Minutes for Children & Young People Scrutiny Commission meeting, Mar 18 2009, 7.00PM official page

1.1  Apologies were received from Cllr Kelly

2.1  Cllr Taylor suggested that because the agenda for this is longer than usual the Minutes of the previous meeting will be discussed in item 10.  In addition, items 7 and 8 were taken in reverse order. 

3.1  There were none

4.1  The Chair suggested that because the meeting tonight was longer than usual the minutes of the previous meeting will be discussed in item 10. 

5.1  There were no updates from other scrutiny commissions.

To receive a presentation from the CAMHS Specialist Substance Misuse Service (CSSS) at the East London Foundation Trust on the impact of Cannabis misuse on mental ill health amongst Children and Young People.

6.1  The Chair welcomed Rosie Winyard, Senior Nurse/Service Manger from CAMHS Specialist Substance Misuse Service (CSSS), to the Commission and invited her to make a presentation.

6.2  Ms Winyard introduced herself and explained that she is the Senior Nurse at CSSS, which covers the Hackney area.

6.3  Ms Winyard explained that the Government has recently produced a report which surveyed 24,000 young people that use drugs. Most young people use a range of substances which are primarily alcohol and cannabis. The national statistic indicates that the numbers of youths experimenting with substances has increased, however this may just be an indication of more young people utilising the drug support services.

6.4  Ms Winyard stated the following national statistics:

•  4/5 young people treated for problems of cannabis and alcohol use

•  51% for primary cannabis use, 36% for primary alcohol use

•  3% using class A drugs-heroin and cocaine

•  Numbers in treatment have increased over past 3 years

Ms Winyard then explained that the use for substances in Hackney is the same as the national statistic. Young men are more likely to experiment with drugs than women of the same age. 

6.5  Ms Winyard then provided a list of all the risks associated with the use of cannabis, these are as follows:

•  Damage to mental health

•  Damage to physical health – Young people often think short-term and do not think of the long-term implications of cannabis use.

•  Impact on accessing education effectively

•  Long term/short term use

•  Gateway effect – often the use of cannabis can lead onto the use of other drugs.

The severities of these effects depend on, the person, the type of drug and amount, the regularity of use, the legal classification and the dependence on the drug. Ms Winyard explained that in Hackney the use of cannabis is more common than other drugs, such as class A drugs. In addition a young person will use more of the drug if there are underlying mental health problems.

6.6  Ms Winyard discussed a survey that Rethink conducted in 2006, for which 600 young drug users were interviewed. She explained that a majority of the young people interviewed stated that they would still use cannabis regardless of its classification.

6.7  Ms Winyard explained that cannabis has been linked to mental health effects such as psychosis, hallucinations, altered perceptions, schizophrenia, depression, lethargy, low self esteem, anger and paranoia. However not all effects may be experienced by a cannabis user, the 600 youths surveyed experienced some of these effects but not others.

6.8  Ms Winyard explained that the more serious effects from smoking cannabis are low self esteem, anger and paranoia as these effects are likely to result in unemployment and antisocial behaviour which can really affect the life of a young person.

6.9  Ms Winyard detailed the barriers that young people can experience in terms of access to treatment. These results have been derived from a survey conducted by the Hackney Treatment Facility which asked  ...  view the full minutes text for item 6.

A discussion with representatives from the voluntary and community sector on its role in the design and delivery of CAMHS.

7.1  TheChair welcomed Ravi Walters, Family Support Services Manager of Norwood, to the Commission and invited her to make a presentation.

7.2  Ms Walters explained that she is the Family Support Services Manager of Norwood. Norwood specialises in supporting Jewish children, families and adults with disadvantage or learning disabilities. The area where Ms Walters works consists of a 90% Orthodox Jewish population. Norwood is a voluntary organisation with a small base but is constantly focussing on building the Jewish communities’ confidence in their services through home visits and providing a family support centre.  Norwood contains various teams to provide mother & toddler groups, therapy rooms and counselling. The services at Norwood are used by thousands of people each year.

7.3  Most of the housing in the Jewish community is overcrowded therefore the Norwood centre offers play activities to children such as toy libraries three days per week where parents are children can play together.

7.4  Ms Walters explained that most of the families Norwood works with are referred by themselves, as the family should want the services in order for them to be effective on their lives.

7.5  Ms Walters explained that the Jewish community is very complex, there are various Orthodox groups, depending on their involvement with there faith. Some community groups will be less likely to accept Norwood workers in working with them, such as the Jewish Orthodox, due to them ‘not being Orthodox enough’ which may present a problem when those that really need the services cannot be reached.

7.6  The workforce at Norwood consist entirely of Jewish people, which is an important factor for the families who wish to seek help in that they often feel more comfortable with those who share the same religion and are from the same community.

7.7  Ms Walters explained that Norwood works with outside organisations such as social services and CAMHS and that the services provided in Norwood operate within tier two of the CAMHS tier model.

7.7  The Chair also welcomed Nursel Tas, Mental Health Team Manager of Derman, to the Commission and invited her to make a presentation.

7.8  Ms Tas explained that she is the Mental Health Team Manager at Derman, and has been in this role since 1991, therefore she was very familiar within the community. Derman is a Turkish/Kurdish charitable organisation which has operated in the Turkish/Kurdish since 1991. Derman services include health advocacy, mental health support, mental health advocacy, and counselling, family support and welfare rights advice for individuals and families.

