Cyflwynwyd yr ymateb hwn i ymchwiliad y Pwyllgor Plant, Pobl Ifanc ac Addysg i gymorth iechyd meddwl mewn addysg uwch

This response was submitted to the Children, Young People and Education Committee inquiry into Mental Health support in Higher Education

MHHE 16

Ymateb gan: Bwrdd Iechyd Prifysgol Hywel Dda

Response from: Hywel Dda University Health Board

Nodwch eich barn mewn perthynas â chylch gorchwyl yr ymchwiliad. | Record your views against the inquiry’s terms of reference.

1. Maint yr angen | Extent of need

· Hywel Dda University HB  have significant  challenge in respect of the rurality and geographical challenge for many students compounded by a lack of regular transport in many areas.

· Transition from school to adult education can be a stressful and disorientating experience for young people who have to negotiate the anxieties of living independently ,  having to budget, manage independent living and develop new friendships and peer relationships.

· Having to register in a new area with a GP may be challenging especially for those  who already have a disorder or having treatment with the different services available or even no service in some areas due to variation in service provision or smaller Health Boards etc

· Within HDUHB,  we have established an All Age Single Point of contact( SPOC) also known as NHS 111 Option 2  and  the service have established  links  with Pembrokeshire college  where the team have attended their open days, engaged with the new cohort of students and care providers to highlight the referral pathway ( self referral and/ or professional referral) in an attempt to de stigmatise mental health.

The adult MH team are also attending their World Mental Health Day October 10th to promote the service .

The plan is to replicate this in Carmarthenshire and Ceredigion ,to promote the new service and also to ensure the quick access

The  NHS  111 service is also looking at business cards to be located in the colleges and also visual posters so students can access the service to have support when required ,and inform students when this will be a 24-hour service.

· HDUHB has in place a  dedicated  team experienced in working across schools, colleges and the universities (Up to age 25)  called Iechyd Da  who would also utilise the professional line for support and advise when required .The  Iechyd Da team are based within the college setting which enables a close working relationship 

Hywel Dda University Health Board (HDUHB) Youth Health Team (YHT) was first established in 2008 as a multi-professional team to work proactively with vulnerable young people throughout Carmarthenshire.  

The aim was to reduce health inequalities and address health issues which may be a barrier to their involvement in education, training and employment. In 2014, the team expanded the service to Ceredigion.

Iechyd Da works with vulnerable young people up to 25 years of age, across the counties of Carmarthenshire and Ceredigion.  We focus on those who are not in school e.g. those who are not in mainstream education (alternative curriculum and electively home educated), those who are NEET (not in education, employment or training), Looked After Children and young people and care leavers, those who are supported by the Youth Support Service (including Youth Justice) and, those who are homeless or vulnerably housed.

· In Aberystwyth,  we have a Link Mental Health Practitioner  who liaises with the University  and the Practice Development Nurse . There is a plan to establish a pathway and improve links with Aberystwyth university to support students and reconnect with the pathways

· There are certain groups of young people who will face additional pressures , those with known mental health disorders may find their mental health and wellbeing challenged due to additional stressors,  people with Autism or Neurodiverse conditions will also face additional pressure and may struggle to adjust to the different experience University brings. Transition from S-CAMHS to Adult Mental Health services can be extremely challenging as these young people may find that not only are they moving to a different area they also have to navigate the complexities of new health services and finding support.

· The effect of the Covid-19 pandemic has brought significant challenges  for students with disruption to education and life in general . Disruption to normal developmental activities such as leaving home and going to university is seen as a particular transition and with this not happening many young adults have missed out on key life events which may have an impact on their future resilience and opportunities. The disruption to young people in college / university must be acknowledged and prevented from occurring in the future. We are seeing higher levels of mental ill health  /disorder  in the community , increased referrals to mental health services ,higher complexity and  acuity compounded by the Covid-19 impact which will remain evident for many years.

· During the Covid-19 pandemic, and in line with government guidelines as to how we were able to work with young people and their families whilst maintaining social distancing, our team members had to adapt and adjust their working practices accordingly as the college where our office is based closed to all staff from the morning of March 24th  2020.

