Eighth Report - Children and young people’s mental health

Children and young people’s mental health is an all-society issue. The problems discussed in this report can only be addressed by Government departments, local government and the health system acting together to promote good mental health and prevent new crises … Read more Children and young people’s mental health is an all-society issue. The problems discussed in this report can only be addressed by Government departments, local government and the health system acting together to promote good mental health and prevent new crises emerging. We recommend setting up a Cabinet sub-committee to bring together different departments to make sure this happens. Show less

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The gap between the 2004 and 2017 NHS Digital Mental Health Surveys was too long, and this must not be repeated. We recommend that NHS Digital regularly collect and publish robust prevalence data for mental health conditions every three years, … Read more The gap between the 2004 and 2017 NHS Digital Mental Health Surveys was too long, and this must not be repeated. We recommend that NHS Digital regularly collect and publish robust prevalence data for mental health conditions every three years, starting from the end of 2021 disaggregated by age, ethnicity, sexuality, gender, and condition, alongside a plan to address any disparities uncovered. Such a study should also examine both unmet need and the risks of overmedicalisation of minor issues. Show less

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We recommend that NHS England & Improvement set out a clear action plan including key milestones, deadlines, and funding for how they will meet their target set out in the NHS Long Term Plan of 100% access to specialist support … Read more We recommend that NHS England & Improvement set out a clear action plan including key milestones, deadlines, and funding for how they will meet their target set out in the NHS Long Term Plan of 100% access to specialist support for all children and young people aged 0–25 by 2029, without raising the already high thresholds for accessing support. Show less

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We further recommend that NHS England & Improvement hold Clinical Commissioning Groups, which have consistently failed to meet national expectations, to account on key measures such as expenditure, waiting times and access rates. National ambitions should be raised in line … Read more We further recommend that NHS England & Improvement hold Clinical Commissioning Groups, which have consistently failed to meet national expectations, to account on key measures such as expenditure, waiting times and access rates. National ambitions should be raised in line with the best performing areas so that best practice becomes universal practice. This is essential to ensuring that provision of children and young people’s mental health services does not remain a ‘postcode lottery’. Show less

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Furthermore, in light of the rise in both prevalence and severity of children and young people’s mental health difficulties, the training of Education Mental Health Practitioners should be reviewed to integrate their skills into a new psychological professions structure. This … Read more Furthermore, in light of the rise in both prevalence and severity of children and young people’s mental health difficulties, the training of Education Mental Health Practitioners should be reviewed to integrate their skills into a new psychological professions structure. This must include training experienced practitioners in more sophisticated psychological therapy so that they can work with more complex cases such as eating disorders and self-harm. Show less

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We recommend that the Department of Health and Social Care fund and roll out open access models to every area across the country so that there is a consistent, comprehensive community offer to complement available school-based and clinical support across … Read more We recommend that the Department of Health and Social Care fund and roll out open access models to every area across the country so that there is a consistent, comprehensive community offer to complement available school-based and clinical support across England. The hubs should also offer outreach support to vulnerable groups and should be integrated with specialist children and young people’s mental health services with a clear step down/step up relationship. National standards for the provision of support should be published so hubs adhere to clinical standards. Show less

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We therefore recommend that the Department accelerates the shift towards increased community-based provision and a reduced inpatient bed base as a national priority to ensure that children and young people with the most complex needs receive good quality care in … Read more We therefore recommend that the Department accelerates the shift towards increased community-based provision and a reduced inpatient bed base as a national priority to ensure that children and young people with the most complex needs receive good quality care in a setting that is right for them. A national strategy should be set out to establish jointly commissioned health and social care services. To ensure children and young people are not ‘parked’ in inappropriate in-patient care, an independent psychiatrist should sign off the need for inpatient provision on a monthly basis for all young people who have stayed for longer than three months in a mental health hospital. This should be backed up by legislative changes. It should equally apply to those with a learning disability, autism, or both. Show less

