Health and Social Care Committee

Wednesday 2nd September 2026

(began 1 month ago)

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None Portrait Speaker 1
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what we tend to see is that I'll just give you an example from my world in adult world to illustrate that point. I think that when when there are long waiting lists, there are long, you know, increase in the rise of people walking into EDI, the temptation is to create another solution somewhere else to manage that, to reduce footfall in Ed. And I think that would work well if you are thinking of the whole pathway. But if you're not, and if you just create another service that just manages that little bit, then you just shifted the you press the balloon and then it pops up somewhere else.

And I think, and I think that's the real risk for your constituents, I think, is that you create a service that says, we'll assess you. And we've seen that with with some of the neurodevelopmental conditions is that you get assessment, but then you are waiting for treatment to start. And I think and that ball is just lobbed in the air and there's no one to pick it up as to who's who's going to pick up that solution about about managing that condition.

So I feel that I don't think we need new services, new structural services. What we need is, is better integration between the services that already exist. And I think we are I think parents want support in schools and they want that. If the issue is raised in schools that someone will pick it up. And if that someone says primary care and primary care identifies the problem to be something severe, that requires the involvement of Cam services, that Camhs will pick it up and so on.

And I think that integration is is really missing right now. And I think I think what we tend to see is that that's why people fall between two stools. And, and that probably is one of the biggest issues that that parents and young people complain of, whether that their care is not owned by anyone and they keep falling between the stools, I think. So clearly that is also compounded by the fact that sometimes we create a workforce in one area, and then we say, well, the front end, we need to triage people, we need to support people.

So we'll create we'll have increased number of support workers. But clearly, I think people have complex, severe presentations, and we need our psychiatrists and pretty much in each of your constituencies. I think if you if you've looked at the data, the real term vacancy for cam psychiatrists is almost 1 in 3. And now you can imagine what kind of pressure that produces. And I think if you have a complex severe presentation and you refer, you get referred to a psychiatrist, the likelihood is that you won't be seen very, very early.

So I feel that. And that then kind of leads to a situation where there are duplicate assessments, but without any resolution of the problem. So you present a crisis or you text a, you know, one of those online services. And then each time you get a little plaster to hold you at that point of time. But there's no proper assessment, proper diagnosis, proper formulation, and a personalised care plan so that you as a parent, you as a child or young person and your team are fully aware of what this is, what's happening.

So which is why my answer to the committee was about what we need is.
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None Portrait Speaker 3
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An inpatient unit.
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None Portrait Speaker 3
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I, I feel that you see we are when we look at referrals and rejected referrals, we are talking at the end of the system. So we are talking about like, if we think about ourselves, when do we get angry and frustrated? And it's very much the same with our children. They get angry and frustrated. And mostly it is because they are trying their best. But for various reasons, which are not sometimes purely mental health, they are not able to get.

So if, like Freud said, if they turn it outward, externalize it, it comes out as violence. When they turn it inward, it becomes depression and violence towards themselves, self-harm and all. And the incidence of both has gone up significantly, as you're all aware. So the question then comes, why are these children like this? And I totally accept your your question about rejected referrals. We shouldn't be rejecting any referrals because these are children in distress, but it is the right door for the right child.

So if we have a child with a neuro disability who is having a burnout, who is having very great difficulty putting him in an inpatient unit, locking him up for any period of time is doing him a massive disservice. And often that is seen as rejection from from Camhs. Very rightly so, because we are not saying what is the answer. So I would say that they should have a proper like what Professor Swoboda has already said, a proper universal assessment to look at where the issue is, and then they should be getting support for that.

It is not always with medication, with therapy or with inpatients, but we need that kind of a universal examination which looks at the child and they do help, need help initially because sometimes the patterns of behaviour are stuck. So saying, oh, go away and get better help in schools again is a terrible thing to do, frankly. But we do need the proper assessment. We shouldn't be keeping children locked up or putting them in an inpatient unit, or giving them pointless therapy for things that are not going to change.

If you have a neuro disability, the word is it's a disability. So you have ability, you have disability. That's not going to change. His IQ is not going to change. His social skills can be improved and can be worked upon. But that internal mechanism, the brain mechanism is not going to change. So we have to scaffold this child, make him effective. And sometimes the factor is not even child centred. It may be just the lack of care.