· In addition to the considerable referrals received regarding the emotional health and wellbeing of children and young people, we received referrals for young people who found aspects of lockdown and restrictions challenging and, subsequently, found the return to education and training overwhelming.  This was compounded by additional life stresses eg bereavement, parental separation, reduction in family income and unstable housing.

During the pandemic Iechyd Da Youth Health Team:

1. Offered distance based support utilising the technology available ie Teams, Whatsapp and Zoom

2. Offered 1:1 support in line with government guidelines and Health Board governance

3. Continued to offer health support to supported housing placements for young people across both counties

4. Collated emotional health packs and distributed them to young people and partner agencies across both counties

5. Packs were also sent to colleagues in Pembrokeshire and Swansea upon request

6. Liaised with our colleagues able to offer counselling services at this time for young people unable to access services through an education establishment.

7. Liaised with colleagues across all sectors regarding young people who are educated through alternative provision, electively home educated, those who receive support from school based social workers and education welfare service, those who are attend traineeship placements and individuals classed as NEET.

8. Linked in with colleagues to address the emotional health and wellbeing needs of Young Carers

9. Fulfilled any and all statutory duties through working closely with our colleagues in children services, youth support services and youth justice services.

10.Pre-emptively held discussions across both counties with the relevant parties regarding how to manage the post lockdown transition for young people who are particularly vulnerable eg at risk of offending behaviour, substance misuse issues, sexual health matters, child sexual exploitation, county lines and misper risks.

Children’s Public Health Pilot

· In November 2020 funding was secured from Welsh Government via the Public Health Directorate for a pilot to extend the services provided by Children’s Public Health across the Hywel Dda University Health Board region. The decision was reached to setup a ChatHealth service for Children and young people aged 11-25. ChatHealth is an age appropriate digital platform for health information and local services, it is designed for users who are more comfortable asking for help via messaging.

The pilot took place in February 2021.  Iechyd Da Youth Health Team and school health nurses have worked in collaboration to address the emotional health and wellbeing of school aged children in the region, both those who access mainstream school and those who do not.  In addition to this, both teams are passionate to contribute their time and energy to the reduction of health inequalities experienced by some children, young people and their families.

Iechyd Da Youth Health team currently work all year round and it was decided that the pilot would be used to establish the need for School Nursing on a 52 week basis, and thereby contribute to the ongoing development of 2 dynamic and ever evolving services.

2. Adnabod a darpariaeth | Identification and provision

· Within HDUHB, we have  developed the School In Reach Service ( SIR)  which has the fundamental aim of supporting teachers to identify early those students who may be struggling with emotional or mental health concerns and ensure, through  early intervention, the right support is provided or signposting the right agency ie school counselling or SCAMHS is prioritsed . We have benefited from this new investment from Welsh Government with a workforce that is able to prioritse early intervention and prevention as a priority. Each school has a named link worker who is available to deal with requests for consultation , provide training and ensure a whole school approach is adopted.

· The Sir team is able to prioritse emotional and mental health supporting teachers and this is a model that can be extended to colleges and universities if additional resources were available.

· Communication with parents/ trusted adult and the need for clear lines of coummication  and support for vulnerable students where there is a risk that adult learning model may result in some young people not getting the support they need.

· Training for lecturers  on mental health and understanding the indicators.

· Within HDUHB, we have developed a Transition Lead Post based in S-CAMHS who is able to support the transition of young people from S-CAMHS to Adult Mental Health Services . The Transition Lead is working with adult colleagues to promote the development of more responsive services for young people who transition  to adult mental health services , ensure they do not “drop out” from services and we have a Transition Policy  agreed which ensures that at 17.6 yrs transition plans are discussed and agreed where relevant . We have also promoted the Transition Passport advcocated by Welsh Governent with young people .We have also employed a Peer Mentor support worker who will support young people as they transition for 3 months to ensure they go to appointments and advocate for them.

· Within our Early Intervention Psychosis Team ( EIP) we have commissioned MIND to support us with young adults  returning to work or education .This service is called the  Individual Placement Support  Servcie ( IPS) which is focused on ensuring that  young adults with mental health disorders are supported to obtain employment either full /part time or to resume their educational studies . The MIND support workers are able to support students ,meet with employers/ tutors and act as a advocate for the young person to assist them to achieve their full potential.

