About the service

• About the service
• Assessment
• Key relationships with other agencies
• Service delivery
• Referral process
• Discharge process

The service covers the following PCT areas:

• Stockton
• Hartlepool
• Middlesbrough
• Redcar and Cleveland

The service is the only NHS low secure adolescent mental health service in the UK, therefore, accepts individual referrals on a cost per case basis from PCTs across the UK.

The service provides care and treatment for young people between the ages of 12 to 18 years who have acute mental health problems who require low secure provision. 

Patient profile

The service cares for adolescent boys and girls between the ages of 12 and 18 years who are experiencing mental health problems.  A younger group will be considered on an individual basis.  The service also accommodates young offenders.

A typical service user profile is as follows:

·       Young people with mental health difficulties who are in conflict with the law and require detainment under the Mental Health Act.  These young people will require, in the first instance, a mental health assessment followed by a possible lengthy period of treatment. 

·       Young people currently receiving care in a generic child and adolescent mental health acute inpatient service who are presenting significant risks to themselves or others and are assessed to require a low secure environment.

·       Young people who are currently receiving care in a medium secure mental health inpatient environment and require rehabilitation through low secure mental health service.

·       Young people presenting with significant risks due to mental health problems who have been admitted to adult mental health PICU facilities and require young persons mental health inpatient provision.

·       Young people referred via social services and who present with high risk behaviours associated with mental health problems or psychiatric disorder.

These are admitted for a complex multi-disciplinary team assessment.

·        Vulnerable young offenders may also be admitted from young offenders’ institutions for assessment followed by medical treatment, depending upon the assessment outcomes.

·        Young people who are presenting with acute mental health problems who have mild learning disabilities.

Tier 4 CAMHS refers to highly specialised provision that may be required by children and young people, depending on their level of needs.  CAMHS tier 4 provision may include intensive out-patient day services, assertive outreach, in-patient psychiatric provision, residential and secure provision or other highly specialised consultations or intervention services.  (Standard 9 of National Services Framework for children, young people and maternity services).

The service aims to provide a range of highly specialised mental health services that are accessible, flexible and safe enough to respond to the needs of, and be of benefit to young people with complex and challenging problems.

These services are evidence based and in line with national guidance. There is meaningful engagement with service users, their carers/families, partner agencies and commissioners. Ongoing service development are shaped by the views of these stakeholders

In line with Every Child Matters, Standard 8: Disabled Children and Young People and those with Complex Health Needs, and Standard 9: The Mental Health and Psychological Well-Being of Children and Young People, services aim to:

Improve outcomes for young people with diagnosable mental health needs working in partnership with other agencies to promote the mental health and psychological well-being of all young people with established or complex and challenging problems.

Core Purpose

The service provides a safe, structured, therapeutic environment that embraces the notion that each service user is treated with respect and courtesy and related to in a warm, non-judgemental, accepting manner.  Their individuality and the need for confidentiality is fostered by all members of the multi-disciplinary team.
The service aims for consistency in its approach and to empower young people to live their lives to the maximum potential constantly striving to keep up to date with the latest research and proven effective therapeutic interventions.  The importance of having a structured day is recognised as is the need to balance security with a therapeutic environment.

Service Description

• The service offers 24/7 access accepting referrals from community based tier 3 CAMHS and other agencies.
• The service promotes inclusion and patient choice.  Where a tier 4 inpatient admission is required and only where community interventions are exhausted, and where needs are so complex, they cannot be met in a community setting or open acute mental health unit, which may include factors such as:

1. Significant risk to themselves or others in community settings or other establishments such as Local Authority provision, youth offenders institutions and open acute units is too great
2. Legal detention Mental Health Act required.

• Liaison with tier 3 locality services – prior to admission, during assessment (in the instance of an inpatient admission), treatment pre and post discharge. (liaison to include all agencies involved; social services, education, voluntary sector, youth offending institutions, youth offending services and the courts etc).
• Formal arrangements with local services to support In-reach and out-reach from a tier 4 service including;

1. Advice and consultation provided to locality CAMHS/LD teams, other agency staff, and acute CAMHS unit staff
2. Joint assessment and planning for admission and discharge
3. Clinical support to locality CAMHS/LD services in some cases
4. Implementation of full CPA process in line with agreed multi-agency CPA policy and procedures.

• Capacity within the CAMHS tier 4 service delivery model to include access to tier 4 clinical services for those young people who present in crisis with acute mental health need requiring emergency admission
• Agreed core set of evidence based therapeutic interventions including dialectical behavioural therapy, EMDR, cognitive behavioural therapy and family work
• Defined care pathways across tier 3 and tier 4, which would include pathways between acute, low secure and forensic outpatient services
• Close collaboration with all partner agencies at all transitions of care responsibilities, including substance misuse services
• Ensure young people continue to have access to appropriate education provision and further education and careers advice, and retain contact with school of origin wherever appropriate.
• Establish protocols with paediatric services to ensure physical care needs are met (particularly for those young people with eating disorders).
  

Services provided are culturally sensitive.

The workforce has the required skills and competencies to deliver the agreed service description to ensure compliance with NICE evidence based practice guidance.

Availability of fit for purpose facilities, which ensure a safe and secure environment, is provided and that:

a. Have sufficient indoor and outdoor space, within the inpatient setting, to create a therapeutic environment;
b. Provide an environment that is valued by service users and their families/carers;
c. Facilities to meet individual need and are age appropriate
d. Provision of activities and facilities – not only to counteract boredom but also to actively contribute to accelerating recovery.
e. To provide adequate low secure environment which includes ongoing risk assessment and management of the environment to minimise risks.