How many what percentage of looked after children keep knocking on our door repeatedly saying, oh, treat this child, but this child has no locus of control. It's totally external. The child has internalized it because he has lost the internal locus of control. So we have to scaffold the child properly and have that kind of a universal care system which supports that child to move forward. Your
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None Portrait Speaker 2
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It's interesting. We've been looking quite hard at where the best practices, where the lowest weights are, and what we're seeing is, is completely open access systems. So Self-referral direct referral from GPS platforms that allow people and families to self-refer. And then early and well, the assessment, which is well informed by good senior professional expertise. So children are getting on to evidence based pathways if they need them very fast. So I do think this you know, what we shouldn't do.

And I recognise that's not the experience of of many of the families of people in this room within your constituencies. But there is something about a shift. It isn't a completely reworking of Camhs. It's a reworking of that pathway in. And I think that can be helpfully facilitated by digital. I think there are ways that we can use different types of workforce better to make sure that that works smoothly. There are other workforce issues in this as well, because, you know, while dancing has absolutely right that not every child treatment is appropriate, there's a whole range of social and other needs.

There are specific areas where there are weights, because children would benefit from very specific evidence based interventions, particularly children who have experienced PTSD or have complex, emotional, complex emotional need where specific types of therapy may be the right solution for them. But we don't we haven't been able to train enough of our workforce to deliver some of those interventions. And I would say, I think from a workforce strategy, we need to have that focus on the psychiatric and psychological workforce, because we've grown the mental health workforce in this area quite extensively.

Mental health support teams in schools and health and wellbeing practitioners. But there are still gaps and there gaps in really crucial areas, sometimes within those evidence based pathways.
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None Portrait Speaker 1
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I think we're all breaking on to violent agreement here. But I think I think the main thing that kind of touches back on Mr. Lynn's point as well is having those key performance indicators or incentives, which are over the whole pathway, because right now I think there are silos. And that obviously, I think when you say the reason why people reject referrals is because you're trying to protect your own territory, because your KPIs, your key performance indicators, are not aligned to there's no stake in the whole pathway.

There's no stake in you having an investment in that child going back to school. Your stake is about managing the workload of your team. And I think that is why it promotes that kind of referral rejection. And so it promotes containment rather than solving. And I think that's what the last thing I was talking about, I think if each child, each young person got a comprehensive assessment with a personalised care plan treatment plan, I think then that would solve things rather than, you know, it being shifting it somewhere else, shifting the balloon somewhere else.

I think. And I mean, I hope that this committee kind of offers solutions that will be applicable across the board because we're seeing the same in the adult world. Right, I think is that if you create a four hour target or whatever target emergency department, then it encourages people to say, well, we'll create a corridor care so that now you're not technically needy so that we don't breach.
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None Portrait Speaker 4
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Serena.
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None Portrait Speaker 2
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I think I referenced a couple of points before. I think a meaningful workforce strategy is really crucial to this. And I think sending the signals to commissioning organisations that this is a priority. Because I think, as you say, it's not about a system that's entirely broken, but it does need a bit of reimagination. It needs some imaginative thinking about commissioning things in a different way. And that transition costs often costs money.

So you're moving from one system to another. You need to invest in a different kind of a different ways of working, sometimes a slightly different workforce. So I think there is something about the government making absolutely clear that young people's mental health is a priority, and sending the sending the message to commissioners that they need to commission for a set of outcomes for young people that are not just about how quickly they access services, services, but what happens as a consequence of them.

And participation in school is a really good indicator, as one example of that. So yeah, and making sure that we aren't in our understandable focus on making sure that acute hospital care is accessible and that people get to see their GPS. We don't lose sight of this particular area of care, which if we're thinking about our our society, our economy, our communities in five, ten, 15 years. And we recognise, for example, the particular challenge that NEETs present, you know, I'm not all that fond of that terminology, but NEETs present at the moment.

This is a fundamental part of of dealing with that. So I think a focus for commissioning appropriate investment and a strategy around workforce and supporting organizations like ours and others to make sure that the good practice we're talking about today is well seen, understood , and shared as far as possible.
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None Portrait Speaker 4
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Thank you. Mike. The Education Committee has taken a great interest in the parallel crisis, but overlapping, I think, in a special educational needs and disabilities. And excuse me, one of the things that we heard in a previous inquiry is that there's a really significant overlap between the children who are in the system in one way or another, and children who are known to mental health services in one way or another, but actually very little exchange of information between those two systems.

