Recommendation 28

HM Government Not Addressed

We accept this recommendation. The NHS LTP commitment is all children and young people experiencing a mental health crisis will be able to access crisis care 24 hours a day, 7 days a week by, 2023/24, with a single point of access (through NHS 111). Part of this ambition was brought forward in response to the pandemic, with all mental health providers establishing all-age helplines, albeit not yet through NHS 111. Four functions of a comprehensive children and young people’s crisis service have been developed. These are: I. a single point of access, including through 111, to crisis support, advice and triage; II. crisis assessment within the emergency department and in community settings; III. crisis assessment and brief response within the emergency department and in community settings, with children and young people offered brief interventions; and IV. intensive home treatment services aimed at children and young people who might otherwise require inpatient care, or intensive support that exceeds the normal capability of a generic children and young people’s mental health community team. Children and young people’s crisis services are expanding at pace and are ahead of trajectory, with current coverage showing 67% of the country have full or partial coverage of the four key components of a comprehensive children and young people’s crisis service. This is against a public commitment of 35% coverage in 2020/21 of 24/7 crisis provision for children and young people that combines crisis assessment, brief response and intensive home treatment functions for 202/21, as set out in the NHS Mental Health Implementation Plan – 2019/20 – 2023/24. NHSE/I has consulted on the potential to introduce a range of new waiting time standards as part of its Clinically-led Review of NHS Access Standards. This includes that patients referred from Accident and Emergency should be seen face-to-face within one hour, by mental health liaison or children and young people‘s equivalent service. The consultation closed on 1 September 2021 and found that more than 80% of respondents agreed or strongly agreed with the proposal to introduce additional mental health access and waiting time measures, including for children and young people presenting to community-based mental health services. With regard to autistic children and young people and children and young people with learning disabilities, our proposed reforms to the Mental Health Act will limit the scope to detain people with a learning disability or autistic people since both learning disability and autism are lifelong conditions that cannot be removed through treatment. We propose creating new duties on commissioners to monitor the local ‘at-risk’ population and ensure that there are sufficient community-based services for people with a learning disability and autistic people. Building the Right Support aims to ensure that people with a learning disability and autistic people are not inappropriately detained in mental health inpatient settings. Instead, we want to ensure people can live in the community, close to their families and with the right support in place to prevent them reaching a point of crisis. The cross-system, cross-Government Building the Right Support Delivery Board is responsible for driving progress in reducing the number of autistic children, young people and adults, and children, young people and adults with a learning disability in mental health inpatient settings. We are developing an action plan that will bring together, in one place, actions to ensure people receive high-quality care through investing in community services and reduce reliance on specialist inpatient care. We aim to publish this as soon as possible.