Emotional Wellbeing and Mental Health

Executive Summary

It is estimated that 1 in 10 Children and Young People (CYP) have poor mental health and 70% of CYP have not had appropriate interventions at a sufficiently early age. Surrey’s 5-14 year old demographic is experiencing the biggest increase in population. In 2017 Surrey is expecting to see a 14% increase in children aged between 5-9 years therefore approximately an additional 10,000 children in this age group. With a projected growth of Surrey’s CYP population and a greater awareness of the need for good emotional wellbeing and mental health there could be an increase in demand on child and adolescent mental health services.

A person can develop poor mental health and lower levels of resilience at any stage of their life however key factors can increase the likelihood of a CYP person from experiences poor mental health. Some of the key vulnerable groups identified in this chapter are Looked After Children, Care Leavers, Children in Need, CYP who are being looked after under a SGO or adoption order and CYP who are SEND.

In Surrey Emotional Wellbeing and Mental Health services are commissioned from universal to acute provision with a key focus on early intervention and identification. CAMHS services should be commissioned and co-designed collaboratively with children, young people and their families. Further commissioning should be more closely aligned to Early Help and SEND Services.

It has been identified that CYP, their families or carers require timely assesses to mental health services and that provision is spread evenly across Surrey. More work needs to take place to ensure that young people who are transitioning from CAMHS to Adult Service or stepped down into other provision feel comfortable and part of the Care Planning.

Greater understanding of need for under served groups such as LGBT+, Gypsy Roman Traveller Families (GRT), Black Minority Ethnic (BME), Children from Armed Forces and English as a Second Language to inform future commissioning decisions.

Introduction

It is Surrey’s vision that Children and Young People (CYP) are happy healthy safe and confident in their future. CYP who have good mental health are more resilient, more likely to have positive relationships, are physically healthier, achieve more educationally and have better social outcomes. This JSNA chapter will focus on Surrey’s Children and Young People 0-18 years (up to 25 years for SEND) and the types of need and provision of services that supports wellbeing and resilience from universal to acute services. If a child or young person does not receive appropriate support for their emotional wellbeing and mental health (EWMH) and intervention this can lead to higher school absence rates, increased risk of poor physical health, poor educational outcomes and mental health issues that can escalate. Therefore prevention with early intervention and access to relevant services is key to achieving better outcomes for CYP and their families.

Who’s at risk and why?

A person can develop poor mental health at any stage of their life, for more information on Adult Mental Health please see JSNA chapter: Wellbeing and Adult Mental health.

This section will focus on key factors that can affect CYP’s wellbeing and resilience and will then look into key vulnerable groups that are more likely to have poor emotional wellbeing and the reasons why.

The below image highlights key factors that Public Health England have identified that can impact on a child and young person’s resilience and emotional wellbeing.

Source: Public Health England (2016) The Mental Health of Children and Young People in England

High Risk Groups

Parental Mental Health

Mothers who have poor mental health or unresolved mental health conditions are more prone to developing postnatal depression which can negatively impact on the infants cognitive, emotional, social and behaviour development both short and long term. Breastfeeding is considered as a protective factor in terms of mother and baby’s short and long term mental health. Poor parental mental health in mothers and fathers can negatively impact on a child’s attachment, self-esteem, resilience and how the child interacts with others. Parents with EWMH needs may require further support with parenting to help the family unit build resilience.

For more information please see JSNA Chapter: Perinatal Mental Health and JSNA Chapter: Maternity and infant feeding.

Looked After Children

Looked after Children are four times more likely to have poorer mental health compared to children that have not entered the social care system. There are a number of factors that can contribute to a Looked After Child having poor emotional wellbeing, for example, they could have experienced poverty, abuse, neglect and bereavement. The impact of a Looked After Child not receiving support for their emotional wellbeing could result in them being at a higher risk of smoking, abusing substances, participating in underage drinking and become a teenage parent. Therefore it is important that this group of vulnerable young people have access to mental health services to support their emotional wellbeing and prevent further escalating of their mental health needs.

Unaccompanied Asylum Seeking Children (UASC)

UASC are at a high risk of having poor emotional wellbeing due to the probability of them fleeing war/ conflict, being trafficked, tortured, sexually exploited and subjected to female genital mutilation. UASC tend to be males in their mid-teens. UASC do not tend to disclose mental health problems until crisis point, this could be due to fear of affecting their asylum claim, issues around stigma, language and cultural barriers. UASC tend to suffer from post-traumatic stress disorder, depression, trauma, self-harm and anxiety. It is important that there are services that are trained to deal with these issues sensitively so that issues can be identified as early as possible.

Care Leavers

Care Leavers are more likely to be at risk of poor mental health due to their experiences before they were taken into care. Approximately half the children in care and therefore care leavers have a clinical mental health problem. Care Leavers can face a multiple of changes as they transition into adulthood for example, responsibility for their own finances, living arrangements and education, which can be daunting. ‘Staying Put’ Care Leavers and Care Leavers who live in Supported Loggings are more likely to have a family based support network therefore they are more likely to have higher levels emotional wellbeing compared to Care Leavers who live independently. If Care Leavers have any unresolved or unmet mental health needs that are not being addressed or monitored this can dramatically affect their mental health as they enter into adulthood.

Children in Need (CiN)

Children in need are identified as a demographic that need appropriate provision and services to support them in having a reasonable standard of life. A child who is identified as ‘in need’ could also have additional physical or mental health needs. In Surrey the main reason for a child or young person to become CiN is due to abuse or neglect, CiN also includes CYP who have a physical or mental need therefore they might require support for their emotional wellbeing.

Special Guardianship Orders and Adoption

CYP who are being cared for through a Special Guardianship Order (SGO) or who have been adopted are more likely to have additional mental health needs compared to CYP who live with their birth families. This could be due to the experiences these CYP had prior to coming into care when some of these young people may have experienced neglect, physical and mental abuse. Family units can struggle when a child or young person is presenting with poor mental health. If a family breaks down this can be traumatic for all parties involved, it can be especially difficult and upsetting for the CYP and could further impact on their mental health and resilience.

Special educational needs and disability (SEND)

Children and young people who have special education needs and disability (SEND) are more likely to have poor mental health and lower levels of resilience due to their Social, Emotional & Mental Health needs (SEMH). SEND children and young people might have trouble with regulating their emotional responses, expressing themselves and exhibit difficult and challenging behaviour which can lead to school exclusion. Some CYP can suffer from depression and anxiety due to the mental or physical nature of their condition. Boys are more likely to be diagnosed with Autistic Spectrum Disorders (ASD), Attention Deficit Hyperactivity Disorder (ADHD) and other neurodevelopmental conditions which may require further support such as medication or coping strategies. Families that have SEND children can sometimes require further support with their own resilience and coping strategies due to the complex nature of the CYP needs they are looking after, some families could even require respite care.

