Headline response to report

1. Headline response to report • Identifies clear inadequacies of the CAMHS to be able to deliver a ‘fit for purpose’ service to children and young people in Sheffield because of capacity. • This is in no way a reflection of the high quality service that is provided - rather the capacity of the service – which is insufficient to meet demand. • Demonstrates that CAMHS is failing to meet reasonable intervention times of the vast majority of children and young people who are referred for the Tier 3 generic community teams. • Currently 510 families waiting for appointments, with 260 waiting over 18 weeks, despite attempts to mitigate from 600 at the peak. • Since October 2011 to 8 February 2012 there has only been a net reduction of 90 families on the waiting list. • Will be impossible to reduce this number on the waiting list to an acceptable time limit unless additional resources are found.

2. Headline response to report • The long and unacceptable waiting times are as a result of both reductions and re-prioritisation of funding; AND the resulting restructuring of CAMHS provision • No evidence of an Equality Impact Assessment to gauge the outcome of the restructure – especially on the Tier 3 generic community teams • Those families who require statutory access to CAMHS services as part of Tier 3 provision (deemed the ‘most vulnerable’) have low waiting periods – maximum of 18 weeks. Service levels have been maintained for these much smaller groups: MAPS; Learning Disability; Forensic and Vulnerable Children; YOT • Generic community Tier 3 services are not adequate to deliver provision for the remaining population of 11,000 children and young people at risk of a mental health difficulty • Only 28 fte staff in the Tier 3 community service (33 in total) • Restructuring resulted in resources being diverted from clinical work.

3. Headline response to report • Likely that of 11,000 children and young people outside of these priority groups there will be a very high proportion of those with an autism spectrum condition (ASC) with complex needs • Generally accepted prevalence rates for ASC are 1:100 and in Sheffield there is a 16% increase in diagnoses in the 0 – 19 population (The Sheffield Children and Young People's Plan (CYPP) 2011-2014 ) • Autism and Asperger syndrome is a serious, lifelong and disabling condition. Without the right support, it can have a profound - sometimes devastating - effect on individuals and families • People with autism or Asperger syndrome are particularly vulnerable to mental health problems such as anxiety and depression, especially in late adolescence - up to 70 per cent of the Asperger syndrome may present with symptoms of psychiatric disorder. • Early intervention in childhood and adolescence is crucial • We need access to the specialist services provided by CAHMS to meet these complex needs and to intervene before more serious mental health conditions arise

4. Actions to mitigate • Have been advised that the only cases that have treated as priority are those where the child or young person has self harmed. • Other cases where there has been evidence of suicidal thoughts and behaviour have not been deemed as priority. How were the most vulnerable cases identified? • Very distressing for parents as they are not equipped to make a judgement on whether their child will follow this through • Report claims that despite the inadequate service that ‘no untoward incidents’ were reported. • We assume this means no suicides have been reported • An increased risk of suicide is observed in persons with Asperger syndrome and ASCs • One suicide is one too many and our children and families should not be put at risk in this way • A suicide would invoke an official enquiry

5. Actions to mitigate • Although CAMHS is working with GPs and MAST teams to improve access to provision the resulting service is not a clinical one. A distinction should be made clear on the remit of this service. • These new teams are based on social models of intervention and do not have specialist clinical knowledge required • This service is a prevention and assessment service with no therapeutic work undertaken • To date no additional training have been provided to these teams although the target date was by end of March 2012. • Acknowledged that this will now happen later in the year and will be provided by CAMHS thus diverting more resource away from clinical work • Autism and Asperger syndrome are complex conditions and do not fit with a social model of intervention but often require specific clinical interventions

6. Actions to mitigate • Introduction of the WRIP • Suggests that families were offered a faster ‘more appropriate’ service such as support packs or an appointment at a Brief Intervention Clinic (BIC) • The families targeted for the WRIP were based on the length of time they were on the waiting list rather than on clinical information • We would consider that this is not an correct way of assessing need based purely on those that had waited the longest. • It is unclear from the report (3.2.4) which was deigned to be the most ‘appropriate’ service – please could we have some clarification? • Noted that some cases were able to be dealt with in one or two appointments • This is possibly appropriate for some instances and where a situation has partially resolved • However for many they will require the specialist services of the Tier 3 and clearly chose to further wait for this – particularly those with ASCs.

7. Actions to mitigate • Despite the introduction of the WRIP and the BIC there has only been a relatively small reduction in the waiting list for Tier 3 treatment • The capacity to reduce the waiting times is severely restricted with new referrals happening each week • How would the service seek to balance these needs? • Clearly need more funding to provide more posts to offer an adequate service • Concerns that attempt to reduce the rate of referrals as one strategy to tackle the waiting list • The decision to reduce the rate of referral appears to be based on financial considerations rather than on clinical need and this is a grave concern for parents • Where will these cases be referred to ? • Suggest that the MAST teams are not satisfactory for many of these cases – much talk of the ‘appropriate level of service’ • Why was this not identified previously as a viable option – appears the be based on financial constraints

8. Recommendations • That the CAMHS Tier 3 service receives additional funding to a sustainable level to ensure that waiting lists are restore to an acceptable level (maximum of 18 weeks) • Greater transparency of the MAST service. What will the lower level triage service consist of? Will this be a dilution of the CAMHS service offer to families in the greatest need? • If no additional funding can be found to restore service level then representations will be made to the Secretary of State via the Scrutiny Committee