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In addition to the recommendations on data we set out in our report on the treatment of autistic people and people with learning disabilities, we further recommend that NHS England and Improvement regularly collect and publish high quality data including … Read more In addition to the recommendations on data we set out in our report on the treatment of autistic people and people with learning disabilities, we further recommend that NHS England and Improvement regularly collect and publish high quality data including from private sector providers on: • the basis of children and young people’s admission to inpatient units; • the number of children and young people not accepted into units; • the waiting list for children and young people waiting for adequate community provision; • the number of children and young people receiving advocacy support; • the number of children placed out-of-area; and • the length of their stay in inpatient units. (Paragraph 155) Children and young people’s mental health 61 Self-harm and suicide prevention Show less

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We recommend that the Department implement a new system of early intervention to support children and young people who self-harm and are at risk of committing suicide. Educational settings, as a universal provision, can have an important role to provide … Read more We recommend that the Department implement a new system of early intervention to support children and young people who self-harm and are at risk of committing suicide. Educational settings, as a universal provision, can have an important role to provide effective early intervention to pupils who may be struggling with self-harm before the mental health need becomes more acute. Mental Health Support Teams are well placed to deliver these interventions and an accelerated roll out of these teams would increase the capacity of schools and colleges to support those children and young people who may be struggling. Education Mental Health Practitioners must be trained in self-harm and suicide prevention specifically. Show less

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We recommend that each Government Department, led by the Department of Health and Social Care should set out specific, measurable objectives for mental health promotion in each policy area. This should include policies that aim to build mental health resilience … Read more We recommend that each Government Department, led by the Department of Health and Social Care should set out specific, measurable objectives for mental health promotion in each policy area. This should include policies that aim to build mental health resilience in the population as a whole, as well as specific interventions targeted at those who have the greatest mental health need. (Paragraph 173) 62 Children and young people’s mental health Show less

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Although the full long-term impact of the coronavirus pandemic on the mental health of children and young people under the age of 25 is as yet unknown, it is already clear that the mental health needs of these groups have been much exacerbated by the pandemic. This has been supported …

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During the pandemic, children and young people’s mental health has significantly worsened and the scale of the backlog mean that the NHS will not be able to treat its way out of this crisis. The need for early intervention and prevention in children and young people’s mental health has been …

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The Department of Health and Social Care—in partnership with the Department for Education and all other relevant Government departments—must take radical steps to shift the focus in mental health provision towards early intervention and prevention. This must ensure that all children and young people under the age of 25 can …

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We expect a full and comprehensive update from the Department on what measures it will implement, how this work will be funded and a timeframe for key outcomes relating to increased early intervention and prevention. We expect this information by the end of January 2022. (Paragraph 36) Increasing access to …

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Commitments in the 2017 Green Paper and the NHS Long Term Plan have been taken seriously by NHS England and led to a significant expansion of provision. We are, however, concerned that many commitments may not yet be ambitious enough to ensure every young person with a diagnosable mental health …

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We welcome and support the proposals in the recent access and waiting times consultation that concluded on 1st September, including crisis response times and a four-week waiting time limit for children and young people, and call on NHS England to publish a detailed roadmap as to how it will be …

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It is clear that young adults between the ages of 18 and 25 face some of the widest gaps between the support that they need and the support that is available to them. 56 Children and young people’s mental health We welcome NHS England & Improvement’s commitment to shift away …

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NHS England & Improvement must accelerate the implementation of the 0–25 offer in every local area as a national priority so that young people do not continue to face a cliff edge in accessing the care they require as they transition from children to adult services.

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One of the largest barriers to increasing access to mental health provision for children and young people remains the size of the mental health workforce. We have seen that children and young people’s mental health practitioners face staff shortages, increasing demand and high levels of work-related stress which in turn …

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In addition, it is paramount that a plan is implemented to increase the size and wellbeing of the children and young people’s mental health workforce based on independently verified estimates of the number of people needed in different disciplines and the training places required to deliver them. The strategy should …

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We have seen that Mental Health Support Teams, where they have been rolled out, are well-placed to facilitate early intervention for children and young people as part Children and young people’s mental health 57 of a whole school approach. They appear to have delivered positive outcomes for children and young …

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We therefore recommend that the Department of Health and Social Care fully fund and scale up the roll out of Mental Health Support Teams to cover two thirds of schools in England by 2024/25 and 100% by 2027/28.

