East Sussex County Council consists of coastal areas with multiple deprivations (despite the county overall being relatively affluent) and there is also fluctuation in the demand for mental health services.
i-Rock, a neutral (not explicitly about mental health) drop-in service for young people aged 14-25, was piloted three years ago in response to the practical challenges of reaching the more remote areas of the county and of the stigma that had been observed discouraging young people from accessing mental health services.
East Sussex County Council and CAMHS identified a cohort of young people in Hastings experiencing barriers to accessing mental health services. It had also been noticed that emotional wellbeing issues tend to peak around the age of 17 pushing to 18, thus causing worry about young people not being able to meet the AMHS threshold. Young people would be already experiencing acute difficulty the first time they would present at services.
Additionally, young people reported being less willing to visit the mental health service based in a hospital setting, being worried that they would be stigmatised if they walked through that door. Alistair McGrory, Operations Manager at East Sussex County Council, says: ‘They would tell me: You are not going to get me to go there’.
i-Rock, a partnership between the council and local CAMHS, was piloted four years ago, mainly funded by the Mental Health Transformation budget. The service was designed to be neutral, not explicitly related to mental health. It is a drop-in service for young people aged 14-25, who can self-refer to the service, or who may be referred by their families, schools or be referred by their GPs.
The service focuses on listening to young people and what they perceive their needs to be and helps them to find appropriate support. Young people are triaged and then signposted to the best service available for them.
The successful implementation of i-Rock led to looking at the pathways for referral into Children’s Services and CAMHS. An exploration of referrals showed that there was duplication with a significant amount of cases being passed between agencies.
Children’s Services had already established a Single Point of Contact to triage referrals. Conversation with partners and referrers pointed towards combining the triage function to reduce duplication and direct children and families to the most appropriate outcome. Staffed with Early Help workers and workers from CAMHS, the service has been providing a front door shared screening for over a year now. ‘It’s not up to those making the referral to decide what service is the most suitable each time for the young person to be referred to. We want to allow them to focus on letting us know what their concerns are and what issues they face’, explains Alistair McGrory. Then, during the shared screening staff can decide which is the most appropriate service to direct each young person to, principally taking into account two parameters:
a) whether there are safeguarding issues to consider, and
b) where the support the young person needs can be best accessed in the system of available services.
The partnership working between CAMHS and Children’s Services has resulted in fewer young people being re-referred by services. i-Rock operating as a 14-25 service based on triaging has proven to be far less stigmatising for young people to access. That has also created a cultural change for staff from the council and CAMHS, bringing them to work together and learn from each other.
Alistair McGrory elaborates further on the financial impact of such services: ‘Money that is spent wisely early in one person’s life can have far better outcomes for the individual and hopefully prevent the need for expensive intervention later in life. It is difficult to invest in early help at the moment, because it is always hard to prove the cost-benefit of such services. But a timely intervention is better for the individual and is less costly than waiting for problems to escalate.’
How is the new approach being sustained?
Hastings i-Rock was the pilot and given its success, there are now three such services across the county. ‘It is a bottom-up service instead of a corporate one’, explains Alistair McGrory and continues, ‘the partnership brought different skills to the table; Early Help staff had strong outreach and engagement with young people skills and CAMHS brought the clinical experience and process of evaluation and measurement’.
The hard work was in the planning phase of the project, making sure the partners were clear about how the system would work and overcoming concern around disrupting existing practice. The shared screening came together with very few glitches as the hard work had been done in the planning stage.
i-Rock has also established a service users’ group to collect feedback and front door staff keep digital statistics regarding young people’s satisfaction with the service. The triage team contacts a sample of the referrers of the young people brought in to ask them about their own experience of referring somebody to the service too.
Making the 14-25 service was a leap of faith"
– Alistair McGrory (East Sussex County Council).
When we asked Alistair McGrory what lessons he would share, he told us: 'I think I would say reaching outside what's comfortable and stretching the limits of the service to include things that may not seem to have an immediate priority for you, but that are important for partners to build services which are better for children and their families and also for the staff working in the service.'
Alistair McGrory - Alistair.McGrory@eastsussex.gov.uk
Operations Manager, East Sussex County Council