Whole system approach making progress in improving emotional wellbeing of children

The emotional wellbeing of children and young people is everyone’s responsibility and partners in the health, social care, education and third sector are working together towards a vision that all children and young people can access the support they need to achieve emotional wellbeing and mental health. This is known as the whole system approach.

The whole system approach has made significant progress over the last twelve months including the delivery of the HeadStart project through commissioned projects in schools and communities in Carlisle and Barrow, and beginning to operate a child and young people’s talking therapy service, and progressing recruitment to more specialist Child and Adolescent Mental Health Service (CAMHs) roles. The approach is being led by a multi-agency group, ‘Emotional Wellbeing and Mental Health Partnership,’ which is chaired by Stephen Wilkinson, Head Teacher of Queen Katherine School in Kendal.                                          

The whole system approach is regularly monitored by the Cumbria Local Safeguarding Children Board (LSCB).  In July the LSCB received an update on the whole system approach which concluded that there was a strong culture of trust in the work being done by a range of agencies.  The partnership group has also commissioned work on delivery of services, promoting a system-wide approach as well as encouraging staff development relevant to staff delivering services in Cumbria.    It is early days to judge the impact but the work already being done by the Cumbria HeadStart Project and more co-ordinated early help services are evident.

What is the whole system approach?

Our vision covers every level of mental health and wellbeing of which there are four – known as tiers. Together they form the whole system.

Tier 1:
Support from those who have contact with the young people on a regular basis. Children and young people’s needs should be supported by services and staff who understand their own role in how these needs are met.  These staff must have received the correct training and ensure early help and targeted support impacts on improved outcomes for these children and young people.

Tier 2:

Targeted intervention to support and address mild mental health issues. There is currently a gap in provision in Cumbria however this is being addressed with new multi-agency working and discussions with commissioners to ensure a longer term and robust service.

Tier 3:

CAMHs – specialist targeted intervention for moderate to severe mental health issues.

Tier 4:

Severe mental health issues requiring Inpatient facilities (currently not available in Cumbria).

For more information about tiers, please visit http://www.icptoolkit.org/child_and_adolescent_pathways/about_icps/camh_service_tiers.aspx

Update on progress made to tiers 1 and 2:
The Emotional Wellbeing and Mental Health Partnership has highlighted gaps in the provision of emotional and mental wellbeing support services at both specialist level and targeted level.

The following work is underway to address this:

  • The HeadStart initial project is now delivering services across 9 specified delivery projects in the Barrow and Carlisle areas and in 26 schools. The pilot schools have developed emotional resilience innovation projects which will be developed further and disseminated as good practice.  Even in this initial stage in HeadStart, projects are delivering targeted services that otherwise would possibly remain as unmet need or result in a referral to tier 3 services (CAMHS).
  • Self-harm and suicide prevention training is being provided by Carlisle and Eden Mind and Self-Harm Awareness across all districts between June 2015 and April 2016.  Self Harm Awareness for All Cumbria (SAFA) is another provider that is now able to offer self-harm training and support to practitioners and schools to raise awareness and help young people who are self-harming
  • A children’s and young people’s improving access to psychological therapies (IAPT) project has been commissioned.  It is operational and beginning to impact upon service transformation and integration.  There are currently five staff from CAMHS undertaking training in the cognitive behavioural therapy component for children and five staff from partner agencies (Barnado’s and Action for Children) training in a parenting approach.
  • Mental health awareness training for schools is being developed by Cumbria County Council in partnership with Young Minds.
  • Cumbria Partnership NHS Foundation Trust in conjunction with 5 secondary schools in North Cumbria have come together to deliver a pilot project to enable school  children and young people access to lower level tier 3 support in school as part of an agreed plan of care. It will start in September 2015 and will be delivered by a mental health practitioner. This will be a combination of drop in sessions and up to 6 follow up sessions. Those accessing this would ordinarily have to come out of school to access this support.
  • The resource directory is being updated with the aim of having the work completed by September so that every district is able to access information about locally delivered emotional wellbeing and mental health support service with up to date contact and referral details.
  • A multi agency self harm and suicide prevention training and professional subgroup has been established to agree on the work plan for 2015-16 in July 2015. The group will support providers to share knowledge and experience and ensure a consistent standard of provision though a pilot development scheme. The group will also ensure the roll out of the self harm pathway.

Update to progress made on Tier 3 CAMHS

The specialist CAMHS service is delivered by three teams across the county (north south and west). There is a Countywide Senior team which consists of a clinical director, consultant psychologist, a quality and safety lead and a clinical services manager. As well as the senior team, each area also has 6 practitioners and 1.5 full time equivalents posts of Consultant Psychiatrists. 

The three teams are now fully recruited to, with the exception of psychiatry, and the operational management of the teams has been strengthened.  We have two substantive psychiatrists and we are covering the vacant posts with locums where it is possible and safe to do so.

There remains a significant risk regarding the difficulty in recruiting to psychiatry posts and this does reflect the national picture. This issue creates a number of challenges in respect of the ability of the service to respond both in and out of working hours to young people in crisis, and work has begun to look towards developing a service delivery model that also works alongside routine CAMHS care.  This work is significant and will include colleagues and partners from within CPFT, the acute sectors, local authority, third sector, Tier 4 providers and commissioners and is important for the service going forward focussed on the needs of children and young people. Ongoing work from our CAMHS teams continues with acute partners for instance, in the form of providing mental health training for paediatric staff caring for young people in hospital settings.

Approximately 1/3 of all referrals into the CAMHS don’t need the specialist support it provides – work is underway with all partner referrers and communities around the purpose of the tier 3 service and the investment into tier 2 services will help to reduce referrals which would be more appropriate for other services.

Although there has been some improvement in waiting times in recent months, waiting times are unacceptably long and lack responsiveness in some areas. We are addressing this by changing the way we communicate with families whilst they are on the waiting list offering them other means of support and advice. The work addressing inappropriate referrals will also help alleviate this.

Work is currently underway to coordinate and develop a nurse led strategy to deliver a service to young people with Attention Deficit Hyperactivity Disorder (ADHD) and their families, the service will include a lead CAMHS practitioner in each of the 3 teams. Care of children with autism continues to be developed outside CAHMS by the specialist community network.

Following the recent OFSTED inspection partners are working hard to develop a fast track access service for children in our care with Cumbria Clinical Commissioning Group investing resource to ensure we can meet the need.   Barnardo’s and Cumbria County Council are looking to develop a new model to prioritise children and young people in our care and to ensure they receive support from the most appropriate service.

In line with the national picture, there are unclear pathways for the provision of a place of safety for young people when a tier 4 bed is required resulting in longer delays than needed.


It has been identified that this work will take several years to complete and whilst significant challenges remain in Cumbria, there has been progress within the last twelve months.  Collaboration between partners is strong and the level of multi-agency involvement from the emotional wellbeing and mental health partnership group demonstrated the high level of commitment by partners to improve emotional and mental health outcomes for our children and young people.


Gill Rigg, Chair Cumbria LSCB

Anne Sheppard, Strategic Manager, Emotional Wellbeing and Mental Health, Cumbria County Council

Dr Amanda Boardman, GP Clinical Lead (Children & Safeguarding) NHS Cumbria Clinical Commissioning Group

Dr Sara Munro, Director of Quality & Nursing, Cumbria Partnership NHS Foundation Trust