And I think one of the things that we saw in our inquiry is really that the compounding impact on children and on families of waiting lists, upon waiting lists, upon waiting lists. So children end up waiting within the Cen system for sometimes for diagnosis, but very often for support for any type of meaningful support to be provided. While they're doing that, their mental health deteriorates. They then end up on waiting lists for Camhs. They then end up in an absolutely terrible state, and they end up losing years of their childhood that they won't ever get back.

So I want to ask you about this relationship between the Sen system, between the kind of waiting lists that we have for diagnosis around autism and ADHD, other Sen diagnoses, the lack of support that is available as a matter of course for children who have those needs and the increase that we have in the population and Cam services. And really, what is the relationship as you experience it, as people who are responsible for delivering services, and what do we need to do to stop that compounding of the impact of waiting lists? Upon waiting lists on children and young people? I might start with you, Professor David.
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None Portrait Speaker 1
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I think I'll make the broad point first, and then maybe Doctor Shankar can come in and talk about the specifics. I think so, I think the waiting list. I think the first thing to say is that not everyone on the waiting list is equal. I think we need to recognise that there will be some children, and I see that as an adult psychiatrist, that sometimes they're given diagnosis of a neurodevelopment, not a diagnosis, but but assigned label of neurodevelopmental condition. And because they've not had that comprehensive high quality assessment, I think, which is maybe because of that joint lack of joined up working between the educational and the health system, I think you then find that they actually had severe mental illness, which has been undiagnosed undetected for a long time.

And that then obviously adds up. And then you end up in, you know, delaying evidence based treatment that could have helped them earlier on. So I feel that there's a there's what is needed is that approach of whole pathway where expertise is available. I think that includes Camhs expertise at earlier points, touch points. So the multidisciplinary team needs to be involved, I think, which is what all three of us have been saying, that, well, you can't have this divide between what mental health support teams and schools do and then what families are doing and what the voluntary sector is doing.

It needs to be joined up. I think there needs to be access to escalation points wherever that's needed, and that's where I think that supervision, building, that supervision capacity. And I think that's where the joined up thinking is, is needed. I think I've been involved in looking at job planning for psychiatrists and other medical workforce. And I think sometimes that work around supervision is not really counted as as proper work. When you advise a social worker or you speak to a teacher.

Now, I think because that's not counted, it then sees what are you doing? You're only you're only seeing two children in the whole week. Well, you've been talking to a whole range of multidisciplinary team professionals. I think that's the kind of joined up working that's needed across the pathway. If we actually build in time to provide that supervision to teams at multiple touch points, I think I appreciate that we have to start solving the waiting lists.

And I think I think the way to solve that, I think, is also to make sure that while people are waiting, they get access to those multiple touch points from specialists as, as and when required.
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None Portrait Speaker 4
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Thank you. Rebecca.
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None Portrait Speaker 2
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Yeah. I think, you know, and I'm sure that this will, you know, we're waiting for the report from the Independent Review of Prevalence. And I'm sure that this will be a feature there. But our reliance on pushing people down a diagnostic path always is not necessarily a helpful one. And I think the logic that you try and think about how needs can be met without the requirement, even if a diagnosis may be required at some point, is a really central one.

We were talking to a south west London Saint George's Mental Health Foundation Trust recently that set up a kind of completely open access service for families and children with emotional behavioral challenges may or may not end up down a route where they are assessed for autism or ADHD, but there's enough expertise within that service to be able to build some support around the family and the parent without having to sit on a waiting list. So I think more of that within schools and outside of schools is, is probably needed.

We also need to, I think, have some differentiation on waiting lists. I think, as you've said. So we know we're starting to see examples of commissioners looking at how needs can be differentiated so that those where potentially the children with the most significant needs or, or most significant impact of those needs not being met can be prioritised within systems. And then the join up, I think mental health support teams have some of the, you know, part of the solution here.

But I think, again, integrated local teams built around, as I said, thinking about what are the needs of this child at this point? What does a multidisciplinary approach that includes education, social care and health and brought in fast, dealt with quickly? What does that look like? And then the right information exchange. We know that, you know, some of our primary care members are concerned. They're not getting all the information back from mental health support teams in schools.

