Children and Young People’s Mental Health and Wellbeing Joint Delivery Board minutes: September 2022

Attendees and apologies

• Angela Davidson (AD), Scottish Government
• Hannah Axon (HA), COSLA
• Amanda Farquharson (AF), Integration Joint Board (IJB) Network
• Judy Thomson (JT), NHS Education for Scotland (NES)
• Michael Chalmers (MC), Director of Children and Families, Scottish Government
• Martin Dorchester (MD), Children in Scotland (CiS) Forum Representative
• Cathy Richards (CR), Mental Health and Social Care Directorate, Scottish Government
• Aileen Blower (AB), Mental Health and Social Care Directorate, Scottish Government
• Hugh Masters (HM), Perinatal and Infant Mental Health Programme Board
• Laura Meikle (LM), Improvement Attainment and Wellbeing, Learning Directorate, Scottish Government
• Morven Graham (MG), Association of Scottish Principal Educational Psychologists (ASPEP)
• Carrie Lindsay (CL), Association of Directors of Education in Scotland (ADES)

Additional attendees

•  Fiona Steel,  Coalition of Care and Support Providers in Scotland (CCPS) Forum representative attending on behalf of Paul Carberry
• Bernadette Martin-Scott, Early Years Scotland, Sponsor T&F group seven

Support 

• Stephen McLeod (SM), Professional Adviser, Mental Health and Social Care Directorate, Scottish Government
• David Leitch (DL), Mental Health and Social Care Directorate, Scottish Government
• Maggie Fallon (MF), Mental Health and Social Care Directorate, Scottish Government
• Ruth Christie (RC), Mental Health and Social Care Directorate, Scottish Government
• Peter Innes (PI), Mental Health and Social Care Directorate, Scottish Government
• Sam Eastop (SE),  Mental Health and Social Care Directorate, Scottish Government
• Jean Carwood-Edwards (JCE), Professional Advisor, Scottish Government
• Carolyn Wales (CW), Mental Health and Social Care Directorate, Scottish Government
• Emma Papakyriakou (EP), Mental Health and Social Care Directorate, Scottish Government

Apoligies

• Hugh McAloon, Co-Chair, Director of Mental Health, Scottish Government
• Nicola Dickie, Co-Chair, COSLA
• Alison Taylor (AT), Deputy Director: Improvement Attainment and Wellbeing, Learning Directorate, Scottish Government
• Paul Carberry (PC), Coalition of Care and Support Providers in Scotland (CCPS) Forum representative
• Abbie Wright (AW), Member of the Scottish Youth Parliament
• Rosy Burgess (RB), Scottish Youth Parliament (YP support)
• Angela Scott (AS), SOLACE
• Alison Sutherland (AS), Sponsor T&F group six,  North Ayrshire Council
• Maureen McAteer (MA), Barnardos, Sponsor T&F group three
• Ruth Miller (RM), Association of Scottish Principal Educational Psychologists (ASPEP), sponsor T&F group three
• David Gibson (DG), Social Work Scotland, sponsor T&F group three

Items and actions

Welcome and introductions

AD chaired the meeting in ND’s absence.

Chair welcomed everyone to the eighth board meeting and provided apologies.

Chair summarised that Board members had received final reports of three task and finish groups and clarified the schedule until the end of the Joint Delivery Board (JDB) in December. Additional updates included:

• the remaining task and finish groups will report in October with the possibility of two groups reporting in December
• officials will gather the board’s views on recommendations to compile a final report
• a workshop will be hosted on 8th November to consider the next steps for the JDB
• political oversight for this board is provided by Minister for Mental Wellbeing and Social Care and COSLA Spokespeople for Children and Young People and Health and Social Care. Counsellor Tony Buchanan and Councillor Paul Kelly have been appointed to these roles at COSLA and the next Joint Oversight meeting will take place in October. The spokespeople and the Minister for Mental Health have been invited to attend the final Joint Delivery Board meeting in December
• agreement to extend the October meeting by one hour to allow time for board members to consider final reports from remaining groups

Chair introduced the task and finish groups that had submitted their final reports, which were shared before the meeting

Board members unable to make the meeting were invited to send in any comments on final reports in advance.

