Provision for children and young people with mental illness in Lincolnshire

Overview

Mental health provision for young people in Lincolnshire

Lincolnshire Partnership NHS Foundation Trust is part way through a pilot project which is seeing more young people with mental  illness being treated and cared for in the community rather than in a hospital environment.

NHS England is committed to reducing the number of children and young people who are admitted to an in-patient environment because the right support is not available for them at home or in the community, so welcomed the Trust’s consideration of this pilot.

The pilot service is a community-based intensive home treatment model looking after children and young people who are at risk of being admitted to a General Adolescent Unit (GAU).

In the first eight months of operation, outcomes appear positive with:

• No serious incidents
• Six admissions to general adolescent units compared to 22 from October 2018 to March 2019
• A significant reduction in length of stay
• The amount of time spent in hospital is reducing
• Positive feedback from patients and carers has increased

Advantages of the service

The greatest driver for the move to a new model of in-patient care for children and young people with mental illness is the resulting improvement in quality for the young people of Lincolnshire. Access for patients will be improved through intensive home treatment being delivered closer to home. Treatment and care will be delivered in the least restrictive setting as a safe and effective alternative treatment model to in-patient care for young people who would otherwise require admission. A focus on recovery rather than dependency will aim to improve the longer-term outcomes for the young people in receipt of mental health services. The provision of a community service aims to reduce the need to separate young people from their families and communities which occurs when an admission is required and also reduce the travel time for carers to visit their loved ones when they are admitted to hospital.  

Disadvantages of the service

As the service is offering a community rather than in-patient model of treatment, anyone requiring admission would need to be admitted to another unit outside of Lincolnshire. This could be further away as a result. However, this may not be the case, depending on where the person lives as there are units in other areas that border Lincolnshire including Nottinghamshire, Northamptonshire, Yorkshire and Leicestershire. We would also expect significantly fewer admissions to hospital which may mean there are no more people needing to travel to units outside of Lincolnshire than previously. Travel time to an inpatient unit can still be considerable even if it is within Lincolnshire due to the size of the county so we would anticipate a community model should mean less travelling overall due to the reduced usage of hospital beds.

CAMHS Inpatient provision in Lincolnshire

Historically, General Adolescent Unit in-patient care has been provided at Ash Villa in Sleaford – a 13 bedded unit commissioned by NHS England. Lincolnshire patients have also been admitted to other units within the East Midlands and elsewhere as necessary when Ash Villa have been unable to admit (due to being full for example). There were 50 Lincolnshire girls and boys with severe and/or complex mental disorders who were admitted to General Adolescent Units in 2018/2019. 43 were admitted to Ash Villa and seven were admitted to other units outside of Lincolnshire.

Ash Villa does not meet the national service requirements for in-patient young people. For instance, the unit is not co-located with other mental health services which is a requirement as it enables services to be delivered more safely. In November 2019, Ash Villa closed on safety grounds owing to staff shortages.

The pilot, which had been due to begin in April 2020, began immediately and will conclude in March 2021.

Pilot Model

The new home treatment model is currently available from 08:45 to 19:00 seven days a week and integrates young people’s mental health teams meaning a seamless transition for those seen in an acute crisis and those who need intensive treatment. Care can be offered at home, at school or other places by a multidisciplinary team that can link with wider CAMHS, social care, primary care, acute hospital and education colleagues.

The new model has seen a greater number of expressions of satisfaction and a reduction in complaints and concerns. Carers in particular have positive comments about the intensive care at home.

The pilot has six months to run when the impact of the pilot will be evaluated before deciding on whether or not to continue with the new care model and how it might work in the future. While Ash Villa is unsuitable to provide CAMHS inpatient care, there is the possibility that it could be provided on another site within Lincolnshire if that was the outcome of the evaluation.

We value any feedback you have on the pilot, and welcome questions.