Some of that flow isn't quite working. We have to be very, very careful around protection, around data and privacy. But I think there must be better ways of using the systems that are being developed to have easier information flows. Thank you.
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None Portrait Speaker 3
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Thank you. This particular question obviously takes up a lot of my time of thinking, etc., and I oscillate between despair and ecstasy. And can I just say I think neighborhoods are part of the answer. So to me, the question that we are asking ourselves in Northampton is, what is the difference between five different services? Giving services in an area and a neighbourhood team? How is the neighbourhood team going to differ from five agencies delivering in a neighbourhood? So, and the answer is in integrated work.

And I think when you have you see, I think when you have a child, I think one of the good terms that we have invented in this country is a child in need. So, you know, when this child is being referred, it's a child in need. It has needs, and he has needs across the spectrum. And I do think that there are specific deficencies. So when you come, you must have a really good universal assessment.

You know, we have got that with our health visiting and we do that up to four. But that doesn't feed up into the higher thing. And that's such a tragedy, you know. So why is that not happening? And you know, when they come in there and then you will have specific things. And then that child and the other thing, which I think is absolutely still poor and is a crusade of mine, is that the family should be included as co-therapists.

You cannot have a plan which doesn't. So how what are you doing to make sure that the. You know, and like all people, there's a whole spectrum of understanding. You may have people who have who are extremely well read and know know it on paper, but can't deliver it on the ground and vice versa sort of thing. But, you know, how are we getting the I'm, I'm going to use the generic term mother or the single most important carer.

If one wants to be politically correct, to be able to get involved in the care of this child and support, because a lot of the time you will find that the frustration, as much as the child is frustrated, the parents are even more frustrated because they are really doing their utmost. They are going from pillar to post and nobody is there who's taking them in hand and saying to them, okay, fine, we've got you. You know, we've got you.

This is the thing of the child. And, and also to make the difference between state illnesses and trait illnesses by that, what do I mean? So you see, when you ask for a diagnosis, people often think of state illnesses like depression or tuberculosis. You have tuberculosis, you have depression, you treat it. You are no longer depressed, you're no longer have tuberculosis. But when it comes to neurodisability and things like that, it's going to be for the rest of your life.

Your autism is not going to end. Your ADHD is not going to end, your intellectual disability is not going to end. So what does it mean at every stage if you are for going into school, what does that mean? And then what does this mean in terms of mental health, etc. at eight and, you know, and, and the sad bit, which always kind of makes me so sad, is that we have our health visitors who have that information, who have put that information in the thing and we have it, but we are not taking it forward.

We are not, you know, moving it forward. So I do think that along with like a proper neighbourhood team which knows this, that, okay, these are the kids who will be knocking on our door. And if we solve the problem at school entry, that will not be the problem at middle school when they hit their teenage years and start thinking of dating, etc. and they will have again hurdles to cross. And that will not be the hurdle when they come to their GCSE level.

You know, that sort of lifelong planning, universal planning and a proper good assessment, you know, which will then be able to predict that, okay, this child has got a trait illness, this is going to last, this is going to be their support and then carry that on. Yeah.
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None Portrait Speaker 1
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Well, I mean, I think that's what we need to strengthen the accountability accountability framework. I think we need to be we need to make sure that Icbs, you know, are supported because they don't know what they don't know. And I feel that that's my, my, my real worry is that you can see that there's a lot of information available here. And I'm not convinced that all the commissioners know all of this, you know, and I think at least I'm not able to utilize information.

I think a lot of commissioning still happens with pages and pages and reams of spreadsheets, and then you are tempted to kind of solve this waiting list or this particular read, but it's the individual stories and individual cases that actually inform what is going wrong. And I think I don't think that kind of knowledge will come into the system unless we have clinicians involved in that. And I think for me, that is the biggest worry is that clinicians are not properly involved in in commissioning decisions, and the accountability frameworks are not robust enough.

So I think if there's one change I'd like to see is, is greater commission involvement in commissioning decisions at the neighborhood level and the ICB levels, I think, which will then drive that integration that we're all talking about. And we know that that integration is possible because we have those examples of good practice. So and then just if I may add quickly, I think digital has a role to play and we haven't touched upon that, but I feel we've talked about assessment. A good assessment is absolutely mandatory and absolutely important, but access to that good assessment is absolutely critical to nothing.