For more information on SEND please see JSNA Chapter: Children and young people with Special Educational Needs and Disabilities (SEND)

Sexual abuse, Harmful Sexual Behaviour (HSB) and Child Sexual Exploitation (CSE)

CYP who have suffered from sexual abuse or CYP who are carrying out harmful sexual behaviour (HSB) are more likely to have poor mental health. CYP who have been subjected to sexual abuse, CSE or display harmful sexual behaviour are more likely to be isolated from friends and family, regularly go missing, have low school attendance, have problems with addiction, partake in criminal behaviour and self-harm. Sexual abuse, CSE and HSB does not tend to take place in isolation, other types of abuse such as neglect, physical abuse, substance misuse and living in poverty are closely linked. Statistically white females aged between 14-17 years are most at risk of CSE. Boys are also at risks of sexual abuse and CSE however this is believed to be underreported.

The NSPCC have stated that over 9,000 recorded child sex offences were perpetrated by children in 2016. There are many interlinking factors that could increase the likelihood of a CYP to carrying out HSB. The CYP could have suffered abuse, neglect, have low self-esteem, be struggling to understand their own gender and sexual orientation, been sexually abused themselves or have SEND needs. CYP who have little boundaries around access to the internet, mobiles and T.V who can easily view non appropriate content can cause themselves distresses and this can be linked to a CYP committing HSB. It is important that children and young people who are at risk or have suffered from sexual abuse are identified early and are able to access services to address their mental health requirements and improve their resilience against other forms of abuse.

For more information on CSE please see Child Sexual Exploitation Needs Assessment 2016

LGBT+ (Lesbian Gay, Bisexual, Transgender and Questioning)

If a young person identifies themselves to be LBGT+ they are more likely to suffer from poor emotional wellbeing and mental health. Poor mental health can be due to a young person trying to understand their own identity and sexuality, they could be experiencing transphobic and homophobic discrimination and bullying. In 2015, 3.3% of 16 – 24 year olds identified themselves as LGB, the largest percentage within any age group in 2015. If a young person is LGBT+ evidence suggests that they are more likely to self-harm or have suicidal thoughts due to social hostility. It is important that LGBT+ children and young people have access to help if they feel that they need help and support otherwise this could affect their social, emotional, educational and physical outcomes and wider relationships.

For more information on LGBT+ please see JSNA Chapter: Lesbian, gay, bisexual and transgender

Gypsy Roman Traveller Families (GRT)

GRT suffer from greater health inequalities compared to the general population. CYP from the GRT communities are less likely to access universal services and therefore achieve poorer health, social and educational outcomes. Therefore there is a higher probability that if a CYP is displaying poor mental health this would not be picked up by professionals such as teachers. If a CYP from the GRT community does not have access to mental health services issue can escalate into their adult life.

For more information on Surrey’s GRT Community please see JSNA Chapter: Gypsy, Roma and Travellers

Domestic Abuse

SafeLives estimates in Surrey that there are approximately 3,300 children living in homes where there is domestic abuse (DA). SDAS data indicates that 50% of perpetrators have mental health needs. DA can have a negative and lifelong effect on a family’s mental health and resilience. CYP who experience DA are more likely to become aggressive, anxious, depressed, have poorer educational outcomes and display anti-social behaviour . If have child has witnessed or been a victim of DA there is also the increased risk of child to parent abuse. DA in adolescent relationships has a relatively high prevalence ‘Define the Line’ research by Refuge and Avon found that over half of 16-21 year olds experienced controlling behaviour from a partner and said that they felt ‘intimidated, humiliated or worthless’. Therefore it is essential that CYP and their families are aware of how to access help for their physical and mental health.

Substance misuse

Substance misuse can affect the quality of parenting a child receives. A CYP might not be receiving a good level of care, have attachment issues with the parent or could be neglected which would impact on the CYP mental health. CYP who misuse substances could be self medicating to try and cope with traumatic events, relieve stress, or those trying to come to terms with their own gender identity or sexuality. If a young person engages with substance misuse this can affect their emotional, social and educational wellbeing.

For more information on Substance misuse please see: JSNA Chapter: Substance misuse

Bullying

There is a strong link between lower levels of overall wellbeing and bullying . CYP who are bullied either physically or mentally are at a higher risk of feeling isolated and alone which can lead to disengagement from education and poorer outcomes across health, social care and education. Surrey County Council’s 2015-16 report into Prejudice-Related Incidents in Surrey Schools found that in Elmbridge nearly one in five CYP had been bullied in that last three months. The same report highlighted that 83% of were bullied at school and 21% were bullied online. This indicates that bullying is more likely to take place in schools. Furthermore the report highlighted that CYP experienced higher levels of prejudice-related incidents in Reigate & Banstead followed by Spelthorne compared to other areas in Surrey. However these findings could also indicate that Reigate and Banstead and Spelthorne have a higher level or reporting these incidents compared to the rest of Surrey. The year group with the highest percentage of both perpetrators and victims in the primary phase was Year 6 and in Secondary School was Year 9. If a child or young person is being bullied they could develop depression, anxiety, an eating disorder, self- harm or abuse substances. A CYP who are being bullied are twice as likely to start bullying others.

Young People in the Justice System

Any behaviour that breaks the law that comes to the attention of the Youth Justice Service is deemed as an offence. Criminal law defines a young person who is aged 10-17 years old. About 60% of Young Offenders who are in a secure setting have an EWMH problem these CYP could have experienced poverty, abuse, trauma, school exclusion or could have been a Looked After Child. Furthermore CYP who are in custody have a higher prevalence of neuro-developmental disorders. Therefore it is important that young people within the justice system have access to mental health services to ensure that their EWMH needs are supported otherwise there is a high risk that they will continue to offend and experience poor mental health when they reach adulthood.

For more information on Young People and Offending Behaviour please see: JSNA Chapter: Young Offenders

CAMHS Transition into Adult Mental Health Services

When a young person turns 18 years old it is a key transition point in their lives, they could be planning to go onto further education, work, live independently and if they have mental health needs they might require transitioning into Adult Mental Health Services. Transitions should be viewed on a case by case basis and it is widely acknowledged that young people should be involved in their transition planning. It is important that young people do not ‘fall through the net’ during this transition period and are appropriately stepped down or transitioned to Adult Services. If this does not happen the young person is at risk of not receiving the help and support required for them to achieve the best outcomes in their adult life.

For more information on Adult Mental Health please see JSNA chapter: Wellbeing and Adult Mental health.

The level of need in the population

This section will describe the level of need in the local population using estimates of the population affected by the risk factors described in the previous section.

