A new dawn for mental health

NHS England’s National Clinical Director for Children, Young People and Transition to Adulthood explains why the new programme to improve young people’s mental health services is so vital:

This has to be the most exciting but, at the same time, challenging time for Children and Young People’s Mental Health.

It is certainly one of the most thrilling, diverse, huge and rewarding pieces of work I have had the privilege to be involved with since becoming a National Clinical Director in NHS England.

Exciting – because never in recent times and memory has the profile of the emotional and mental health of children and young people been so high. There are a wide range of local and national established work programmes from health and education, and more coming on line since the publication of Future in Mind, as well as the very welcome announcement of further resources to allow us to move more quickly to build capacity.

Challenging – because every day there is evidence on how we are currently, across the system, failing so many children and young people who desperately need and deserve our care and support. These very human, and sometimes tragic situations, are what drive us to do so much better.

One of the finest achievements this year has been the publication of Future in Mind, with 49 proposals which are all underpinned by the commitment to  involve children, young people and parents not just in their own treatment but in service design and commissioning.

The principal themes indicate than we must do better with what we already have, while promoting resilience, prevention and early intervention, improving access to effective support, care of the most vulnerable, accountability and transparency, particularly in commissioning, and with all of this developing the workforce, so essential to the delivery of excellent skilled care.

The foreword from Simon Stevens, NHS England’s Chief Executive, was a strong endorsement:  “There is now a welcome recognition of the need to make dramatic improvements in mental health services. Nowhere is that more necessary than in support for children, young people and their families”.

He also urges us not too focus too narrowly on targeted clinical care, ignoring the wider influences and causes of rising demand and risk “over medicalising” our children along the way.

It was very gratifying to hear the commitment to continuity of purpose from the new Minister, Alistair Burt.   At a recent event, he reiterated the priority of supporting children, young people and families in difficulty, and his desire to build on the work of the previous government.  We also have in Education a Minister, Sam  Gyimah with a particular brief to support the emotional and mental health of children and young people.

Now our work moves forward in earnest as we work closely with our partners in Education, Social Care and the all-important Voluntary Sector to drive improvements.

NHS England has been working with the National Collaborating Centre for Mental Health since the announcement of £30million recurrently in the Autumn Statement in 2014, to enable the further development of community based eating disorders.

The guidance published today sets out a clear model of care, access and waiting times’ standards to support commissioners and providers to improve their existing services.

Dedicated community based teams will support children and young people with the goal of the earliest possible intervention.

This has 11 key messages, one of the most crucial being that the standard is for evidenced-based NICE approved treatment to be received within a maximum of 4 weeks from first contact with a designated healthcare professional for routine cases and within one week for urgent cases. To establish, then achieve this target, will be progress of unbelievable magnitude for CYP.

I am also delighted that after many years CAMHS will be included in the new Mental Health Services Dataset. It is so important that we demonstrate the outcomes of the work we do, benchmark ourselves and can join the payment revolution if CAMHS is to grow to offer services to more children and young people.

As well as using some of the pre-committed funding to expand the successful CYP IAPT programme both in extent and depth, from the current 68% coverage of the vulnerable population to 100% by 2018, the curricula will be extended to include the 0-5s, Autistic Spectrum Disorders, and children with Learning Disability, plus a module combining medication with therapy for  prescribers.

In addition, we have created a new team in NHS England to support the wider Transformation of CYP mental health, linking to our colleagues in Specialist and Direct `commissioning and to external stakeholders.

The team has been working with colleagues such as the Local Government Association, Association of Directors of Children’s Services as well as other departments and arm’s length bodies to develop the Guidance for access to the new resources to support the delivery of local Transformation Plans.

CCGs and Local Authorities are already developing these plans working in partnership with cross-system organisations, particularly Education, and Youth Justice. These plans will cover the full spectrum of interventions from prevention to support and care for existing or emerging health problems, as well as transitions between services and address the needs of the most vulnerable. They will include an initial focus on key objectives for which the additional funding was announced, but recognise that these plans will be locally driven and published to bring transparency and local accountability to communities.

It is absolutely apparent, and something endorsed by young people themselves, that more of the same is simply not an option. Unless we make real changes across the whole system, opportunities to build resilience promote good mental health and intervene early when problems first arise, then these will continue to be missed and the opportunity to build a stronger youth for future generations will be lost.

Pivotal to delivery of all of these plans is the work of the CYP and Mental Health Strategic Clinical Networks whose progress already is impressive, and whose work locally facilitating the necessary conversations with all commissioners and providers is vital to improvement in CAMHS.

And finally, amid all this is the recognition that our care and attention is for the whole child and young person, with full integration of physical and mental health needs up to and beyond Transition to Adulthood. We shall support them to not only take control of their future health and wellbeing but also aim to deliver a positive experience which keeps them engaged with their services and central, with their families and carers, to the co-production of their own safe and robust Transition Plans.

I have the strong impression that we are on the  brink of a new dawn for Children and Young People’s Mental Health and Wellbeing – we all have roles and responsibilities, and together with our children, young people and their families  we shall move to an unrecognisably new and more secure place with a brighter and more hopeful future.

Jacqueline Cornish

Dr Jacqueline Cornish was the National Clinical Director for Children, Young People and Transition to Adulthood in NHS England from 2013 to 2019.

As a clinician she specialised in pioneering treatments for childhood cancer and leukaemia, and brought to NHS England 20 years’ leadership experience in the NHS, having been Head of Division of Women’s and Children’s Services at University Hospitals Bristol NHS Foundation Trust, and a former Director of Paediatric Stem Cell Transplant (SCT) at the Bristol Royal Hospital for Children.

The post of National Clinical Director for Children and Young People is now held by Professor Simon Kenny, Consultant Paediatric Surgeon at Alder Hey Children’s NHS Foundation Trust in Liverpool and National Clinical Lead for Paediatric Surgery for the Getting It Right First Time programme.

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  2. Albert West says:

    There is always a catch: ‘commissioners are responsible for participating in the development of a Transformation Plan for their local area.’ and it’s my honest opinion that the CCG in my area ‘Central Bedfordshire’ who have not been honest with us regarding recent tender for CAMHS which was awarded to East London Foundation Trust, will not participate in any meaningful way that will enable them to assess any additional funding that may be available.