I, as a clinician, find sometimes I have to spend three hours to find that good quality assessment, even if it's already on the system. So I think that we've seen this again, I think, Rebecca, you talked about it, that the marginalisation of psychiatry and mental health is real. I think none of us are here with a chip on our shoulders. I think we've seen that with digital investments. And I think if that digital investment was directed at the right sort of things, making those assessments accessible to clinicians at the right time, you know, to have two click access rather than a 3040 click click access to to those assessments and investing in prevention.

I think I'd like to talk about that, but maybe a bit later.
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None Portrait Speaker 2
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I think I've got lots of examples of what that would look like, but I'm going to go back to North Staffordshire because I think they are a good example. And you can talk about the rest of East Midlands very, very effectively. But it's the combination of, you know, getting getting away from a point that everybody's just getting on to a list and then you wait and you get there. So if you look at the model in North Staffordshire, it's a mix of the offer.

It's good assessment upfront. It's a single point of access that GPS and families can trust. Then it's the combination of providing resources for self-help, a mixture of interventions, whether it's group interventions or individual interventions, which will vary from child to child. Family interventions are bringing family and carers into the mix. Schools based support using the VCs, and then making sure that when children's needs are quite intensive and more complex, there is then quick access to specialist intensive support via Camhs.

So in some ways we're asking the wrong question, aren't we? In terms of what happens when you wait, wait and you don't get what you want, it's how do you start the process? And the way we try to describe today in a way where the children, where they may not need, they may actually not need clinical intervention, they may need some support in building confidence. And that might be through a completely different type of approach that they are not sitting on a waiting list.

I was talking to the person leading Camhs in Lancashire and Cumbria and South Cumbria NHS Foundation Trust. They said the absolute priority is to make children are on the right pathway. They've assessed really well. They're on the right pathway first because there is nothing worse than talking to a parent that's waiting 52 weeks to be told their children's waiting for the wrong service, they should have been assessed differently. So there are things that are not rocket science that can be built into some of these, but it's very tough.

You know, mental health trusts are operating often trying to be asked to make cost savings in the next year of, you know, 4 or 5, 6% of their current expenditure. They're making really difficult choices. So making these kind of transformations in that environment, it sounds we're painting a story of this is how you do it. It can be very difficult to shift a model of care in very limited resources. And can I make one point we've talked a lot about as we should be doing prevention, early intervention, getting in fast, dealing with need quickly.

We shouldn't ignore the very the opposite end where children have very, very severe and complex needs, the kind of young people who are showing up in A&E very regularly, very, very high levels of self-harm and attempts at their own life. And again, there it is about connected services. So really good. We've got really good examples of really effective cooperation with local authorities to create residential settings for young people to be able to get really intensive programmes of things like DBT.
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None Portrait Speaker 5
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Thank you chair.
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None Portrait Speaker 2
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So some of the best examples, one of the best examples is sitting next to me. But we've got another example. And sometimes these things happen by necessity not designed. So Lincolnshire Partnership NHS Foundation Trust essentially couldn't staff its 13 bed inpatient unit. So it just took a really different approach. It focused its resources on intensive home treatment and crisis support in the community, and actually pretty much removed the need for those beds entirely.

You know, we know, and the direction of travel in psychiatry, I think, has been for a long time that the direction of travel should be to reduce to a minimum the number of young people who are in an inpatient bed. So and I think that many trusts are moving in a relatively positive direction towards that place. I think some of the barriers and when I talk to chief execs about who are the patients who keep you up at night, where's the thing that really, you know, makes you they're often talking about young people with what might have been diagnosed in the past as borderline personality disorder or as emotionally unstable personality disorder.

Complex emotional needs, a complex, often coexisting with autism or ADHD, often a complex history of trauma, often a disordered eating of some form. And they will often be the young people who are in hospital the longest, with challenges finding an alternative which is not an inpatient bed. And that's the example I was trying to use earlier. So Hertfordshire Partnership NHS Foundation Trust have got a really fantastic unit called Cherry Tree Cottage, entirely joined with the local authority.