Children and young people population in Surrey

Surrey’s 5-14 year old demographic is experiencing the biggest increase in population. In 2017 Surrey is expecting to see a 14% increase in children aged between 5-9 years therefore approximately an additional 10,000 children in this age group. The Mental Health Foundation state estimate that 1 in 10 CYP have a mental health problem furthermore ‘70% of children and young people who experience a mental health problem have not had appropriate interventions at a sufficiently early age’. With a projected growth of Surrey’s CYP population and a greater awareness of the need for good emotional wellbeing and mental health there could be an increase in demand on child and adolescent mental health services.
The Children’s Society recent report into CYP wellbeing in Elmbridge highlighted that CYP’S wellbeing declined with age and that boys had higher levels of wellbeing than girls which matched the national trend. One of the most noticeable differences that contributed to lower levels of happiness was how girls significantly scored lower than boys with their happiness in regards to their appearance. This highlights that boys and girls can face different types of risks to their well-being during different stages of their lives.

Perinatal Mental Health

10-15% of mothers will experience a mood disorder such as depression or anxiety in the perinatal period (from conception to one year post-partum). Surrey’s Parent Infant Mental Health Service (PIMHS) has been running for a number of years and helps support and provide early intervention in regards to mother/father attachment. A sample survey which consisted of 18 responders carried out in July 2016 for parents that have accessed the PIMHS Service found that 89% of mothers felt ‘Very Satisfied that they had learned to cope with things better as a result of the service’. Health Visitors also play a key role in early identification of low mood/post-natal depression. Young mothers are particularly vulnerable to developing poor mental health. The Family Nurse Partnership programme supports young mothers (19 years and under) who are expecting their first child to ensure they receive emotional support and guidance. Other Early Help Services as Sure Start Children Centres can help provide support for families in need of additional help.

Looked After Children

As at 31st March 2017 871 CYP were Looked After compared to 872 as at 31st March 2016. Out of the 871 children, 58% were male and 72% were aged 10+. Children who are in care will have been through a range of experiences that could include neglect or abuse which will impact on their emotional wellbeing and mental health. In addition they may have a number of additional needs such as SEND which may also contribute to their high level of needs. In Surrey the Strengths and Difficulties Questionnaire (SDQ) can highlight if a child requires additional support for their emotional wellbeing. In 2015-16 33% of returned SDQ questionnaires indicated that Looked After Children required further support. Nearly half of the children who took part in The Big Survey 2016 (a survey that is for children and young people who are Looked After or open to the Care Leavers Service) said they had experienced bullying, which can also impact on their mental health. The Children in Care 3C’s Service has been commissioned to specifically work with CYP who are Looked After to ensure that their specific needs are met.

The percentage of children placed out of county and more than 20 miles from home rose to 25% as at March 2017 compared to 22% in the previous year. If a child is placed out of county and requires mental health services they are still able to receive treatment for their emotional wellbeing due to CAMHS services being commissioned to support CYP 20 miles outside of the county. If a child in placed further than 20 miles outside of the county Surrey CCGs retains responsibility for them as the responsible commissioner as services would need to be commissioned in the area in which they are living.

Fostered Children, Young People and their carers

Nationally as at March 2016 there were 44,320 approved fostering households, this is a 1% decline from the previous year. In Surrey as at the end of May 2017 600 Looked After Children were in Foster Care. 390 of children were placed ‘in house’ with Surrey Foster Carers and 210 were placed with other providers, including Independent Fostering Agencies (IFAs) and other Local Authority Fostering Services. . It is important that fostered CYP and their carers have timely access to emotional wellbeing and mental health services to prevent mental health issues from escalating and placements breakdown. Foster Carers may also need help and support when looking after their Foster CYP. Therefore services such as the Children in Care 3C’s Service are essential to help this demographic of Surrey’s population needs.

UASC

In September 2015 Surrey County Council was in the top five local authorities that held the largest caseload of Looked After UASC in the country. As at March 2017 Surrey was looking after 141 UASC CYP and 93% were males aged between 13-17 years. The below chart demonstrates the ethnicity of Surrey’s Looked After Children as at 31 March 2017. The chart also highlights how the UASC population has increased in Surrey.

Source: Surrey County Council (2017) 903 Briefing Paper 2016/17 Corporate Parenting Board

UASC are supported under the Children Act 1989: Section 20 and provided with safe accommodation, the Local Authority then becomes their corporate parent. As a Looked After Child UASC are able to assess the same mental health services but they may well have additional needs related to their specific circumstances such as significant post-traumatic stress disorder needs. As these children become 18 years old they move into the Care Leavers Service continuing as the responsibility of Surrey County Council as their corporate parent.

Care Leavers

As young people are moving to independence from care they may have continuing needs for support with their mental health. As identified Care Leavers can face a multiple of changes as they transition into adulthood for example, responsibility for their own finances, living arrangements and education which can be daunting. The number of Care Leavers in Surrey is due to increase by 31% over the next three years due to the rising number of 16 and 17 year olds in care which is partly due to the increased numbers of Looked After UASC. Therefore the CAMHS Care Leavers service are likely to see an increase in demand. If Care Leavers do not have accesses to support from appropriate mental health services this might increase their levels of poor mental health. There is a specific commissioned service for Care Leavers which helps supports their specific emotional wellbeing needs.

Children in Need

In 2015/16 Surrey County Council supported 4,251 Children in Need. At the close of 2020/21, this is projected to rise to 5,435. The highest rates of CiN in Surrey are in Spelthorne, Epsom and Ewell and Elmbridge. This would indicate that children and young people living in this areas are more likely to have lower levels of resilience and poor mental health. Therefore mental health services need to be easily accessible from these locations.

SEND

As reported in the SEND JSNA chapter ‘Surrey has a higher prevalence of SEND in its young population with 3.1 per cent of its population in receipt of a statutory plan, compared to 2.8 per cent nationally’. It is expected in Surrey that by 2020 there will be 6,300 children with statutory plans and by 2025 there will be 6,650. Education Health Care Plans (EHCP) were introduced in 2014 and out of Surrey’s 287,600 children 5,751 children and young people had an EHCP.

CYP who are SEND could have poorer mental because they struggle with their communication and interaction skills, have sensory and or physical needs and cognitive and learning difficulties. Surrey County Council’s 2015-16 Prejudice-Related Incidents Reports indicates that that 45% of CYP who are SEND were recorded as the perpetrator of bullying but only 19% of victims (similar percentages to 2014/15). This could suggest that SEND CYP’s Social Emotional Mental Health needs are not being met and therefore these CYP are presenting bullying behaviour.

