Supporting children and young people in mental health crisis

Improving the experience and outcomes of children and young people in  a mental health crisis for the NHS.

All children and young people experiencing a mental health crisis should be able to access timely age-appropriate crisis care 24 hours a day, 7 days a week. A combination of access to urgent mental health helplines via NHS 111,, crisis assessment, brief response, and intensive home treatment functions should be offered.

Crisis services must, as a minimum, offer the functions and hours of operation outlined below, to all children and young people aged 0-18 years (up to 17 years and 364 days)

Note: extended hours are hours outside the standard hours of operation (Monday to Friday, 9am to 5pm).

Developing local mental health crisis pathways: national implementation guidance

Local mental health crisis pathways include a range of alternative services. Depending on local need and service configuration, crisis services in some areas will be provided by community children and young people’s mental health practitioners, but in other areas may be provided through support from inpatient and/or adult mental health practitioners. Where services are provided with inpatient care and/or existing adult team practitioners, there must be an integrated approach with children and young people’s mental health services including knowledge of community pathways and systems.

Local areas should be mindful of the necessary workforce and training needs required to ensure all staff are appropriately trained, competent and experienced in working with children and young people with mental health needs, and that services offered provide safe, effective and appropriate crisis care 24/7 for all children and young people. Systems are encouraged to explore local solutions and training packages that are tailored to meet the unique needs of their local communities.

National implementation guidance for urgent and emergency mental health care for children and young people is available to support ongoing local implementation of crisis services by commissioners and providers, working with service users and their families, carers, and other partners.

Supporting children and young people with mental health needs: a joined-up approach

While most children and young people will receive care in community settings, there are occasions where attendance or admission to a paediatric or adult acute setting may be the best clinically appropriate option.

A few examples of such instances include:

• when a child or young person needs an urgent assessment during a mental health crisis, they may need to be seen in A&E where some mental health providers provide a 24/7 service
• children and young people who have taken overdoses and/or self-harmed having their physical health assessed and managed at their local A&E/paediatric department
• a short admission to a paediatric ward while waiting for a specialist assessment and treatment
• children and young people with low weight eating disorders who may require hospital admission for physical monitoring and treatment (see for further detail)
• children and young people who present in a confused, severely agitated or psychotic state may require physical assessment and investigations

Achieving parity of esteem – valuing mental health equally with physical health – is a key priority. For services to be delivered effectively and for patients to feel supported and staff to feel confident, we need to facilitate better integration of physical and mental health for children and young people.

A framework for systems

Our framework for systems and its associated resources facilitate systems to come together to collectively support children and young people with mental health needs who present in acute and paediatric settings, as well as supporting the clinical teams who care for them.

The framework was co-developed with Royal Colleges, professional bodies, national, regional, local system colleagues, children and young people and their parents/carers, with a view to continue to support transforming pathways of care, whilst ensuring services work together to provide a holistic approach for children and young people with physical health needs, mental health needs, or both.