NHS England welcomes new plans for radical shake up of youth mental health care

NHS England has welcomed plans for a radical shake up of youth mental health care to be announced today by MP Norman Lamb (Tuesday).

Care and Support Minister Mr Lamb will say that children and young people’s mental health services need a complete overhaul to stop vulnerable young people missing out on vital support.

Following an in-depth look at mental health and wellbeing support for children and young people, the Government has set out a blue-print for improving care over the next five years.

Tailored support to match the needs of individual children and young people; easier access to care; and better support for families are some of the proposals outlined in a wide ranging report, commissioned by the Government last year.

Co-chaired by Martin McShane, NHS England’s Director for Patients with Long Term Conditions, and Jon Rouse, Director General for Social Care, Local Government and Care Partnerships, a Taskforce was convened by Norman Lamb last year and has worked over six months to develop proposals.

Dr Martin McShane, NHS England’s National Clinical Director for Long Term Conditions, said:  “The taskforce has laid the foundations on which we will now build an effective mental health service for our children and young people; we must deliver real change.

“A safe, effective, available service close to home is what we want to give to families and while this is being delivered really well in some places access is still patchy in others.

“By introducing these recommendations we want to make sure there is a reliable offer for children and young people everywhere.”

Read more about Dr McShane’s thoughts in his blog.

Care and Support Minister, Norman Lamb, said:  “Children and young people face enormous challenges – from exam pressures and starting higher education or work, to relationships and peer pressure – and these can be intensified by constant exposure to social media.

“I want to change the way we think about mental health care so that any child, whether they have a mental illness or simply need support through a difficult time, can get the right help at the right time. There are some excellent examples of areas that have got this right with ‘one-stop-shop’ services in the community, information and support online via apps, and help for whole families. These plans set out how we can ensure no child is left struggling alone.”

This week, the Government also announced a £1.25 billion funding boost for young people’s mental health care, including new access and waiting time standards for children’s services and plans to make specialist talking therapies available in every area of the country – plans which align with key proposals in the report.

Nikki Mattocks, 17, who took part in an engagement project by the Taskforce, said:  “Children and young people have an extremely powerful voice when you listen to it. By listening to us, who have experienced mental health services, The taskforce report heard the issues that matter most to us, where the system failed us and when we couldn’t get the help we so badly needed. Children and young people’s voices are the most important and should continue to be listened to as the recommendations of the report are carried out.”

Other proposals include:

  • Tackling stigma and improving attitudes to mental illness by building on the success of Time to Change and developing a targeted campaign to create a culture where young people and their families are not afraid to seek help.
  • Information and self-help via online tools and apps with approved information and support that will help young people ‘self-care’ and know how to seek professional help if they need it.
  • Changing the way services are commissioned so that care is based around the needs of children and their families and they can get the right support from the right service at the right time
  • Continued support throughout teenage years in to early 20s to avoid a cliff-edge of lost support at 18.
  • ‘One stop shop’ support services in the community so that anyone needing support knows where to find it.
  • Improved care for children and young people in crisis so they are treated in the right place at the right time, as close to home as possible. This would build on the work of the Crisis Care Concordat to make sure no-one under 18 experiencing a mental health crisis is detained in a police cell.
  • More support for parents to help them improve family relationships, avoid early trauma, support their children to build resilience and improve behaviour.
  • Mental health training for health professionals, including GPs, and others who work with children and young people such as staff in schools to help them identify problems and make sure children and young people get the help they need.
  • Improved access for children and young people who are particularly vulnerable, such as looked after children and care leavers, and those in contact with the youth justice system.

The report sets out how much of this can be achieved through better links between the NHS, local authorities, charities, schools and other local services. It is also clear that many of these proposals can be achieved by reorganising and without the need for significant further investment.

There are numerous centres which illustrate best practice in England. Here are a few of them:

London Youth Health Centre supports mental wellbeing

The Well Centre is a one-stop ‘health’ shop that supports 13-20 year olds in Streatham, London.  Established in October 2011, it gives young people access to youth workers, counsellors and GPs, all under one roof, so it can cover a range of cases, often without the need to refer on.  It also offers a confidential drop-in service three days a week.

The Centre is run jointly by Herne Hill Group GP Practice and charity Redthread Youth Limited, and is now primarily funded by NHS Lambeth Clinical Commissioning Group. Young people have been actively involved in developing the facility from the start, from its design and layout, to shaping services through its Youth Panel.

