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Petition number: P-05-0754

Petition title: Lack of support for children with disabilities at crisis

I am trying to highlight the need for the Cwm Taf children's crisis team to recognise there is a vital need for children with disabilities to be supported through crisis and have the right to be treated as any other child would.

I am a mother of four children, my middle son Tom has numerous needs, severe learning difficulties, autism, a mood disorder as well as other additional health issues. Tom hits a crisis point every now and again. Which involves increase in aggression, shouting louder than usual, hurting himself as well as others, as well as many other changes in behaviour. Tom has extremely limited communication skills and is unable to tell us what is wrong or what we can do to help. We have been at crisis point with Tom who is now 15yrs old and on high doses of medications, many times over the years and it's astonishing how things have not progressed with regards to support for children with disabilities while at crisis. Tom is currently at a crisis point and has been for some time. We as a family have had very little if any support to help him through this difficult period. I have been made aware there is a children's crisis team however they do not support children with disabilities! Surely a child at crisis no matter if they have disabilities or not, is still a child at crisis. In fact I may be wrong but in some cases may need more crisis support. I can not believe at this day in age this divide is still exceptable. I am trying to highlight the need for the Cwm Taf children's crisis team to recognise there is a vitial need for children with disabilities to be supported through crisis and have the right to be treated as any other child would.                                                                                          


The Cabinet Secretary for Health, Well-being and Sport’s response to the petition describes how the Welsh Government has been investing in mental health services for children and young people. He refers to the Together for Children and Young People Programme, which has as one of its priorities the improvement of neurodevelopment services for children with attention deficit hyperactivity disorder and autism. The Cabinet Secretary also highlights that:

§    under the Together for Children and Young People Programme, £2.7 million funding is being used to establish crisis care teams in CAMHS (child and adolescent mental health services);

§    a new, national Integrated Autism Service (IAS), designed to provide extra support for children, adults and families to help them avoid crisis, is being rolled out across Wales (by 2018).


CAMHS

As described in the Royal College of Psychiatrists’ guidance document Building and sustaining specialist CAMHS to improve outcomes for children and young people, ‘CAMHS’ is a broad concept embracing all services that contribute to the mental healthcare of children and young people, whether provided by health, education or social services, or other agencies. It includes those services whose primary function is not to provide specialist mental healthcare, but who have a general role in meeting the emotional and mental health needs of children and young people (for example general practice, schools or universal services). Specialist CAMHS are services with a core remit and responsibility to provide specialist mental healthcare.

A child’s or young person’s journey may involve movement through tiers/levels of service in a stepped care approach, as their condition is recognised as more complex or as and when conditions are ameliorated. Some children and young people will receive services from more than one of the tiers at the same time.

In 2014, the Fourth Assembly’s Children, Young People and Education Committee carried out an inquiry into specialist CAMHS. The Committee noted the Welsh Government’s position that this is a specialist medical service and is not intended to be ‘the whole of the answer’ to meeting the needs of young people who are experiencing emotional or mental health difficulties. The Committee’s view however was that:

§    the level of CAMHS provision is not sufficient to meet the needs of young people in Wales who do need a specialist medical service, and;

§    the absence of services for those children and young people who do not meet the ‘medical model’ criteria for CAMHS may mean that there is a significant level of unmet need.

Before the Committee’s report was published, the then Minister for Health and Social Services announced a review of CAMHS. This work is being taken forward as the Together for Children and Young People Programme.

Together for Children and Young People Programme

Together for Children and Young People (T4CYP) was launched in 26th February 2015 to consider ways to modernise and redesign mental health services for children and young people in Wales. It is a multi-agency service improvement programme, led by NHS Wales and funded by the Welsh Government. The Programme’s priority workstreams are:

§    early years, resilience and well-being;

§    early intervention and enhanced support;

§    neuro-developmental and co-morbid mental health/learning disabilities;

§    specialist CAMHS.

The Programme’s framework for action states:

The ability to identify early on where there may be additional need for support is critical and will require increased focus to prevent young people needing the services of specialist CAMHS.

Autistic Spectrum Disorder Strategic Action Plan

The Welsh Government published its refreshed Autistic Spectrum Disorder Strategic Action Plan in 2016. A key development is the establishment of a National Integrated Autism Service, which aims to support the improvements in children’s diagnosis, treatment and support services being delivered through the Together for Children and Young People Programme.

The Strategic Action Plan also highlights that a specific chapter about learning disabilities and autism is now included in the Mental Health Act 1983 code of practice for Wales (revised 2016). This is based on the principle that the least restrictive options should be used and for the least period of time, and the expectation that positive approaches will be used to help manage challenging behaviour. It also includes recommendations about appropriate training for staff.   

Social Services and Wellbeing (Wales) Act 2014  

Under the Social Services and Wellbeing (Wales) Act 2014, health boards and local authorities have a duty to assess the levels of need for care and support services in their areas, and the types of services required to meet them. One of the core themes of these population assessments is learning disability/autism.

Rhondda Cynon Taf and Merthyr Tydfil County Borough Councils with Cwm Taf University Health Board have been developing a Learning Disability Joint Statement of Strategic Intent. Set within the context of the Social Services and Wellbeing (Wales) Act, the vision is that children, young people and adults with a learning disability (including those people with autism and complex needs) will be able to access efficient and effective services that enable person-centred outcomes and minimise escalation of need and risk through the promotion of early intervention, prevention, greater independence and access to opportunities. This, the document states, will be achieved through:

§    maximising the use of universal services;

§    increasing early intervention, prevention, information, advice and assistance;

§    building community support and developing people’s independence;

§    sustaining people in their own homes;

§    enabling people to live full lives and achieve their potential;

§    keeping people safe;

§    making best use of our resources.

Further information about the Social Services and Wellbeing (Wales) Act 2014, including codes of practice and briefings on relevant parts of the Act (such as assessing the needs of indidivduals and meeting needs) can be accessed via the Social Care Wales website.