It's a local authority, registered children's home for relatively short stay, very intensive care. So it's not an inpatient unit, it's not a ward, but it's a space where children can get a variety of support for a short period of time. They've had no admissions back into inpatient care for that cohort of patients who are very regular admissions into inpatient services. So I think in doing so, in setting out its mental health strategy, the question about what the government should do, we need a focus on early intervention and prevention, but we can't ignore what's required for those children, often who have been in the care system, not all, but often been in the care system.

And I know the ten year plan said we will have a specific focus on the mental health needs of young people who are experienced. I think we've got to see that really play out in the mental health strategy.
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None Portrait Speaker 3
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So yeah, thank you very much for that question. So one of the things that we talk about in our Camhs meeting is the so-called golden thread, and that is like a door from the door of the patient back to the door. And really, if I'm if there is a challenge that I'm working towards the moonshot, and that is not to have to admit any of these patients that Rebecca was talking about at all in inpatient, but manage them in the community.

So what do we have? We have the crisis team, which can support them. We have what we call crisis cafes. So they can come. They have a cup of tea, they get some support, they have a cup of tea, they have a biscuit. And you know, it takes care of that small thing. The next level is Day Hospital, which we are developing, and then we have the intensive outreach team, which actually can go and see patients more than once a day.

And on top of that, we also want to now develop what we are calling the virtual ward or hospital at home. So they will get all the support. Can I just say, you see, this is a very vexatious issue we have, and we often get criticised for these kids who are, and they are the ones that really keep us awake at night. But the problem is, when you take them out of their home environment, put them in a fully scaffolded, supported environment of an inpatient unit where there is very little stress, where my wonderful nurses ask them questions like, how would you like your toast? Would you like it lighter or darker? You know, this is the kind of stuff which passes for care, which is fantastic.

But then they come back into that environment and within a week they're again looking for admissions. So therefore the care and support must be developed in the community. And I think we need to go to this virtual psychiatric bed model of supporting these children in the community to develop their skills. So what are we developing? We are trying to develop resilience. We are trying to develop a locus of control within themselves.

This locus of control. They have exported it to to people outside. So that's why they go and stand on the bridge on the other side of the bridge, and they hope to get rescued. If they don't get rescued, they jump and they die, you know? So this is the terrible state that we are in because they are not able to contain this. So we need to support this and develop this structure where we can care for them and to make people understand again, you know, this thing of diagnosis is fantastic.

But if we look at the data that we have, even at inpatient admission, only about 40 to 60% of the cases actually have a diagnosis. Because that's the nature of children, you know, and the fact that they don't have a diagnosis doesn't mean they don't have a problem. They have a problem. So they have they need to have a formulation which will then support them to do this. And it is about these life skills. It is about giving them a locus of control which is within them.

It is about developing the resilience. And this must be done as close to their home as possible, not to export it out, not to send them to hospital. And this is what, you know, couples work about distance from home. The more further away from home children are placed, the longer will be the stay, the more will be the impairment and the more difficult will be their re you know, and I'm totally 100% have kind of day to day evidence of that.

I don't need anybody. I don't need a paper because I know it.
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None Portrait Speaker 7
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I'm Vanessa .
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None Portrait Speaker 6
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And I might start with you, Doctor Jones, if that's okay. You're talking about my lived and breathed experience really on a on a daily basis. So I think there is really good examples of good crisis. support at the time that the family and the young person is already in crisis. And it's. devastating that they're in. crisis at that much of a need that they feel the only option to them is where the door is open, which is the emergency department.

So families and young people come to us because they tell us there's there's nowhere else to go. That doesn't mean there isn't anywhere else to go, but certainly 24 over seven, it is a place where they can walk through the door and get the help that they have been crying out for for a long time. I think these children that are in crisis are younger and more complicated. Often we know who they are in terms of the more complex need children.

They're the send. children there. They're children who are care experienced. They are children who live in abject poverty. And, and I think from my perspective that where they are, whether that be that they remain in an emergency department for an. extremely long length of time, or whether they get admitted to the to the children's ward, where they also wait for. extremely long lengths of time. And when you start looking at the data, it's not.

just days and weeks, it's months in children's hospitals. So across the board, I totally agree with with Doctor Sancar. and Professor Dovey. These children don't need tier four, so.
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None Portrait Speaker 7
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If you like, to our to our crisis service, we typically get requests for conversations. between 1500 and 2000 a day for support. About 40% of those conversations relate to suicide and. suicidal thought and intent, and a further. 15% self-harm. What we can see, which I think matters. Your experience is that the the numbers are getting younger. So we've seen very significant increase in in under.