The Centre takes a holistic approach to health and wellbeing, starting with an initial assessment by the GP and youth worker that helps to identify mental health and other medical and social issues, early on.   Individuals are then quickly signposted to the Centre’s most appropriate service, whether it is counselling and support from the youth workers, attending the Centre’s Voice Collective group for young people who hear voices, or working with a more senior mental health worker, seconded from CAMHS (Children and Adolescent Mental Health Services). This early intervention also helps to reduce the long term costs associated with treating mental health conditions.

The Well Centre’s GPs offer the assessment and treatment of a wide range of physical and psychological conditions.  The broader team also provides advice on sex education, exercise, diet and nutrition, and smoking and alcohol use, that all support young people’s physical and mental health and wellbeing.

Since it opened, just over a 1,000 young people have used the Centre and 30 per cent of those have had mental health conditions.   Of those that have visited the facility, 97 per cent said they would recommend it to friends or family and 68 per cent reported an improvement when asked ‘how are they doing’.

Tower Hamlets CAMHS parenting groups

Tower Hamlets has a culturally diverse community, with pockets of deprivation and high unemployment alongside areas of extreme wealth. The area also has high levels of young people with behaviour and emotional disorders, and attention deficit hyperactivity disorder (ADHD).

To support parents and carers in managing young family members with these conditions, the borough’s Children and Adolescent Mental Health Service (CAMHS) CYP-IAPT partnership has a rolling programme of Improving Access to Psychological Therapies (IAPT) funded parenting training.  The courses are delivered jointly by East London NHS Foundation Trust CAMHS, the local authority and voluntary sector, with translators and a crèche so they are accessible to all members of the community.

The initiative – that is part of the ‘Incredible Years’ programme – offers different sessions for parents of children aged 3 to 5 years and 6 to10 years, comprising 12 to 18 therapeutic sessions over three months. The sessions involve psychologists, parenting therapists, nurses and interpreters, and a high proportion of the attendees have children that have been identified as ‘Child in Need’ cases, with complex and additional needs beyond parenting.

Early feedback captured through a post-course questionnaires clearly demonstrates the positive impact of the programme. The evaluation shows a significant decrease in the overall difficulties encountered by families  in relating to young people at home, an increase in kind and helpful behaviour, a decline in scores for difficulties in ‘getting along with others’, hyperactivity and in emotional difficulties.   All but one parent/carer said that their child’s behaviour had ‘improved’ or ‘slightly improved’.  More significantly, the number of cases whose conduct scores were deemed ‘clinical’ and requiring additional more intensive support, dropped from 86 per cent to 43 per cent following the course.

Positive feedback from attendees include: “I don’t know what I would have done without this course and your support” and “I have done a lot of parenting courses but this one is different as we do a lot of practical things here.”

Young people and parents are now involved in further developing the programme.

Joint working on the Liverpool CAMHS model

In Liverpool, the Child and Adolescent Mental Health Partnership, brings together all the key partners, to jointly commission CAMHS and ensure a continuum of care for children and young people.  It offers a single point of access to services through CAMHS at Alder Hey Children’s NHS Foundation Trust which is supported by a shared referral form, robust partnership and information sharing agreements, and a CAMHS passport – so information follows the young person – to prevent duplication of assessment.

There is also a central website for both service users and professionals, which enables one point of access to information and promotes the CAMHS training offer for anyone who works with children.

Now led by NHS Liverpool Clinical Commissioning Group, it covers the six key areas across the care pathway of mental health promotion, early intervention and prevention, access, service user participation, tiers 3/ 4 and transition to adult services, and routine outcome measures (ROMS).

The Partnership also offers a range of training, including targeted training for health visitors, school nurses, social workers, teachers and Youth Offending Services case managers, to identify and support young people early and prevent inappropriate referrals.

The joint working between all the partners enables potentially complex cases to be effectively managed in the community – allowing a step up and step down model of care –  with a named care co-ordinator for individuals that can orchestrate all the relevant support, to meet  the individual’s needs.  A flexible approach to appointments, including home visits, telephone support and out-of-hours and weekend cover, ensures that people have  comprehensive support.

Feedback from service users is captured on a session by session basis and shows that over 90 per cent have had a positive experience of children and young people mental health services, and 90 per cent have had improved outcomes – these range from improved mental health and the ability to cope/manage their difficulties, to improved attendance and attainment at school.