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A whole school approach to mental health and wellbeing should include the promotion of good mental health as well as the early identification of those who are at risk of mental health difficulties. Designated Senior Leads for mental health can have an extremely important role in overseeing and leading this …

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It is vital that the Department rolls out the training for Designated Senior Leads to all schools urgently with a commitment to completing the roll out before the end of the current Parliament. Moreover, given the worrying trends in self-harm and eating difficulties among children and young people, it is …

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Whilst Mental Health Support Teams and Designated Senior Lead training is being rolled out, the Department of Health and Social Care and the Department for Education should work closely together with all schools to ensure that they have the support they need in order to offer a whole school approach, …

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For some children and young people where schools are not their preferred place to access support, drop-in hubs that operate on an open access, self-referral basis provide a valuable alternative opportunity to access help. We have heard that the large-scale roll out of a similar style system has improved outcomes …

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The social care sector is essential to the provision of mental health services to children and young people and it is essential that it is funded to do so as part of the forthcoming social care white paper.

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Equally vital is the role of the new Integrated Care Systems and it is essential they publish detailed plans with timescales as to how community provision for the mental health needs of children and young people will be improved working jointly with the local social care system.

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For those children and young people who prefer accessing help online, digital services can be an important way of reducing barriers to access so it is important that a digital offer should be available for all young people. To prevent over-medicalisation of mental health conditions this should include self-help options …

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Inpatient units have a role to play in treating some of the most severe and complex mental health conditions, especially those that are resistant to community treatment. However, in most cases the most compassionate and effective care for children and young people is provided in the community–and increasing its provision …

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In order to achieve this shift towards community-based care, every area should have a community service for children in crisis which is available 24 hours a day, seven days a week. A clear map is needed of where current gaps in this provision are and a plan should be in …

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For those children and young people for whom inpatient admission cannot be avoided, a continued focus is needed to increase the quality of this care. As well as much improved data collection, this should include access to therapies, activities and education, including from private sector providers. It should include a …

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It is disappointing that the Government’s 2021 Mental Health White Paper leaves expanding the legal right to support from an advocate to all children and young people subject to future funding availability. There is a compelling case that Independent Mental Health Advocates have a valuable role in helping inpatient children …

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The Department should commit to expanding Independent Mental Health Advocates support so that all children and young people admitted to hospital informally have the same legal right to an Independent Mental Health Advocate as those admitted under legislation without qualification. This advocacy should all operate on an opt- out basis.

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We welcome the Government’s commitment to reducing the use of seclusion, segregation and restraint for children and young people in inpatient units and the Mental Health Units (Use of Force) Act in particular. However, we have heard that 60 Children and young people’s mental health restrictive interventions, and particularly restraint, …

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In addition to our recommendations on the use of restraint that we set out in our report on the treatment of autistic people and people with learning disabilities, the use of prone restraint on children and young people should be banned in all inpatient settings and in transit. Further action …

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It is vitally important to be able to monitor the experiences of children and young people in inpatient care, particularly how often restraint is used in each setting and whether there is appropriate access to advocacy. This is key to ensuring individuals in inpatient care are receiving quality support and …

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We are deeply concerned about the increasing numbers of children and young people who experience self-harm and suicide and the quality of care they are able to access. Much more needs to be done to tackle suicide and self-harm amongst children and young people. In particular, given the link between …

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For those children and young people for whom school is not the most accessible place to seek support, there must also be a community-based offer. This could be based on the network of drop-in hubs outlined in Chapter 4 of this report, which provide open- access mental health support without …

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Preventing the worst mental health outcomes means first creating the conditions across society that are conducive to good mental health and wellbeing. We welcome the support provided by the former Minister for Patient Safety, Suicide Prevention and Mental Health to a ‘cross-governmental’ strategy to prevent the worst mental health outcomes …

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