Thank you. Good morning. In terms of local primary mental health support services, what is your understanding of the issues leading to some health boards not meeting the Mental Health (Wales) Measure 2010 targets for assessment and therapy for children and young people, and how much of this is due to an increase in demand?
Yes, thanks very much. So, it's important to say, I think, at the outset, just by way of reminder, that the target, quite rightly, changed for children and young people. The target changed some years ago for adults, so it was only right that there was an equalisation around children. So, the services were working, a couple of years ago, with significant demand and then a change in the standard. I think you're absolutely right; your question alludes to the fact that some health boards are struggling to maintain the full performance around seeing children, particularly within the 28 days. I would say—. And we've had some discussion about whether the impact of the mental health Measure has actually drawn perhaps some of the workforce, the staff, who would have been working at that earlier stage in local primary mental health, into a bit more of the secondary element, which is why the review being undertaken by the NHS delivery unit into primary care CAMHS is so critical, because, actually, if we don't have—and I believe we don't have—enough capacity in that part of the system, then referrals will move towards the more specialist end of this. So, I think we will have seen, by the evidence submission, that demand has increased, not just in Wales but in the UK, and it has increased significantly. We are doing reasonably well at meeting that demand—so, we have more contacts, more staff, shorter access times, so that is a good news story. We've not got it completely sustained at this stage, and therefore the focus of the delivery unit's primary care CAMHS report is what more can we do in that part of the system to help to see children and young people or provide consultation and liaison to others and support people at that level of intervention.
Thank you. I know, from my own experience as a constituency AM, I have families who tell me that they can't get into the early interventions and eventually things just become so—they end up in the more specialist ones and believe that that's—. And I don't like to put it in resource terms, but it's false economy in terms of the impact on the child and the family, but, obviously, in terms of cost as well. Do you find that that's a common theme across Wales?
Yes. I think that the thrust of that is absolutely right. So, we absolutely need to see children and families at the earliest intervention and that's why this is a whole system, not compartmentalised. I think there have been really good attempts in a couple of areas of that greater reach out and that earlier help—hot clinics and those sorts of initiatives that help people not to get in a long queue for specialist CAMHS, but can be supported, often by telephone, at that earlier stage. My sense of where we go next, in terms of, you know, you talk about early help and enhanced support for all the 'missing middle', as you referred to it in your report, is to make sure we've got a fully joined-up, multi-agency team approach to that. And I think that will need some resourcing to support that, yet to be fully determined. But yesterday's announcement about youth work, the Government's commitment to primary care, CAMHS, et cetera—that's all going to be very helpful to prevent those young people having to go into specialist CAMHS. And just a final note on that, if I may—at the beginning of the programme, we had a report from Hafal called 'Making Sense' and there were 10 key asks, if you like, of the system and the service from young people who had experience of the service. They said, 'Please don't medicalise it'—I'm paraphrasing now, of course—'Please don't medicalise it; please focus on supporting teachers and others who can support us at an earlier stage and then, when we really need help, please ensure that it is there at that more specialist level.' That's been a bit of a guiding principle for the programme. So, that reflects the questions that you were asking, really.