Autistic Spectrum Disorders ASD in Surrey schools has increased by 89% from 1,258 pupils in 2010, to 2,378 pupils in 2016. ASD is the fastest growing need type and the highest rates of ASD are found in Woking (9.1) and Mole Valley (6.7). Children and Young people in Surrey who have ASD, ADHD and complex needs may have a range of behaviour and emotional management needs. In Surrey there are a range of specific services which supports CYP and their families from early help services around parenting, to short breaks, support in schools and pre and post diagnostic support.

For more information on SEND please see JSNA Chapter: Children and young people with Special Educational Needs and Disabilities (SEND)

Special Guardianship Orders and Adoption

As at 31 March 2015 14% of children in Surrey ceased to be looked after as a result of an SGO, compared to 11% (England) and 14% (Stat Nbs) The below table presented in the 2016 Looked After Children Annual Report shows the numbers of orders granted in Surrey. The table provides an indication of the level of potentiation demanded for CYP who would might require further support from mental health services and in particular the Post Order Service.

Source: Surrey Health Team for Looked After Children Annual Report 2016

As at 31 March 2015 13% of children in Surrey ceased to be looked after as a result of adoption, compared to 16% (England) and 15% (Stat Nbs). Adoptions are more likely to breakdown if a child is placed after they are four years old. If an adoption breaks down it is usually during the young person’s teenage years.

Sexual abuse, Harmful Sexual Behaviour (HSB) and Child Sexual Exploitation (CSE)

Levels of sexual abuse is under reported nationally and locally. Nationally it is estimated that 16% of people under 16 years old are sexually abused. In 2015-16 340 Surrey children were deemed to be at risk of CSE. 78.8% of the children that were identified as being at risk of CSE were white females aged between 14-17 years. The STARS (Sexual Trauma and Recovery Service) is commissioned to help children and young people who have suffered sexual abuse and help with their recovery.

The A.C.T (Assessment, Consultation, Therapy) service support CYP who display sexually problematic or harmful behaviours. The team work holistically providing assessment, consultation and treatment interventions as well as supporting and offering training to the professional network in order to further reduce risk of further offending and CYP displaying with harmful sexualised behaviour into adulthood. Over a hundred children and young people are referred to A.C.T each year. CYP who access the service tend to be aged between 5-17 years and are more likely to be males, however more recently referrals for females has been growing. The typical most common reason of why CYP are referred onto this service is due to ‘non-contact’ sexualised behaviour e.g. CYP is sharing or viewing graphic sexual content. The service works with the families of CYP to increase their awareness and understanding of what has happened, to enable them to support their child or young person whilst they attend A.C.T.

Anxiety

‘One in six young people will experience an anxiety related problem’. There are four main types of anxiety as described by the NHS are panic disorder, phobias, post-traumatic stress disorder (PTSD) and social anxiety disorder (social phobia). Anxiety in CYP tends to peak around exam periods and transitions form primary to secondary school and secondary to college/work. Surrey’s Emotional Wellbeing and Mental Health Community Nurses consistently report anxiety as the primary reason for referrals into the service. During January – March 2016 Anxiety was the main reason for referrals (38%) followed by Behaviour (20%).

Self-harm and suicide

The NHS defines self-harm as: ‘when somebody intentionally damages or injures their body. It’s usually a way of coping with or expressing overwhelming emotional distress.’ Mental health conditions which are closely associated with self-harming are depression, eating disorders, anxiety, post-traumatic stress disorder and borderline personality disorder. Teenagers and young adults are more susceptible to self-harm, in particular individuals who have been neglected, experienced trauma or abuse. About one in ten young people self-harm and girls are more likely to report self-harm than boys. Due to the nature of self-harm it can be hard to estimate how many children and young people are using self-harm as a coping mechanism if they are not accessing services.

Hospital admissions in Surrey due to self-harm indicates that in 2015-16 self-harm hospital admissions between 10-24 years have increased in Surrey. Nationally 430.5 of the directly standardised rate – per 100,000 were admitted to hospital as a result of self-harm, in 2015-16 Surrey had a higher rate of 448.1 per 100,000. Surrey however have a slightly lower rate compared to the South East of England which is 469.4 per 100,000.

Source: Public Health England, Children and Young People’s Mental Health and Wellbeing, Fingertips

Self-harming and suicide are not directly linked however if an individual does self-harm they can be at a higher risk of a completed suicide. Suicide is an intentional act of ending your life and is usually due to a combination of factors such as bereavement, depression, childhood abuse, substance misuse, physical or mental illness, social factors, bullying and alcohol or drug misuse. Completed suicide rates for children and young people have continued to remain low in Surrey compared to the increase in suicides nationally. A study carried out on suicides found that ‘the number of suicides at each age rose steadily in the late teens and early 20s.Most of those who died were male (76%)’. Furthermore ‘suicide in students took place more often in April and May, conventionally exam months’. Therefore if a young person is not receiving the right support at the right time there is a possibility that their poor mental health can escalate to self-harming and on rare occasions even suicide.

Healthy weight and Eating Disorders

Maintaining a healthy weight is linked to having better health and wellbeing outcomes. Areas of deprivation tend to have lower levels of healthy weight. The NHS describe an eating disorders as ‘an abnormal attitude towards food that causes someone to change their eating habits and behaviour.’ Females tend to suffer from eating disorders more than males however there has been an acknowledgement that eating disorders in males is increasing. The most common types of eating disorders are anorexia nervosa, bulimia and binge eating disorder (BED). These types of disorders usually develop during adolescence and can negatively affect a young person’s physical health. In the most severe cases 1 in 5 people will die prematurely from an eating disorder.

In Surrey-wide CYP Specialist Eating Disorders Service, young people under 18 years old who have a suspected Eating Disorder are able to be referred onto the Eating Disorder Service. All suspected eating disorders are now responded to within 5-15 days. Therefore early intervention is able to take place which gives children and young people better chances of a quicker and more sustained recovery.

The below table shows the total number of Eating Disorders Referrals into the Surrey-wide Specialist CYP Eating Disorders Service for outpatients since its’ inception in 2009. Referrals have slightly increased since March 2017, following improvements in clinical access to treatment and additional staffing resources being made available due to the NHSE Access and Waiting Times agenda and additional funding being provided by the Surrey CCG’s. Admissions to hospitals have also reduced by 60% due to this resource improvement (see second table).

Source: SABP Eating Disorders Service for Children and Young People

Source: SABP Eating Disorders Service for Children and Young People, Transformation Funds Summary Document 2017

Specialist Complex social, emotional and behaviour needs

CYP sometimes require more specialist level of support with their complex emotional wellbeing and behavioural needs. To prevent CYP from having an unnecessary admission to an adolescent psychiatric bed. The Hope service provides an intensive community support package and a therapeutic day programme for CYP whose needs cannot be met by one agency alone and require intensive support. The Hope service helps to prevent or shorten young people being admitted to an inpatient unit or being placed in an out of county placement. Extended Hope provides an out of hours intervention, assessment service and respite beds for CYP who are experiencing an emotional/mental health crisis. 80% of CYP who accessed the HOPE service between April-May 2017 said that they ‘were either ‘extremely likely’ or ‘likely’ to recommend the Hope Service’.

