CYPE(5)-19-19 - Papur 2 - Bwrdd Iechyd Prifysgol Aneurin Bevan



The ‘Mind Over Matter’ Report has been welcomed. The recommendations outlined in the document align with the direction of travel the Health Board and our Regional Partnership Board is taking forward in respect of Children's Mental Health. The evidence presented to the Committee reflected the growing consensus across health and the five Local Authorities we serve. It is heartening, therefore, that Welsh Government have now developed a response that aligns to the recommendations and conclusions of the report.


The Health Board’s Child & Adolescent Mental Health Services (CAMHS) Transformation plans map well onto the response, using the Iceberg Model (referenced in ‘Mind Over Matter’) as a framework to identify a clear programme of work.


The welcomed financial investment from Welsh Government has enabled us to progress this work at pace, and in doing so we have already acquired significant learning that can help inform how recommendations move to implementation. A key focus of Mind Over Matter is a whole system approach, and embedded within that a whole school approach. Although it is early days, our SPACE Well-being hubs (Single Points of Access for Children's Emotional Well-being) are proving an invaluable forum for learning about the scope of services providing mental health and well-being intervention and support.  It recognises the gaps and skills deficits that might lead to clinicians holding on to patients rather than referring on to specialist services.  Importantly, these forums also provide the potential to identify gaps and local trends, ensuring a more proactive and localised approach to service development, based on need.


A Whole School Approach is also an identified area of work within our transformation plans. We are fortunate in that we already host the Schools In-Reach pilot in some of our localities, and can identify the over-lap with this. Integrating the work with the Local Primary Mental Health Support Services has enabled us to identify what overlap there might be in these strands of work. In our development of this workstream so far, it is clear that the definition is crucial to avoid any confusion in this area.


For some, a 'Whole School Approach' refers to a stepped care model, where efforts are made to support individual children within school followed by clear and easy access to increasingly specialist support, as required. Whilst this is a very important aspect of a whole system approach, a Whole School Approach, as defined in our transformation, is much broader and refers to every aspect of the school day viewed through a well-being lens from the greeting children receive in the morning, to the environments where they play and learn, to the focus on the unique strengths of each child. This is alongside an equal emphasis on teacher well-being, psychologically informed teacher training and how the success of a school is measured. It is important to distinguish the two models to ensure that a 'Whole School Approach' does not become watered down and focused only on the role specialist services can provide.


It is recognised that this is a challenge to balance the many areas of improvement required in child mental health services without giving undue focus on single aspects to the detriment of another. Timely access to services is essential for children (that they have one opportunity at childhood) but this must not be confused with an exclusive focus on waiting times. The quality and outcomes of services need equal attention, as does a process of ensuring that families are receiving the right services at a time, and in a way that is right for them.  The Health Board is well placed to take this meta-perspective on services given the maturity of our Regional Partnership Board and its commitment to our transformation agenda and how we relate to five different Local Authorities. It will be important to develop an integrated transformative accountability framework that holds each partner agency responsible for their contribution to all the shared aims.


Linked to this, our learning through partnership working has brought into sharp relief the importance of a robust core offering for children and families from all services. Time to focus on relationships and the unique needs of children and their family, and flexibility to respond to need beyond the sharp boundaries of their 'business' is central to psychologically informed children's services. It is essential that core frontline services are well resourced and that there is a clear understanding of the role of all front line professionals and is further developed, where necessary. Investment in front line areas of work is essential, from children's centres through to youth workers, and the impact of these areas of work on the mental health, from prevention through to intervention and the importance of this cannot be underestimated.


The Health Board is well placed to implement the recommendations of ‘Mind Over Matter’ locally, and this has been enhanced by the support of Welsh Government both financially and strategically. The importance of us all working together towards a child focused and rights based agenda is essential, and the focus on any gaps or overlap in services enables us to achieve this in a multi-agency, co-produced way with the voice of children, young people and their families firmly at the centre.