Transcript Pathways to care in the absence of a local specialist

Pathways to care in the absence of a local
specialist Forensic Service, what we do in York.
By Bekki Whisker
As a lone YOT/CAMHS representative,
working with high risk clients without
clear referral pathways
B
aged 15,
 Arrested for serious sexual offences,
 Learning difficulties,
 Full care order directly following arrest.
 Over a 4 month period he receives 7 different
assessments as a result of the pathways leading
from the family court system, criminal justice
processes and CAMHS assessment.
P
aged 15,
 long history of CAMHS involvement
 familial sexual abuse and domestic violence.
 high risk behaviour within the home, - fire
setting, substance misuse, fascination with
weapons, sexualised behaviour, animal
cruelty, TWOC, physically aggression.
 Lack of consensus regarding risk assessment
and risk management, from an internal and
multi-agency perspective.
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F is 16,
Well known to CS, YOT and CAMHS.
Assessed High risk offender for some time.
Long term neglect and parental substance
misuse,
Huge difficulty with engagement with all
services.
Receives a custodial sentence.
Within weeks he is sectioned, admitted to a
secure hospital and medicated with antipsychotic medication.
A
aged 14,
 Arrested for serious sexual offences
 Court bail for an extended period,
 Self-harm concern.
 Absence of mental illness, no suicidal intent,
very little evidence of self-harm – CAMHS
discharge.
 2 months later the Court outcome is that he is
unfit to plead and he receives a Hospital
Order.
Z
– 17
 serial fire setter
 ?LD
 CAMHS and CS advice to refer direct to fcamhs
due to lack of specialist risk assessment skills –
forensic report makes recommendations for
the Local Authority and CAMHS
 Lack
of local specialist forensic CAMHS and
legal expertise
 Poor co-ordination of services, a lack of
partnership working, no one wants to take
ownership of these cases
 Limited success in terms of Court diversion
 No support/supervision for those staff
working as lone practitioners with these high
risk clients
 No forum to monitor the progress of
cases/potential cases- they just get lost in
the system, an offence is then often the
trigger to action/assessment
We are a small city, we know our client group
and we know our staff
 Adult forensic mental health services wanted to
help us
 CAMHS, YOT and Childrens’ Services
representatives had registered an interest in
forensic cases
 The Yot health Worker had developed a good
understanding of the needs of this client group
and had built some good relationships across the
relevant agencies
 There were enough interested and motivated
individuals to make a multi-agency panel
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YOT Service Manager (Chair)
YOT CAMHS representative
YOT admin
CAMHS Psychiatrist
CAMH Service Manager
CAMHS Psychologist
Head of Services Resources (Children’s Services)
Adult Forensic Mental Health Practitioner
CAMHS Commissioner – (provided with minutes)
Where are the cases coming from?
CAMHS
Children's’
Services
Youth
Offending
Team
 Assessed
as posing a high risk of harm to
others (YOT ROSH or similar)
 Stuck cases
 Those at risk of custody
 Other forums have not been successful in
addressing the emotional and mental health
issues
26 cases discussed
 3 females
 23 males
 2 cases raised by Children’s Services
 4 cases raised by CAMHS
 20 cases raised by YOT
Clarity to risk assessments
 A consistent multi-agency response to risk
management
 Early identification and intervention
 Better outcomes for high risk clients
 An enhanced experience for clients in transition
to adult services
 Identification of local skills, experience and
knowledge
 An opportunity for professional challenge
 An opportunity to explore diversion pathways for
individuals
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Expertise
 A service – the panel is a forum we don’t provide
therapeutic input, consultation, written reports
etc
 Service Level Agreements and funding
 Time – we meet monthly therefore we are not as
responsive as some cases require
 Court diversion schemes (we have had some
success but they are minimal and messy)
 Clear pathways and therapeutic provision to
those young people who sexually harm
 Specialist fcamhs assessments which are locally
relevant to the service provision
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The panel ‘felt right’ but this publication
confirmed what we had identified and
developed in York was not a local ‘whim’:
Community Forensic Child and Adolescent
Mental Health Services (FCAMHS): a map of
current national provision and a proposed
service model for the future.
Final Report for the Department of Health .
January 2013
 Are
locally relevant, similar issues identified
 Evidence the need for Specialist Services and
expertise
 Highlight the unmet needs (but enables us to
recognise the progress we have made in York)
 Identify that we are targeting the correct
clients for discussion
 Identifies need for minimum standards for
community FCAMH service provision and a
standard commissioning framework to provide
a level of consistency
 Thank
you, if you have any queries regarding
the panel please contact:
Angela Crossland, YOT Service Manager:
[email protected]
Tel: 01904 554565