The requirement for Surrey’s CYP to access Tier 4 services has been on a downward trend since September 2016. This coincides with the opening of the Extended Hope service which aim to prevent children and young people having unnecessarily referrals/visits to hospital or A&E. Over recent years there has at times, been difficulties identifying and securing Tier 4 adolescent psychiatric beds in a timely manner and local to Surrey. This has occasionally resulted in young people being admitted to beds many miles from their family and community. This has impacted on the level of community outreach that can be offered to young people whilst in hospital, which in turn can increase bed days. In addition the difficulty sourcing appropriate beds has also resulted at times in delayed discharge from acute hospital beds and 136 suites to specialist psychiatric beds. On rare occasions it has been necessary for young people to be temporarily admitted to adult wards with CAMHS staff offering daily visits until an adolescent bed can be sourced. There is now work and planning in progress to commission and secure more local beds across Surrey, Kent and Sussex to alleviate some of the above issues. This will be in place from 1st April 2018

Transition from CAMHS to Adult Services

Information on young people who have or will transition onto Adult Services or stepped down into other provisions is currently not being captured. Young people that have transitioned from CAMHS Services to Adult services have told us that is can be ‘scary’. The Mindful Service is aimed at 16-19 year olds who do not access Mental Health Services. Although this service does not work with young people who are already receiving support from a Mental Health Service, they do work with those young people who find it difficult to engage with mental health services. If a young person is accessing the Mindful Service and they require secondary Mental Health support this team works with the young person to help facilitate and support young people in order to meet their needs and promote engagement. The CYPS Haven, which is part of the Mindful Service also helps to support young people who will transition to Adult Services by supporting young people to develop relationships with the Adult Havens by slowly introducing them with supported visits and a robust care plan.

Services in relation to need.

Surrey’s Children and Young People EWMH health services commissioning structure consist of 6 CCGs, NHS England, Public Health and the Local Authority. Other funding sources such as from Transformation Funding also helps support innovate ways of commissioning EWMH services. Services are commissioned from universal to acute provision which has a key focus on early intervention and identification.

The promotion of positive emotional wellbeing and mental health in schools is recognised as being key to building resilience and giving CYP a greater understanding of mental. The Targeted Mental Health in Schools service (TaMHS) addresses and promotes positive mental health and ‘enables schools to access assistance in order to help meet the needs of local communities. As at July 2017 93% (364) of schools were engaged with TaMHS. 65% of engaged schools had core mental health training with 8% of these schools accessing this training for a second time. 26% of engaged schools have taken part in attachment training. 207 schools engaged with their Primary Mental Health Worker (PMHW) – up from 158 (March 2016). 62 schools have now received additional bespoke training. If schools are regularly in contact with their designated PMHW this promotes better mental health in schools with CYP being taught coping techniques and CYP being able to access help quickly and effectively.

For information on mental health support in Surrey schools please see JSNA Chapter: Developing Healthy Lifestyles.

The new CYP Haven is another option for CYP to go to seek support for their EWMH needs. ‘The Haven is a safe place to go where young people can go to talk about their worries and mental health in a confidential, friendly and supportive environment. The service is a drop-in so there is no need to phone or make an appointment. Any young person aged between 10-18 years can visit so long as they are in need of emotional support or concerned about how they are feeling. CYP Haven has a number of professionals who work there including a Mental Health Nurse, a Youth Worker and a Peer Mentor.’

Other ways CYP can access peer support is through the CAMHS Youth Advisors (CYA) is a network of around 250 young people who all access or have accessed mental health services in Surrey. CYA works to ensure that CYP who use CAMHS have a voice in what goes on in CAMHS through being involved in recruitment, staff training, service development and lots more. CYA present at schools and colleges to raise awareness and reduce stigma around mental health, by sharing young people’s experiences and provide information and training to the Police and GP’s in a young person’s perspective of mental health.

For more information on CYA please see their website CAMHS Youth Advisors (CYA)

It is important that CYP and their parents/carers who need support with emotional wellbeing are able to access a range of different services through Surrey’s Early Help Offer and other universal mental health services, to prevent mental health issues from getting worse.

Transformation Funding

Transformation funding (2015-2020) is part of NHS England’s programme to Transform CAMHS services and encourages innovation, improved outcomes and service quality. Transformation funding in Surrey has helped support key initiatives such as CYP Haven in Guildford and Enhancing the Eating Disorder Service and pathway, Hope and Extended Hope. For more information on Transformation Funding please see Surrey Child and Adolescent Mental Health Whole System Transformation Plan.

Below is a visual overview of the current Emotional Wellbeing and Mental Health Services available for Children and Young People in Surrey.

Source: SABP CAMHS Service Model

The below table displays the key services that support the most vulnerable groups

Vulnerable groups or specific need Service in relation to need
Easy and accessible way to make a referral to the CAMHS Services OneStop
Surrey-wide NHS community health service for children and young people from birth up to 19 years of age (up to 25 for young adults with additional needs) and their parents and carers Children and Family Health Surrey
Parent infant Mental Health – Mothers who have mental health issues and poor attachment to child Parent Infant Mental Health Service (PIMHS)
Online mental health support Xenzone – Kooth
Help young people build their wellbeing, resilience Eikon
Children and young people start to present with poor emotional wellbeing and low levels of resilience Primary Mental Health Team
Support children and young people when they begin to feel unwell (For CYP over 10 years old) Youth Support Service
Looked After Children & UASC Children in Care 3 C’s Service
Care Leavers Care Leavers Service
Adoption or SGO Post Order Support Service
Sexual Abused and Child Sexual Exploitation
Children who display Harmful Sexual Behaviour
STARS (Sexual Trauma and Recovery Support)

A.C.T (Assessment, Consultation, Therapy)

Intensive day service support for 11-18 year olds experiencing complex mental health and social care needs Hope Service
Out of hours support for 11-18 year olds experiencing a crisis Extended Hope
ASD, ADHD, Complex Needs
Parenting programme for parents of CYP with ADHD
Behaviour & Neurodevelopment Service (BEN)
Brain In Hand
National Autistic SocietyBarnardo’s parenting programme
CYP with moderate to complex or chronic problems mental health issues Specialist CAMHS
CYP up to 18 years with sever Learning Disabilities Community Learning Difficulties Service
Support for CYP and their families who have an Eating Disorder Eating Disorder Service
16-25 year olds who require support with their mental health Mindful Service
Substance Misuse Catch 22

The Family Information Directory provides more information on the types of services that are available to help support CYP and their family’s emotional wellbeing and mental health.

