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EU Milestones study Signorini EJCAP 2018

0-25 models and transitions: the scale of need Dr Bernadka Dubicka chair faculty C&A psychiatry RCPsych honorary reader University of Manchester consultant Pennine Care Foundation Trust, Manchester London 2019. EU Milestones study Signorini EJCAP 2018.

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EU Milestones study Signorini EJCAP 2018

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  1. 0-25 models and transitions:the scale of needDr Bernadka Dubickachair faculty C&A psychiatry RCPsychhonorary reader University of Manchesterconsultant Pennine Care Foundation Trust, ManchesterLondon 2019

  2. EU Milestones studySignorini EJCAP 2018 • 25-49% CAMHS YP will need transitioning • ~1/3 AMHS users under 30 yrs with previous contact with CAMHS • Only Denmark & UK have transition policies/guidelines • UK YP concerns: eligibility, culture, lack connections between CAMHS/AMH, AMH competencies

  3. Preschool children (2 to 4 year olds) • One in eighteen (5.5%) preschool children had a mental disorder. The prevalence of mental disorders for two to four year-olds in England has been surveyed for the first time so these figures are experimental statistics. Source: NHS Digital. 2 to 4 year olds identified with any mental disorder, England.

  4. Learning disability: importance of early detection • 4.5x more likely to have MH disorder • EU: neurodevelopmental disorders most frequent diagnostic group (up to 81%) in CAMHS (Signorini, 2017, Lancet Psych) Institute Health Equity 2018: • 40% LD not diagnosed in childhood • Die 15-20 years before general population

  5. NHS Digital prevalence survey 2018Emotional disorders, 1999 to 2017 Source: NHS Digital. 5 to 15 year olds identified with a mental disorder, England.

  6. Prince’s Trust Macquarie Youth Index 2018 • 2,194 respondents,16 to 25 years • happiness & confidence dropped to lowest levels since 2009 • 61% regularly feel stressed • 1/4 regularly feel hopeless • those who don’t feel in control of their lives increased from 28% (2017) to 39%

  7. 15.4% of 17 to 19 year olds had ever self-harmed or attempted suicide

  8. Differences between boys and girls Source: NHS Digital. 2 to 19 year olds identified with any mental disorder, England.

  9. Sexual Identity (14 to 19 year olds) Young people who identified as lesbian, gay, bisexual or as another non-heterosexual sexual identity were more likely to have a mental disorder Source: NHS Digital. 14 to 19 year olds identified with any mental disorder, England.

  10. Social and Family Context (5 to 19 year olds) Children with a mental disorder were more likely to live in a family that struggles to function well, as well as where a parent struggles with poor mental health. Source: NHS Digital. 5 to 19 year olds identified with any mental disorder, England.

  11. Exclusion from school • One boy in ten with a disorder had been excluded from school • One child in twenty with a hyperactivity or behavioural disorder had been excluded on three or more occasions.

  12. Prevalence of Neurodisability for YP in custodyHughes, Williams and Chitsabesan, 2012

  13. 76% suicides male male to female ratio: 2.6:1 in those aged 15-19 3.7:1 in those aged 20 and over Source: Suicide by Children and Young People (2017) National Confidential Inquiry into Suicide and Homicide by People with Mental Illness

  14. Recruitment and Retention • Only 1/4 CYP with MH disorder treated in UK (NHS digital 2018) • 10 yr plan: 100% of those in need 0-25 yrs • Green paper requires doubling workforce • If aim to treat 100% disorder, 6-fold increase needed (based on past figures and to 18) CAP all grades, incl trainees, England 2009-18

  15. RCPsych activitiesTraining, values, recruitment, QI

  16. 0-25 RCPsych position paperin progress • No one model • Services need to be age appropriate with staff trained in the developmental needs of each age group (infants, children, adolescents, young adults), & training on developmental disorders • CYP centred, accessible, values driven with patient choice and shared decision making • ‘think family’ • ‘think systems’ • Quality, evidence and outcomes driven • Build on good current practice with considered implementation, lessons learned • Flexible • Needs must be matched by resource

  17. Where next?Build on recent progress • NHSE Long Term Plan: 18-25 services & offer for 0-25 yr olds: integrated approach (‘iThrive’); student mental health services • Trained, supported workforce + resource + values + meaningful participation • Levers e.g. CQUIN • STPs/LTPs: incl service users • Peer reviews and outcomes e.g. Benchmarking Network, RCPsych Quality Improvement Network • Research e.g. EU MILESTONES study (Singh)

  18. Thank you: Questions Bernadka.Dubicka@manchester.ac.uk

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