Final report task and finish group two – crisis

MF presented on behalf of AS on the work of task and finish group 2. MF provided an overview on the background to the group, aims, work completed and recommendations. MF highlighted that there had been lots of discussion on the language/definition of the term ‘crisis’ provision and the importance of a consistent approach across the mental health landscape. The group collated information on local provision submitted by Health and Social Care Partnerships. Listening to children and young people’s voices/experiences was a key component of the group’s work.

Chair invited the board’s comments on the recommendations. The following points were raised:

Language and definition:

• all agreed that defining ‘crisis’ with stakeholders should involve young people, particularly those with lived experience
• consistent use of language/interpretation around crisis, crisis services and immediate access to emergency provision is vital

Understanding what children and young people say they want:

• it was recommended that there should be focussed work to garner a deeper understanding into the JDB’s engagement findings and HSCP returns indicating a low preference for video calls. It would be helpful to have further understanding of the other factors that may have led to ‘video call fatigue'

Emergency and out of hours services:

• the board was reminded that a number of crisis presentations do not need to be dealt with through an Emergency Department (ED), although ED’s are widely seen as the best place to receive out-of-hours support for someone experiencing a mental health crisis
• there are challenges to offering a face-to-face service operating overnight as when crises most frequently occurs
• consideration should be given to promoting supports available through GIRFEC approach to try to prevent cases escalating to crisis level. The Board discussed immediate access to crisis support. Children, young people and families can often be supported overnight with information and assurance in order that that they can be seen face-to-face in a dignified way in the morning. It would be a huge challenge to replicate an emergency service for non-medical crisis in the short term

Incorporating crisis support within community supports and services framework:

• board agreed there are important links with the communities task and finish group and consideration could be given to an expansion of the framework; particularly in relation to face-to-face support and addressing where young people look for support other than via Child and Adolescence Mental Health Service (CAMHS) or Emergency Departments (EDs)
• agreement on the potential benefits of consolidating reporting frameworks to minimise cross-reporting
• further promotion of available supports and services is required. There are some services not reaching the audiences that may need them
• colleagues offering supports and services commented that effective communication and promotion can take up to a third of their time
• it is often those with the most complex needs that require more immediate clinical input at that crisis point. An offer of family support and/or respite care might be more appropriate for these examples. A well trained and experienced professional decision maker who has time to engage will sometimes be all that's required - similar in approach to the Distress Brief Intervention (DBI) model
• it is vital that training is required to ensure that staff are equipped with the right skills and knowledge to support the needs of all children and young people. Working directly with a range of groups would give a fuller understanding of what they require, but equally it is vital we utilise existing knowledge of diverse needs into account

Summary of responses and actions

Board members supported the recommendations and will take them, and subsequent board discussions on them, into account when producing the final Joint Delivery Board recommendations.

AP01: Officials to compile and begin to align draft recommendations presented and issue to Board members in advance of next meeting. Themes across Task and Finish group recommendations will be considered in order to support a cohesive package of recommendations for the final Board report.

Final report – task and finish group seven: three to five year olds

JCE and BMS presented on the work of task and finish group seven. The presentation outlined the range of supports and services which are currently available, the gaps identified and what could be proposed / recommended to further support this particular age group and their families

Chair welcomed comments from Board members on the recommendations. The following points were raised:

• agreement that improved ratios to reduce practitioners’ caseloads would allow more time to support families, with emphasis on those who are particularly vulnerable
• suggestion made to consider potential Early Learning and Childcare(ELC) models that could work and be built within ELC delivery. This could include opportunities for parents/carers to be much more a part of the service
• support for improved connections between health visiting and ELC
• support for the ‘happiness’ terminology as parents want their children to be happy and this facilitates a strength-based approach. However, it was agreed that it is also important and realistic for children and parents to understand that it is okay and normal to not always be happy
• a lot of recommendations are proposed in the paper. Discussion highlighted the need for a sequential order, with focus given to the most critical
• the recommendations focusing on parents and carers’ awareness, and learning and development of the workforce are suggested as being most important
• the recommendations reflect the Scottish Government’s commitment for Scotland to be the best place to grow up. Integrated early years teams providing a whole family support model for the most vulnerable families is a good example of this support
• board members questioned the need for an infant mental health service given the existing work ongoing through perinatal and infant mental health programme. Suggestion that this is at odds with the other recommendations focused on getting it right for early years
• task and finish group and correspondence group members were keen that the need for specialist services for this age group was captured within the recommendations
• further thought required on how a national review group might be empowered
• consider the possibility of incorporating a life stage approach to the recommendations
• discussion around whether the recommendations considered the needs of young parents. This could come through the ELC model, encouraging parents to stay, to learn and play with their children might be particularly helpful to young parents