· KOOTH – we have commissioned for 2 years an on-line digital counselling service for young people (11-18) to support emotional wellbeing , this digital resource appeals to CYP with the focus on digital accessibility and anonymity.

· SilverCloud- we are currently working with  Powys  HB  on a pathway for referrals to the SilverCloud CBT programme, again a online provision which will address key mental health disorders.

· The post pandemic landscape is further complicated by the current cost of living crisis.  Increasingly, we are seeing high numbers of emotional health referrals form a diverse group of service users.

· With each different group comes different challenges; there are notable similarities in young people struggling with the impact of increased isolation and decreased socialisation due to the lockdowns and restrictions.

· There has been a noticeable increase in referrals for young people who are electively home educated and for school refusers.  The team continues to support communities of interest already facing inequalities eg. People who are: care leavers/young people in care, gypsy and traveller, homeless/vulnerably housed, the lgbtq+ community, people who are living in poverty, have experience of domestic abuse, have experience of substance misuse, learning difficulties, sensory issues and young carers.

3. Polisïau, deddfwriaeth a chyllid Llywodraeth Cymru | Welsh Government policy, legislation and funding

We acknowledge the proposal for all funding being streamlined however there remains much work to be done in ensuring a whole system approach to address mental health and wellbeing across tertiary providers.

The evidence for the School In Reach service could be considered as a approach to strengthen  emotional and mental health support across college/ university settings with dedicated resources . Support and training for educators/ lecturers  should also be considered to promote early intervention ,promote support and intervention  and also  to  prevent burn out when supporting students with emotional or mental health concens.

4. Argymhellion ar gyfer newid | Recommendations for change

1. To learn from the School In Reach evaluation and recommendations

2. To give equal priority to young adults at a point in their life when transitioning to adult services and Education providers

3. Consider the impact across Wales of rurality and lack of pubic transport in certain areas.

5. Arall | Other

All Age Mental Health Single Point of Contact

Mental Health & Learning Disabilites Services have been working with Welsh Government (WG) to implement an all-age Mental Health Single Point of Contact (SPOC) operating via the national 111 service.

The structure of the service means that local care is provided by locality-based teams, which was highlighted as service need during the Transforming Mental Health (TMH) consultation. The aim of the MH SPOC is to improve service user and carer experience and reduce the number of people attending A&E in a mental health crisis by increasing the support available in the community. The Service provides triage of urgent mental health requests for help, ensuring that service users, carers and referrers receive an efficient and timely response when accessing mental health services or needing advice, support and signposting. 

It is an open access all age telephone triage service which is accessed via the national 111 call line, by selecting Option 2. Hywel Dda are the first health Board in Wales to offer the service publicly since mid-June 2022. It currently operates from 09.00am – 11.30 pm 7 days a week. The service is available to any individual of any age residing within the Health Board footprint of Ceredigion, Carmarthenshire and Pembrokeshire. This includes anyone visiting the area, including those who may be homeless or living in temporary accommodation.  

When a call comes through Option 2 the caller will be connected to a Mental Health Practitoner based in either Bryngofal, Llanelli or Whitybush Hospital in Haverfordwest. The Option 2 facility means that the caller will bypass the 111-call service and be directly connected to our local teams. Using a recognised triage tool and compassionate focused interventions Practitioners will assess the mental health needs of the individual and as appropriate escalate. They will connect individuals to the most appropriate mental health and well-being provision to meet their needs in a timely manner, including those with common mental health problems and those with more complex, acute and high-risk presentations. 

Callers can self-refer or calls can come from family, friends, carers etc. A secondary Professional Line can be accessed by calling a local telephone number which has been shared with health board and partner professionals. This line provides mental health advice on assessment and triage to a wide range of professionals such as GP’s, Police, WAST, 111 service, Accident & Emergency (A&E) Local Authority, Third Sector and other health professionals.

There will be a phased implementation of the service to 24 hours a day, 7 days a week, 365 days a year as remaining staff onboard. The expected date for 24/7 operation is early November 2022.