13 seconds using our service. So that's now about. 250 conversations a day with that age group. About just under 40% of those relate to suicide. So we have seen that that sort of, you know, creep younger. And then we've also seen over the sort of 8 or 9 years that the service has been running, that the percentage of conversations relating to suicide has. increased quite substantially.

I think what we see from young people. particularly is that they there is an element in which they they feel that they have to be saying they are in that level of crisis in order to to be able to get help and support. So, you know, about 2% of our conversations, roughly speaking, we work with with the met to, to get emergency support to that person straight away. So through by locating them through their phone number, that percentage hasn't changed.

So the, the. 2% of, of conversations where we, where we believe that there is imminent risk to life has remained stable. But the percentage of. conversations that relate to suicide and self-harm has significantly increased, which we think supports this view that young people and parents of young people now feel that they have to say that their child is suicidal, or they have to say that they feel that they are going to end their life in order to get any help and support.

And that is a that is a that is a problem which is driving additional, you know, kids are getting the . The
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None Portrait Speaker 8
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And there are families that believe that. sometimes that is being done at a convenience, because it's a way of passing on people who are becoming critical. But we also have this real blocker around nice guidelines. Nice guidelines are really clear. The the latest. guidelines that came out in January for children and young people with an eating disorder. It's that early access to special assessment, which you've already heard about a lot this morning, the no single measure, not just using BMI as a as a single measure to to either admit or not admit and.

coordinating care. None of these things are new or shocking, but what is. happening is that we have young people turning up at. their GP who are told they're not sick enough, or they're turning up at another service saying they're too high risk to be seen. So you've got to have this. Goldilocks illness where you are just right for the service that happens to be offered to you, rather than the service you need.

And again, the, you know, I, I speak regularly and I'm sorry if you've heard this before, but last year I met a young woman who had had five A&E. visits for self-harm. They wouldn't refer her to the. specialist eating disorder team, or they wouldn't refer her to the crisis mental health team because she was under the eating disorders team. The eating disorders team won't start seeing her because she has complex PTSD as a result of trauma from treatment in the past, and the clinician who was offering could offer her a specialist PTSD.

treatment won't stop because she's not stable enough, because she keeps self-harming and going into A&E. And I spoke to her again this year. You know, we're now up to. 11 A&E. admissions and there is no route out for her. We are. designing crisis into our. system and this. isn't us saying the clinicians aren't doing a good job. It's saying that there are answers out there, but we need to make sure those are offered early and quickly enough.

And we know from a Australia, certainly with eating disorders, which are seen as one of the most complex.
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None Portrait Speaker 6
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Like in.
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connected.
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Okay.
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None Portrait Speaker 7
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Victoria, is there anything you'd like to add to that? Only that again, I think with, with a lot of these things, we, we certainly on our service see them coming much earlier. So most of the young people that contact us are not requiring. hospital care, but they tell us that they're self-harming and they tell us why. And I think self-harming is self-harm is very. normalised in, in young people. It's, you know, it's a coping.

mechanism for a lot of young people. And we see that early. There are two things I'd like to say. One is that there is very little support for organisations like ours that are. digital in terms of in terms of safeguarding and safeguarding legislation. So all. safeguarding . legislation assumes that you are sitting in front of the child and you know where they are. There is there has been no update to safeguarding legislation that recognises that there are a lot of digital.

services where, you know, we don't know where the child is. We have a very we have a very complex and expensive. safeguarding system internally, but we're not helped by the fact that there's, you know, there's no there's, there's nothing for us to rely on or to, to work. alongside except to contact the police. We can contact the police with a phone number and a and, and the name. Sometimes we have as much as a first name.

And the police are maybe an idea of age. That's not enough for the police to use their investigatory Powers Act to. That's. It's not sufficient. It's got to be imminent risk or risk to life or crime in progress. So we are kind of stuck because we could be really supporting that, you know, that. process and particularly the process in schools where we where we know that a child is .

Talking to us
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None Portrait Speaker 9
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about.
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The more.
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None Portrait Speaker 7
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Which . I know we
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young people,
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overcome?
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.
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enough.
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start? How
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.
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Works going to . Work
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None Portrait Speaker 11
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expertise on the.
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