7.9  Ms Tas explained that Derman has a well established community service in Hackney primarily. In the Turkish/Kurdish community mental health is an enormous issue, especially for parents which then greatly affects their children. As such the children of parents with mental health issues often suffer from the following issues:

Separation

This is a big issue in the Turkish/Kurdish community as often adults/children develop mental health issues after being separated from each other for long durations.

Adjustment

The adjustment to the new  ...  view the full minutes text for item 7.

To hear from colleagues at the Tavistock and Portman Trust about working with diverse communities in Camden.

8.1.  The Chair welcomed Dr Renee Singh, psychotherapist from the Tavistock and Portman NHS Foundation Trust, to the Commission and invited her to make a presentation. Dr Singh introduced herself and explained she has extensive experience working with the South Asian community in Camden.

8.2.  Dr Singh explained that she worked with the South Asian community and that young Asian women have higher rates of suicide and self harm compared to other young women. South Asian women are often forced into arranged marriages which can lead to depression. Additionally the provision of culturally appropriate mental health services and training is in keeping with recent government initiatives that focus on the need for community based services and the recruitment of staff from diverse cultural backgrounds.

8.3.  Dr Singh further explained that South Asians make up the largest minority ethnic group of 4 million in the U.K. Although South Asian children and adolescents may be more at risk for mental health difficulties than their white English counterparts, they are far less likely to access child and adolescent mental health services. Children from minority ethnic communities, particularly Asian children, are more likely than white children to be referred to Social Services for allegations of physical abuse.

8.4.  Dr Singh explained that it is important to improve ethnic minority use of the service, retention rates, improve outcomes and decrease emergency and inpatient services. The Tavistock has provided a service designed for cultural and ethnic matching, which helps to engage and retain clients. This is because each culture is different so if a person in need is comfortable with the specialist because they share the same cultural values they are more likely to continue treatment. Often clients will choose their own specialist, this helps prevent “internal racism”, when a person does not like a certain culture. Currently 90% of the work is based in the community at people’s homes as often they may be too frightened to attend clinics.

8.5.  The Asian services at the Tavistock were set up in 1996 to meet the needs of the Bangladeshi community as 1 in 4 Bangladeshi’s living in the Borough have mental health issues. The services started up as the Bangladeshi project, however continuous funding was achieved in 2002. In 2002 it expanded to the Asian Service, to offer choices to clients from diverse Asian communities in Camden. The service mainstreamed to South Camden Community CAMHS in 2007-2008, with the South Asian clinicians in the team reaching out to South Asian communities. The services are integrated across different tiers in the community.

8.6.  Dr Singh explained that in her experience starting with a specialised service is a good way to gain a community’s trust, then moving on to a more mainstreamed approach further down the track.

8.7.  Dr Singh stated that the Tavistock currently works with the South Asian Community in Camden and provides the following services:

·  Assessments and clinical services

·  Consultations and co-working

·  Research – Research was done into  ...  view the full minutes text for item 8.

Discussion with a representative of leading national charity Young Minds.

9.1  The Chair welcomed Roger Catchpole, Principal Consultant at Young Minds, to the Commission and invited him to make a presentation.

9.2  Mr Catchpole commented that he has a lot of interaction with CAMHS services at a national level and stated that a lot of what has been discussed tonight, in particular by the community groups, is relevant in many local areas across the country.

9.3  Mr Catchpole explained that young minds have a mission to improve life chances for children and young people at risk of and experiencing difficulties with mental and emotional health, achieve better outcomes for parents and families who engage with children's mental health services and to promote the good mental health and emotional well-being of all children. The methods in which these aims are received are through the following:

•  Participation

•  Outreach with schools and with dads

•  Campaigning, information and policy development

•  Publications and magazine – in particular a magazine for parents concerned with the mental health of their child

•  Parents Information Service 0800 018 2138

•  Consultancy & Training

•  Website: www.youngminds.org.uk

9.4  Mr Catchpole explained that Young Minds made a submission to the CAMHS review which covered the following areas:

Leadership

Mr Catchpole explained that it is important that service systems are the exceptional, in particular at a management level. Services that do very well are often the product of a manager who is very passionate about their work, this then filters down the service structure, which results in an excellent service.

Joint working

It is important that statutory, voluntary, community organisations and families work closely together. All reports published demonstrate that this collaboration will result in the best outcome, however this is not easy to achieve and progress is minimal, all that can be done is to learn from good examples from the past.

Relationships

Quality of the relationship is central to youth development.

Training and development

Mr Catchpole explained that this is an area that needs work, training should be available for those who require it.

Terminology

Each agency has different methods of delivery services to their clients, this presents a terminology barrier. As such problems arise when dealing with different organisations. Therefore it would be useful if a mechanism was developed to help deal with each organisation.

Funding and commissioning

Research shows that community mental health organisations are grossly under funded. However funding is not a short term solution to mental health, more focus is required on preventative services to the community.

Outcomes, monitoring and evaluation

The outcomes of all organisations should be shared.

Early years and early intervention

The early stages are important to determine the mental health of a child, more recognition of this is important.

Cultural competence

Young minds takes on a national view in terms of cultural competence.

9.5  Questions and Answers

Cllr Siddiqui explained that the children of today are very different to those of the past, in terms of mental health. He asked what the balance was between services getting  ...  view the full minutes text for item 9.

10.1  The minutes were agreed as a true and accurate record.

10.2  Cllr Taylor reiterated previous discussion that had been held regarding the proposed work programme for 2009/10.  This is due to include a substantial piece of work on the Youth Provision, a short study of safeguarding, and a briefing on progress of the Learning Trust.  These proposals will also be discussed at OSB on 23^rd March.