An update provided to the Committee by the Berkshire Healthcare NHS Foundation Trust on mental health and neurodiversity services provided to people of all ages across the 6 local authority areas in Berkshire. 

The Committee received a report on the mental health and neurodiversity service provision, including waiting times and trends.  These were provided across three specific areas of provision: working age adult services, children and young people’s mental health, and neurodiversity.  The presentation was provided by Kishan Waas, Service Director Mental Health Community Services, Louise Noble, Service Director to LD and CAMHS and Karen Cridland, Divisional Director Berkshire Healthcare NHS Foundation Trust.

The presentation included information on:

·         Working Age Adult Services

o   ARRS - recruitment of specialist primary care mental health practitioners under the additional roles reimbursement scheme (ARRS) to work within GP surgeries and offer triage, assessment, and signposting to primary care patients who present with a mental health need.

o   Let’s Connect - a social network to support the wellbeing of citizens over the age of 18 by connecting with each other, with organisations and services and with the many opportunities in the community.

o   IAPT - the NHS Talking Therapies, for anxiety and depression programme (formerly known as Improving Access to Psychological Therapies, IAPT) aimed to improve the delivery of, and access to, evidence-based, NICE recommended, psychological therapies for depression and anxiety disorders within the NHS. Reading referral and waiting times for Talking Therapies for 2023 was 92% of clients started treatment within seven weeks of referral.

o   Mental Health Integrated Community Service (MHICS) - offered a service to patients in primary care with significant mental health difficulties would previously would have fallen in the gap between primary and secondary care. The referral and waiting times for this service were an average of 2 weeks.

o   Community Mental Health Teams (CMHT) - a non-integrated service provided care and treatment for people with serious mental health difficulties, including but not limited to psychotic illnesses, mood and personality disorders, and other disorders. The referral and waiting time for Care Coordination was four weeks and psychiatry assessments 9.1 weeks.

o   Individual Placement & Support Employment Service (IPS) - an employment support service integrated within CMHTs, MHICS, and EIP for people who experienced severe mental health conditions. It was an evidence-based service that aimed to help people find and retain employment.

o   Early Intervention in Psychosis (EIP) – a team that provided specialist treatment and care for people aged between 14 and 65 who had signs of psychosis.

o   Crisis Resolution Home Treatment Teams (CRHTT) – a service that provided intensive support for patients experiencing an acute or ‘crisis’ episode during their mental illness. The service was available 24 hours a day, 365 days a year.

o   Intensive Management of Personality Disorders and Clinical Therapies (IMPACTT) – to help patients better understand personality disorders and support with developing coping strategies to help manage the difficulties with both emotions, and interpersonal issues.

o   Liaison and Diversion (L&D) - identified people who had mental health, learning disability, substance misuse or other vulnerabilities when they first came into contact with the criminal justice system as suspects, defendants or offenders.

o   Reconnect - a care after custody service for adults, to improve the continuity of care of people leaving prison or an immigration removal centre (IRC) with an identified health need.

o   SUN – a user network offering support through peer groups, with people helping others by using their own experiences as a guide for others.

o   Context and challenges of the services included demand and capacity, workforce challenges, staff burnout, complex presentations, differing thresholds and variations in financial offer.

o   Service Transformation – The development of Project One Team to transform Berkshire’s Mental Health offer in line with the NHS Long Term Plan. This would build upon the work already done by the Community Mental Health Transformation Programmes to create a brand-new model for Berkshire.

·         Children and Young People Mental Health Services

o   Berkshire Healthcare were commissioned to provide evidence-based mental health services for children and adolescents across the West of Berkshire. The THRIVE framework conceptualised five needs-based groupings for young people with mental health issues and their families. Under the Thrive framework, most services provided in Reading were within the Getting More Help and Getting Risk Support needs-based groupings.

o   Berkshire Health did not provide school based mental health services or primary mental health services in Reading but were commissioned to provide specialist expertise as part of the mental health in schools’ service.

o   The total number of referrals to the service from the Reading locality had increased by approximately 7% since 2019 (pre-pandemic). This was similar to the national picture and to other areas of Berkshire.

o   Approximately 12% of the service caseload were Reading children and young people.

o   The were no national access and waiting time standards for general CAMH services. However, national guidance had been introduced to provide a standard definition of waiting.

o   In 2023 mean waiting times were 10 weeks and 21 weeks for routine referrals.

o   Berkshire Healthcare services were meeting targets in relation to eating disorders and early intervention in psychosis services.

o   New services included CAMHs Children in Care Service, Extended CAMHS Crisis Service, Berkshire Link Team, and the CAMHS Learning Disability Service.

·         Neurodiversity Services

o   Berkshire Healthcare provided the diagnostic service and medication support for children/young people with ADHD. However, many of their needs were met by other providers across the system.

o   Referrals for autism and ADHD services outstripped the service capacity which resulted in large numbers waiting and long waits. This was a national picture with services across the country facing similar pressures.

o   Services experienced more complex presentations for both adults and children/young people and reducing waiting times remained a top priority.

o   Assessments completed during the financial year indicated the 48% waited up to two years and 52% waited 3-4+ years.

o   Actions and support included a holistic assessment, prioritisation of referrals, ongoing programme of quality improvement service transformation, increased capacity of qualified staff, early needs led support, collaboration and shared learning, reducing wait for annual ADHA medication review for adults, reducing autism assessment process, ADHA post diagnostic support options for adults and quality improvement projects.

The Committee discussed the report and raised concern at the two-year waiting list for referrals.  In response it was reported that investment in resources had reduced the waiting lists down to two years and support was provided to individuals ahead of diagnosis if necessary.

The Chair thanked officers for the report and presentation, and requested an update be provide at a future meeting

Resolved – That an update be provide at to a future meeting.