The Five Year Forward View for Mental Health was commissioned by NHS England to outline a strategy for improving mental healthcare provision across the UK. The report was published in 2016, and its recommendations now form part of the NHS England Dementia and Mental Health Programme.
Amongst the various areas of focus within this larger programme, NHS England Health and Justice are delivering work known as the Health and Justice Specialised Commissioning Workstream. This looks at the needs of some very vulnerable children and young people whose particular mental healthcare requirements can be hard to meet through conventional services, as a result of their unique and complex circumstances. This group is sometimes described as “high risk, high harm, high vulnerability”.
Whilst this group is diverse and can be hard to define, it may include children and young people (up to the age of 18) who are accommodated in a Young Offender Institution, a Secure Training Centre or a Secure Children’s Home. They may be held either because they have been sentenced or remanded to custody (i.e. on youth justice grounds), or for the protection of themselves or others (known as a welfare placement). Together, these three types of institution are known as the Children and Young People’s Secure Estate (CYPSE).
Moreover, NHS England Health and Justice Commissioners recognise that a placement in the CYPSE is temporary, and part of a broader care journey for the child or young person in question. Therefore, the workstream is also intended to look at the needs of those who are at risk of entering the CYPSE but who have not done so yet and who are still in the community.
It also has a focus on the needs of those who have transitioned out of the CYPSE back into the community. Such children and young people may be receiving specialist child and adolescent mental health services and displaying complex needs. However, they may also not be in receipt of any mental health services, and may only come to the attention of the authorities when, for example, they have come into contact with the Police (either as a suspect or victim of a crime), when they come into contact with other agencies as a victims of a crime (e.g. Sexual Assault Referral Centres), or if they are experiencing another form of crisis.
The mental health and well being needs of these children and young people are often not like those of many other children and young people. For example, they may:
- Have a higher likelihood of having been subjected to trauma or severe neglect;
- Have experienced high levels of social disadvantage;
- Have multi-layered, unmet and complex needs;
- Not be accessing services in a timely manner in the first place, despite high levels of need.
The workstream itself has three discrete projects:
Specialist Child and Adolescent Mental Health Service for High Risk Young People with Complex Needs project, (also known as “Community Forensic CAMHS”) which is looking to:
- Establish specialist child and adolescent mental health services for high risk young people with complex needs across England;
- Provide improved and clearer pathways between local specialist child and adolescent mental health services for high risk young people with complex needs and secure inpatient services;
- Provide improved and clearer pathways for children and young people leaving custody or secure welfare care and for those with complex cases currently beyond thresholds for locality CAMHS provision.
Framework for Integrated Care project, (also known as “SECURE STAIRS”) which focuses on:
- Development and roll out of an integrated care framework that addresses the needs of children and young people in Secure Children’s Homes, Secure Training Centres and Young Offender Institutions. This framework allows for a joined up approach to assessment, sentence / intervention planning and care, including input from mental health staff regardless of previous diagnosis, as well as from social care professionals, education professionals and the operational staff working on a day-to-day basis at the setting. It also seeks to ensure that staff have the right skills and support to care for the children and young people appropriately.
Collaborative Commissioning Network project, which is aimed at:
- Supporting NHS England Health and Justice commissioners to work together with local partners to coordinate commissioning activities more effectively;
- Providing full clinical pathway consideration for all children and young people who have received services delivered via NHS England Health and Justice directly commissioned provision;
- Creating better links to children and young people who have been in contact with NHS England Health and Justice directly commissioned services to mainstream services in the community in the future.
Safeguarding these children and young people is a priority, and remains a core focus for NHS England’s work with a number of its key partners. These partners include local authorities, the Department for Education, Integrated Care Systems (ICS), Public Health England, HMPPS Youth Custody Service, voluntary groups, and others.
Secure Settings for Young People: A National Scoping Exercise
This suite of reports was funded by NHS England to provide more evidence about the present and future care needs of children and young people placed in secure settings. The project is part of wider work designed to enable services to better meet the mental health needs of some of the most vulnerable and high risk children in our society, which has included the development and implementation of a Framework for Integrated Care for the children and young people secure estate.
This project was completed in significantly changing times for the commissioning and delivery of services within this sector, therefore some of the agencies referred to in the reports have changed roles during the duration of this work.
This research shows us how the current care pathways for these children work and considers the differences between the types of secure care that are currently available to these vulnerable children. It also looks at where there are areas in which services could be improved, in order to enable more effective and appropriate provision of services to these children, helping to support their long term life chances and life outcomes.
Children and Young People Secure Estate National Partnership Agreement
The new Children and Young People Secure Estate National Partnership Agreement for 2018-2021 has been published to enable a more fully integrated approach to the commissioning and delivery of excellent health services for children and young people within the secure estate in England. This replaces the original partnership agreement between NHS England, the Youth Justice Board and Public Health England that was set up in 2013.
The new Partnership Agreement has been expanded and strengthened to a group of six organisations, who have a key role to play in ensuring high quality outcomes based health services for this group of children and young people. These are:
- Department for Education
- Department of Health and Social Care
- Her Majesty’s Prison and Probation Service – Youth Custody Service
- Ministry of Justice
- NHS England
- Public Health England.
Healthcare Standards for Children and Young People in Secure Settings
Furthermore, work has been led by the Royal College of Paediatrics and Child Health, funded by the Youth Justice Board, to produce a set of healthcare standards for children and young people in secure settings. The standards and tools described in this document are a core part of the coordinated approach that NHS England and its partners are adopting to provide effective and comprehensive care across a complex commissioning environment. They include a key focus on mental health and well-being.
These are the core outcome based service specifications, based on the Healthcare Standards for Children and Young People in the Secure Estate (RCPCH 2019).
- Healthcare provision overarching healthcare specification
- Chapter 7 physical healthcare and intervention healthcare specification
- Chapter 8 mental health and neurodisability care and intervention healthcare specification
- Chapter 9 substance misuse care and intervention healthcare specification
National protocol on reducing criminalisation of looked-after children
This national protocol, developed by the Department for Education, and which NHS England have supported, is aimed at local authority children’s services, local care providers (fostering services, children’s homes and other arrangements), police forces, Youth Offending Teams (YOTs), the Crown Prosecution Service (CPS) and HM Courts and Tribunal Service (HMCTS), local Youth Panel (Magistrates), and local health services including mental health. Its key purpose is to encourage and provide the framework for these agencies to co-develop local arrangements to reduce the unnecessary criminalisation of looked-after children and care leavers.