Chair summary and actions

There was a general support for the recommendations, particularly greater focus on ‘happiness’ but prioritisation/sequencing and join-up with related programmes was key. In thinking about the follow-up to the perinatal and Infant mental health programme, consideration was being given to a pre-conception to age five approach. It is worth examining how the recommendations could be framed to be set within that work.

Board members supported the recommendations and will take them, and subsequent Board discussions on them, into account when producing the final JDB recommendations

Final report task and finish group eight: communications

MD provided a presentation on the aims of the group, tasks the group has completed and reflections on work so far, including challenges encountered

Chair welcomed comments from board members on the recommendations. The following points were raised:

Participation and engagement of children and young people:

• this group positively recognised the work young people have contributed to throughout the JDB
• young people need to continue to be engaged in policy in the future beyond the JDB to ensure understanding of their needs and make sure we are getting it right
• young people involved in the JDB should be given the opportunity to provide feedback to inform the development of engagement in the future
• using information previously gathered from children and young people is very important, and also helps to ensure young people feel they are being listened to

Communicating key messages, supports and services

• accessing support is dependent on knowledge of its availability and how to access at a local level. 
• messaging needs to be considered around implying parents are doing the wrong thing by going to CAMHS when in need of immediate support. The challenge is to get the parents to the right place at the right time and it might be needed quickly
• need to identify threads from other recommendations across the Task and Finish Groups and tie up the communication asks collectively
• this group needs to explore what national messages are needed focused on prevention and targeted information of supports and services in the community
• importance for this group to weave appropriate messaging that should continue beyond the JDB to promote conversation and challenge current messagesdDevelopment of the JDB communications has been a learning process. It has highlighted the importance of the right messaging reaching target audiences such as the parent forum
• the negative media presentation of CAMHS as a failing service was unhelpful for the morale and motivation of the workforce. Data shows the majority of those who access CAMHS are satisfied with the service they receive and more people are accessing support than previously. Currently, there is little or no communications around the positives. This point was discussed further with one member highlighting that first treatment appointments will continue to be the political and media focus. Aim should be focused on progress against the whole JDB programme, and all elements of the CAMHS and ND specifications within

Communication methods to wider audiences:

• agreement the newsletter was a useful communication tool but appropriate versions may need to be considered to reach targeted audiences such as the workforce, parents, carers, children and young people
• the Information Bulletins with stakeholders across the mental health landscape have been positive but we need to explore if the messages we are giving are what parents / children and young people want
• sharing the work of the board with wider groups, including young people, is important in order to remain accountable to them

Board members supported the recommendations and will take them, and subsequent board discussions on them, into account when producing the final joint delivery board recommendations.

Task and Finish Group Templates, Dashboard and Additional Papers

No comments from board members on the additional reporting templates and papers issued.

Chair invited JT to share an update on the work of task and finish group six, education and training.

• JT highlighted the work of this group took longer to commence due to considering the needs from wider Task and Finish Groups as they progressed
• JT updated the group on the three main areas of work and reinforced that while the work would continue beyond the life of the Board, this group would have three outputs for the end of the JDB closing

AOB and close

Chair updated the group on the mental health strategy consultation, which has formally closed. There’s a commitment to publish a new strategy in the coming year, allowing time for further consultation with JDB members on the direction and detail of the Strategy, including the draft outcomes. Themes coming through the consultation responses included the need for continued investment in services and importance of aligning the mental health offer with the broader GIRFEC approach. 

Chair highlighted the valuable input from the members of the board to the suicide prevention action plan and strategy and thanked members for their contributions. This had influenced both the direction and language of the strategy which would be launched on 29 September. 

Chair thanked everyone for their contributions to the meeting. The next meeting will be held on 26 October 2022.