Pleases see the following table for a full list of services that includes Surrey’s Early Help provision which helps to support CYP and their families wellbeing and resilience.

Universal Community Health Providers Contract

  • Emotional Wellbeing and Mental Health Community Nurses
  • Universal 0-19 Healthy Child Programme Service
  • Community Nursing for Children’s Emotional Wellbeing and Mental Health
  • Parent Infant Mental Health Service (PIMHS)
  • Special School Nursing
  • Paediatric Occupational Therapy (OT)
  • Paediatric Physiotherapy Service
  • Early Years (0-5 years) and acute intervention (0-19)Speech and Language Therapy Service
  • Safeguarding Children
  • Looked After Children Health Services
  • Children’s Community Nursing
  • Children and Young People’s Continuing Healthcare
  • Developmental Paediatrician Service
  • Community Paediatric Audiology Service
  • Tongue Tie (Ankyloglossia) Service
  • Provision of Services for Child Victims of Sexual Abuse in Surrey
  • Integrated Enuresis & Continence Assessment and Treatment Service
  • Paediatric Nutrution and Dietetics Service for Children and Young People with Neurodisability
  • 0-19years community and school-age immunization service Surrey

Beacon UK – One Stop
Brain in hand
Catch 22
National Autistic Society
Surrey Youth Support Service
Xenzone – Kooth.com
Voluntary Youth Services
Eikon
Heads Together
Learning Space
The Lifetrain Trust
Relate West Surrey
Reflex Woking
Step by Step
Windle Valley Youth Project

Early Help Offer

  • Education Welfare Service
  • Family Information Service
  • Pre-school Settings
  • School’s Support Team
  • Early Years Safeguarding Service
  • Out of School Providers
  • Sure Start Children’s Centers
  • Nurture Groups
  • Stop Smoking Service
  • Condom distribution scheme and Chlamydia screening
  • GUM and contraception services
  • Children’s weight management services
General Support Services

  • GPs
  • Occupational Therapy
  • Family Information Service
  • Community Youth Work Service
  • Police
  • Midwives
  • Health visitors
  • School Nurses
  • Educational Psychology
  • Education Welfare Service
  • Surrey Online Service
  • School/Early Years: SENCO, HSLW
  • Children’s Centers
  • PSHE Curriculum/TaMHS
Targeted Targeted Contract

  • Primary Mental Health Service
  • Special Schools and specialist Centres
  • Learning Disabilities
  • Youth Support Service
  • CAMHS Extended Hours Service
  • Looked After Children (3Cs)
  • Adopted Children and Special Guardianship Order (Post Order Service)
  • Care Leavers Service
  • HOPE Services (Epsom & Guildford)
  • Extended HOPE Service
  • STARS (Sexual Trauma and Recovery Service)
  • Parent Infant Mental Health Service
  • Behavioural, emotional neurodevelopmental (BEN) Pathway
  • Barnardo’s – Parenting Programme for parents of children and young people with Attention Deficit Hyperactivity Disorder (ADHD).
Early Help Offer

  • Homestart Surrey
  • Oasis Family Centre
  • Leatherhead North and Walton North Early Help Volunteer Support
  • Welcare South East Surrey (Redhill)
  • Sandy Hill Estate Volunteer Support (Waverley)
  • Out of School Providers
  • Family Information Service
  • Pre-school Settings
  • Sure Start Children’s Centres
  • Early Years Safeguarding Service
  • Health Eating in the Really Young (HENRY)
  • Education Welfare Service
  • School’s Support Team
  • Year 11/12 Transition Service
  • Carer’s Break Grants
  • Merlin Pass lottery
  • Play & Leisure services (community based)
  • Play & Leisure services (school based)
  • Personal Support
  • Autism Outreach Service
  • Learning Disability Outreach Service
  • Cygnet autism parenting programme
  • Portage service
  • Earlybird autism parenting programme
  • Nurture Groups
  • Early Support Service
  • Early Years Language Team
  • Catch 22 Substance Misuse Service
  • Stop Smoking Service
  • Condom distribution scheme and Chlamydia screening
  • Emergency Hormonal Contraception and Chlamydia treatment
  • GUM and contraception services
  • Sexual Health Advisors
  • One to one prevention
  • Neighbourhood prevention
  • Community Youth Work Service (CYWS)
  • YMCA Open House (Guildford)
  • Paediatric physiotherapy
  • Children’s weight management services
  • School nursing team child, young person and family weight management pilot
  • Surrey Domestic Abuse Support Service
  • SLT
  • Social Care
  • Voluntary sector providers
  • Social care transition team
  • Health
  • Occupational Therapy (U,S)
  • Speech and Language Therapy (U,S)
  • Physiotherapy (S)
  • Primary Mental Health Workers (CAMHS community service)
  • School nurses (U,S)
  • Home start
  • Neighbourhood local prevention
  • One to one local prevention
  • Surrey Domestic Abuse Support Service
  • Safe Havens
  • Community Youth Work Service
  • Surrey Family Support Programme
  • Youth Support Service
  • Young carers
  • Education Welfare Service (U,S)
  • Education
  • Educational Psychology (U,S)
  • Portage (S)
  • Surrey Online School
  • Nurture groups
  • Cygnet
  • Early Bird
  • Specialist Teachers (S)
  • Outreach
Specialist Specialist Contract

  • Community Child and Adolescent Mental Health Services- Specialist
  • Children and young people Learning Disability Service- Specialist
  • Eating Disorder Service- Specialist
  • Hardtoengage 16-25 year old service– known locally as the Mindful Service –Targeted
Early Help Offer

  • Oasis Family Centre
  • Welcare
  • Family Nurse Partnership
  • Education Welfare Service
  • School’s Support Team
  • Play & Leisure services (community based)
  • Residential short breaks (in house)
  • Residential short breaks (community based)
  • Personal Support
  • Surrey Domiciliary Care Service
  • Surrey Short Break Carers
  • Autism Outreach Service
  • Learning Disability Outreach Service
  • Cygnet autism parenting programme
  • Portage service
  • Earlybird autism parenting programme
  • Early Support Service
  • Catch 22 Substance Misuse Service
  • Paediatric physiotherapy
  • Surrey Domestic Abuse Support Service
  • Sure Start Children’s Centers
  • Community Youth Work Service
  • Surrey Domestic Abuse Support Service
  • Youth support service
  • Early years language team
  • Primary Mental Health Workers (CAMHS community service)
  • Occupational Therapy
  • Looked after children
  • Social Care
  • Ruth house
  • Hope (+ Health)
  • Residential short breaks
  • Personal support Direct payments
  • Extended HOPE
  • Education Welfare Service (U,T)
  • Education
  • Portage
  • A2E – medical
  • A2E – non medical
  • Cygnet
  • Early Bird
  • Speech and Language Therapy (U,T)
  • Specialist Teachers (U,T)
  • Surrey Online School
  • Educational Psychology (U,T)
  • School nurses (U,T)
  • Early Support Service
  • Leap
  • Physiotherapy (T)
  • Physiotherapy
  • Surrey Domiciliary Care Service
  • CYP Haven
Acute
  • HOPE
  • Extended HOPE
  • 365 / 24 / 7 psychiatrist on call
  • Paediatric liaison
  • Home treatment team for 16-18 year olds
  • Crisis Cafe model for children and young people

In Surrey we do not have any acute beds and are low users of national acute beds, due to Hope and Extended Hope Provision crisis beds which keep young people out of hospital paediatric wards and A&E.

