full explanation is given about why the change would be supportive. He went on to say:

If someone has been able to open up, the thought of doing it to another is difficult. Respect and dignity are important, and if this is not being done, feedback is important to ensure what went wrong is addressed. The child should be fully aware and agree with what is suggested

When asked about the waiting list he stated for the community team it has reduced from 86 to 40 over the last six months.

In respect to the duration he stated there is around a six to nine month wait when the list was higher, and now they are down to between four and five months.

The service aims to get rid of the list and ensure that every referral is allocated straight to a worker, who will continue to work with the child throughout their journey.

He said the waiting list to see a clinical psychologist is longer than expected due to the fact the service has one clinical psychologist, where there would normally be three. The service aims to get rid of the waiting list for the community team by the summer.

In response to the lack of continuity with patient risk factor when going from service to service he stated that with any child they feel will benefit from a period at a lower service, such as the Youth Trust, as they are a tier two service (Service tiers originate out of the 2014 THRIVE model, where tier one services are the lowest and four, which is inpatient services are the highest, Island CCAMHS falls within Tier Three, which means it is a multidisciplinary service dealing with high risk service users)

If a child goes to a lower tier a full risk assessment is conducted so the risks or self management of risks, along with communication is "up to scratch" within the lower services, and if the child struggles in areas of risk CCAMHS will be contacted and a decision will be made whether or not to take over treatment. He emphasised:

Child safety is paramount, and whilst the service wants people to continue with a worker from a lower service they've built up a rapport with is important, some children must be moved for the sake of their safety, though the aim is to return them to their worker from before.

In terms of communication the service aims to ensure good communication with the initial referrer, it is not uncommon to send information to GPs, families and other relevant services.

The service does a lot of link working with education, the Island's Mental Health Support Team goes into schools, and while they are not part of CCAMHS the joint worker between the MHST and CCAMHS allows access to the service, the service also does link work with the Youth Offending Team and has a member of staff in the Paediatric Ward.

These members of staff "ensure the strongest link possible which allows early access and a lack of miscommunication."

In respect to neurodevelopmental issues, concerns were raised by the CQC about the provision of services for children with Autistic Spectrum Condition and ADHD, it was clarified that CCAMHS is not directly commissioned to provide diagnostic services in this area, and services for people with just a neurodevelopmental concern. They work closely with the Psicon service, which provides diagnostic services for Autism and ADHD. 

A report published in 2018 from Healthwatch Isle of Wight raised concerns about the percentage of people who presented at the St Mary's Emergency Department with attempted suicide and self harm were discharged without follow up.

The service has addressed this by clarifying the following:

Within our service, anyone seen in Children's A&E gets followed up by the inreach/outreach team which supports children in this area who present to A&E or have been admitted for a mental health need"

When a report is received and treatment is done, and discharge occurred the service aim to make contact within three days, however it was noted this should ideally be within 24 hours, as they do not operate during the weekend the three day target is necessary, but it was stressed the follow up is done as soon as possible to ensure "child safety and get to the root cause of the incident" and while offers of support will be made, it was noted that they "cannot make children engage with the service" but they try their best to support them and make them not go further down that line. This is one of the areas the service aims to have a robust process for.

In respect to the next steps of the service it was emphasised that Project Fusion will bring an alignment of services on the Island to ones offered on the mainland, and the opportunities for exchanging information, giving an example of interventions used on the mainland not on the Island, giving us an opportunity to learn from and adapt them.

He said: "It is also an opportunity to show the good work Island CCAMHS is doing to colleagues on the mainland."

In the shorter term the main steps the service will be taking is to be more accessible for children and young people. The service is working hard to get as much feedback as possible, he noted that:

Disclosure of things is a privilege for the staff member in a position of trust, from a child who may disclose what can be painful information, a safe, understanding, and validating environment is a focus for them, and it must look as best they can as a priority alongside recruitment