THE FUTURE AND PRIMARY MENTAL HEALTH WORKERS your contribution to a whole systems approach to emotional health and well

1. THE FUTURE AND PRIMARY MENTAL HEALTH WORKERS your contribution to a whole systems approach to emotional health and wellbeing Dawn Rees National CAMHS Implementation Lead

2. Where did we come from? From 1995, a gathering momentum in policy and practice toward delivery in primary care based on equity, access, non stigmatising services DH 1998 locally based CAMHS achieved through improved liaison between primary care, specialist CAMHS, social services and other agencies DH 2003 PSA target to improve life chances of adults and children with mental health problems CAMHS a joint responsibility between health and children’s services 2004 CAMH grant emphasised need to increase PMHW numbers NSF and ECM Public Health – improving quality, access, diversity of services, a patient led NHS CNO review 2005 Health System Reform Delivering Race Equality Mental Health and Social Exclusion HM Treasury Review of child poverty

3. UN CONVENTION ON THE RIGHTS OF THE CHILD 1990 A mentally or physically disabled child should enjoy a full and decent life 23.1 The education of the child shall be directed to the development of the child’s personality, talents and mental and physical abilities to their fullest potential 29.1 Take all appropriate measure to promote physical and psychological recovery and social reintegration of a child victim 39

4. What are we doing Involvement in a range of direct provision GP surgeries Children’s centres Classrooms Extended schools Tier 3 CAMH liaison and joint work Children’s services Children in care Children with disabilities Youth justice Substance misuse Research Parenting support Training, liaison, consultation

5. Who is doing it School nurses, school health advisers Health visitors Clinical and educational psychologists Social workers, families therapists, psychotherapists PAM Occupational therapists, art therapists, play therapists, speech and language Classroom teachers, SEN coordinators, youth workers

6. The importance of mental health National Service Framework for Children, Young people and Maternity Services (DH, DfES 2004) Mental health problems in children are associated with educational failure, family disruption, disability, offending and antisocial behaviour, placing demands on social services, schools and the youth justice system. Untreated mental health problems create distress not only in the children and young people, but also for their families and carers, continuing into adult life and affecting the next generation. The importance of mental health goes across all areas of a child’s life. If opportunities for promotion and early intervention are not taken the impacts may be felt in other parts of a child’s life. Take, for example, the mental health component of ‘resolve (face) problems and setbacks and learn from them.” if a child is not helped when this seems to becoming a problem, the impact on their education and achievement could be great. A child will not be able to connect with learning when they are concerned with something that they have been unable to deal with. The importance of mental health goes across all areas of a child’s life. If opportunities for promotion and early intervention are not taken the impacts may be felt in other parts of a child’s life. Take, for example, the mental health component of ‘resolve (face) problems and setbacks and learn from them.” if a child is not helped when this seems to becoming a problem, the impact on their education and achievement could be great. A child will not be able to connect with learning when they are concerned with something that they have been unable to deal with.

7. Seeing families in context~PMHW advantage Disadvantage in childhood adversely affects both socio economic circumstances and health in adulthood through a set of interlocking processes Disadvantage is not an event that strikes at a single point in childhood it is the context in which Clarity of components the child is conceived, born, grows up The origins of childhood disadvantage lie in the disadvantages experienced by parents, its effects endure into adulthood Childhood disadvantage and adult health - a life course framework H Graham C Power HDA 2004

8. PMHWs in context PMHWs well placed to respond, depending on service model Depending on commissioner understanding of how PMHWs might be utilised Depending on type and level of liaison with specialist teams, referral pathways up and down Depending on other professionals’ appreciation of the skills, experience and unique position of PMHWs to engage with hard to reach families

9. Development of new models of working PMHW services placed outside Tier 3 teams offer potential for different models of delivery but the models appear to be variable In number, type, staff composition, management, geography, relationship with a Tier 3, relationship with children's services, methods of engagement “All these models will have an impact on patterns of referral and development of inter professional relationships with staff at other tiers” Garralda 2004

10. Clarity of components of PMHW work are required What needs to be done, based on best evidence Who needs to do it, based on competencies Where it needs to be delivered, based on safety and convenience With which additional resources e.g. equipment, investigation access, decision support

11. SO, where are we and how many?