Early Help

  • Medical Access to Education
  • Specialist Teaching Teams
  • Education Welfare Service
  • Access to Education Non-Medical
  • School’s Support Team
  • Play & Leisure services (community based)
  • Residential short breaks (in house)
  • Residential short breaks (community based)
  • Personal Support
  • Surrey Domiciliary Care Service
  • Surrey Short Break Carers
  • Catch 22 Substance Misuse Service
  • Paediatric physiotherapy

Unmet needs and service gaps

Surrey’s Children and Young People who have accessed mental health services have told us that:

  • Transitions to adult services can be challenging and scary
  • Clinic hours and locations changes can affect how easily young people can engage with services
  • Young people should be able to complete questionnaires sent to them online as well as by hand
  • Different GP’s have very different views on mental health i.e some can hold unhelpful views on mental health stigma
  • There is very little out of hours mental health support for young people – although this is changing
  • The different thresholds for adult services vs CAMHS can cause issues and anxiety among young people turning 18
  • Good communication between CAMHS workers and other services can aid service transition when a young person turns 18.

Access to services in a timely manner

Children and young people who have experienced Surrey’s CAMHS services have told us that they were unable to access services as quickly as they would have hoped, one young person reported ‘If I was to improve CAMHS service I would reduce the wait time.’ It is important that children and young people are able to access services as soon as possible to prevent issue from escalating. Waiting times should be closely monitored to ensure that children and young people are able to access services as soon as possible.

Children and Young People being able to access local provision

Surrey’s CYP have told us that ‘Clinic hours and locations changing can affect how easily young people can engage services’ Therefore it is important that services are based in easy to reach venues and can be accessed via public transport.

Transition from CAMHS to Adult Services

Surrey does not currently have a service or pathway dedicated to helping support young people transitioning from CAMHS to Adult Services. It is hard to obtain data in relation to how many young people transition successfully to Adult Services and how many young people are stepped down to other services. Based on the information young people are telling us a clear pathway needs to be developed. This unmet need has been recognised and there is currently a pathway being developed as part of a two year National CQUIN however until this has been implemented there is a service gap.

Continue to improve communication of the local EWMH offer with other agencies

A substantial investment into Surrey’s EWMH provision has taken place and it is important that these services are clearly communicated between partners, such as schools, GP and the Police. To ensure that CYP are able to access the appropriate level of support as soon as it is required.

LGBT+ Mental Health Support Services

Children and young people who are LGBT+ require specialist help and support. This demographic are more likely to self-harm or have suicidal thoughts therefore it is necessary that mental health services are available and easily accessed.

Accurate Data on the Emotional Wellbeing and Mental Health Needs Nationally and Locally

Key data missing:

LGBT+ (Lesbian Gay, Bisexual, Transgender and Questioning), English as a second language

Gypsy Roman Traveler Families (GRT), Black Minority Ethnic (BME), Children from Armed Forces Families, Young Offenders, Adoption/SGO breakdown figures,

CAMHS Transition into Adult Mental Health Services

What works

This section will describe what a good mental health service looks like for children, young people and their families. The range of services that should be available based on best practice and commissioning guidance.

The CSF Commissioning Plan 2017-22 identifies the below key factors which contribute to better commissioning outcomes for children, young people and their families, information specific to mental health services has also been included:

  1. Strengths based, restorative and asset based practice
  2. Primary prevention and universal provision
  3. Early and Targeted interventions (Easy access to CAMHS Services so that children, young people, parents, carers and professionals can get help and support)
  4. Integrated delivery models – where multi-agency professionals work alongside each other sharing processes, resources and information, provides more holistic support for children and families, and prevents them from having to tell their story multiple times.
  5. CAMHS services are commissioned and co-designed collaboratively with children, young people and communities.

National Policy Initiatives and Evidence Base

Implementing the Five Year Forward View
Five Year Forward View for Mental Health
Future in Mind
Sustainability and Transformation Plans
Sustainability and Transformation Plans – Surrey Heartlands
Better Start in Life Promoting good emotional wellbeing and mental health for children and young people
NICE Guidance
Delivering with and Delivering Well
Mental health and behaviour in schools
Children and young people’s mental health—the role of education
Prime Minister transform mental health support plans

Recommendations for Commissioning

  1. CAMHS services are commissioned and co-designed collaboratively with children, young people and their families
  2. Commission services to focus on building CYP and families EWMH needs and resilience
  3. Continue to improve communication of the local EWMH offer with other agencies
  4. EWMH commissioning should be more closely aligned to Early Help and SEND services
  5. Integrated service delivery models should be person centered and include health, social care and education to prevent repetition, delay and gaps in service delivery
  6. Ensure that there is an equitable level of EWMH service across the county
  7. Ensure that services are accessible in a timely way
  8. A pathway for CAMHS Services to Adult Services could be established and clearly defined.
  9. Greater understanding of need for under severed groups such as LGBT+, Gypsy Roman Traveller Families (GRT), Black Minority Ethnic (BME), Children from Armed Forces and English as a Second Language to inform future commissioning decisions.

Key contacts

Surrey County Council

Frank Offer – Head of Market Strategy

Diane McCormack- Deputy Director of Commissioning, G&W CCG

Sheila Jones – Head of Countywide Services

Laura Hoyles – CAMHS Service Development Manager

Chapter References

  1. The Mental Health Foundation (2017) Children and Young People https://www.mentalhealth.org.uk/a-to-z/c/children-and-young-people accessed 23.08.17
  2. Public Health England (2016) The mental health of children and young people in England, p.5 Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/575632/Mental_health_of_children_in_England.pdf accessed 23.08.17
  3. NSPCC (2017) Children in care Emotional wellbeing and mental health https://www.nspcc.org.uk/preventing-abuse/child-protection-system/children-in-care/emotional-wellbeing-of-children-in-care/ accessed 28.07.17
  4. Community Care (2015) ‘We must do more to support the mental health and wellbeing of care leavers’ http://www.communitycare.co.uk/2015/05/05/must-support-mental-health-wellbeing-care-leavers/ accessed 02.08.17
  5. Legislation.gov.uk (2017) Children Act 1989 c. 41, Part III, Provision of services for children and their families : Wales Section 17 http://www.legislation.gov.uk/ukpga/1989/41/section/17 accessed 02/08/17
  6. Surrey County Council (2017) CSF Commissioning Plan 2017-22, unpublished p.9
  7. Surrey County Council (2016) CSE Needs Assessment 2016, unpublished p21
  8. NSPCC (2017) Harmful sexual behaviour Facts and statistics https://www.nspcc.org.uk/preventing-abuse/child-abuse-and-neglect/harmful-sexual-behaviour/harmful-sexual-behaviour-facts-statistics/ accessed 22.08.17
  9. Young Minds – Bush. M, (2016) The Voice of young people’s mental health and wellbeing, Beyond Adversity Addressing the mental health needs of young people who face complexity and diversity in their lives, p.21
  10. NHS Choices (2017) http://www.nhs.uk/Livewell/LGBhealth/Pages/Mentalhealth.aspx accessed 03.08.17
  11. Office of National Statistics (2016) Sexual identity, UK: 2015 Experimental Official Statistics on sexual identity in the UK in 2015 by region, sex, age, marital status, ethnicity and NS-SEC Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/culturalidentity/sexuality/bulletins/sexualidentityuk/2015 accessed 07/08/17
  12. McDermott. E, Hughes. E and Rawlings.V (2016) Queer Future Understanding lesbian, gay, bisexual and trans (LGBT) adolescents’ suicide, self-harm and help-seeking behaviour p.12 Available at: http://www.queerfutures.co.uk/wp-content/uploads/2016/06/Queer-Futures-Final-Report.pdf accessed 23.08.17
  13. SafeLives (2017) Domestic abuse overview report: need and provision in Surrey, unpublished, p.2
  14. SafeLives (2017) Domestic abuse overview report: need and provision in Surrey, unpublished, p.8
  15. NSPCC (2017) Domestic Abuse Signs, indicators and effects https://www.nspcc.org.uk/preventing-abuse/child-abuse-and-neglect/domestic-abuse/signs-symptoms-effects/ accessed 11.08.17
  16. Refuge for Women and Children against Domestic Violence (2017) Define the Line Report http://www.refuge.org.uk/2017/03/06/more-than-half-of-young-people-experiencing-controlling-behaviour-in-relationships/ accessed 07/08/17
  17. Young Minds – Aynsley. A, Bradley. R, Buchanan. L, Burrows, N and Bush. M Dr (2016) Childhood adversity, substance misuse and young people’s mental health Available at: https://youngminds.org.uk/media/1547/ym-addaction-briefing.pdf accessed 11/08/17
  18. The Children’s Society (2016) The 2016 Report on Children’s Well-being Elmbridge p.28
  19. CSF Commissioning Plan 2017-22, unpublished, p.11
  20. Surrey County Council (2016) Report on Prejudice-Related Incidents in Surrey Schools (2015-2016) p.4
  21. The Children’s Society (2016) The 2016 Report on Children’s Well-being Elmbridge P.29
  22. Surrey County Council (2016) Report on Prejudice-Related Incidents in Surrey Schools (2015-2016) p.3
  23. Surrey County Council (2016) Report on Prejudice-Related Incidents in Surrey Schools (2015-2016) p.5
  24. Young Minds (2017) Bullying, How it can affect you https://youngminds.org.uk/find-help/feelings-and-symptoms/bullying/#how-bullying-can-affect-you accessed 11.08.17
  25. Ditch the Label (2017) The Annual Bullying Survey https://www.ditchthelabel.org/annual-bullying-survey-2016/ accessed 11.08.17
  26. Surrey County Council (2013, updated 2017) JSNA Chapter: Young Offenders
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  27. Surrey County Council (2013) JSNA Chapter: Young Offenders
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  30. The Children’s Society (2016) The 2016 Report on Children’s Well-being Elmbridge p.4
  31. The Children’s Society (2016) The 2016 Report on Children’s Well-being Elmbridge p.15
  32. Surrey County Council (2016) PIMHS for Parents July 2016 Survey
  33. Surrey County Council (2017) 903 Briefing Paper 2016/17 Corporate Parenting Board p.3
  34. Arnold. C, Channing. E, Rapley. M (2016) Surrey Health Team Looked After Child Annual Report (2015-2016) p.8
  35. Surrey County Council – Care Council (2016) The Big Survey 2016, A survey of the experiences of Surrey’s children and young people in care p.3
  36. Surrey County Council (2017) 903 Briefing Paper 2016/17 Corporate Parenting Board p.6
  37. National Statistics for Fostering in England 2015 to 2016: key findings https://www.gov.uk/government/publications/fostering-in-england-1-april-2015-to-31-march-2016/fostering-in-england-2015-to-2016-key-findings accessed 17.08.17
  38. Surrey County Council (2017) Draft – Fostering Recruitment & Retention Strategy 2017 – 2019, unpublished, p.1
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  40. Surrey County Council (2017) 903 Briefing Paper 2016/17 Corporate Parenting Board p.4
  41. Surrey County Council (2017) 903 Briefing Paper 2016/17 Corporate Parenting Board p.4
  42. CSF Commissioning Plan 2017-22, unpublished, p.20
  43. CFS Commissioning Plan 2017-22, unpublished, p.19
  44. CFS Commissioning Plan 2017-22, unpublished, p.19
  45. Surrey County Council (2017) JSNA Chapter: Children and young people with Specials Education Needs and Disabilities 2017
  46. CFS Commissioning Plan 2017-22, unpublished, p.22
  47. CFS Commissioning Plan 2017-22, unpublished, p.3
  48. Surrey County Council, (2016) Report on Prejudice-Related Incidents in Surrey Schools (2015-2016) p.4
  49. CFS Commissioning Plan 2017-22, unpublished, p.22
  50. CFS Commissioning Plan 2017-22, unpublished, p.22
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  56. CFS Commissioning Plan 2017-22, unpublished, p.11
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  73. HOPE Service (2017) Hope Service your views matter report, unpublished p.1
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  75. Surrey County Council (2016) School Bulletin, Issue 167 | 22 April, 2016 http://surreycountycouncil.newsweaver.co.uk/SchoolsBulletin/xc8gqlf73l2?a=3&p=50171758&t=20022785, accessed 16.08.17
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  82. CSF Commissioning Plan 2017-22, unpublished, p.35

Signed off by

Health and Wellbeing Board

Commissioning Overview Group