Mental health provision for young people needs radical overhaul to avert crisis

Mental health services for children and teenagers should be brought into schools to help rescue a vastly overstretched system that is failing more than half a million young people a year, a think-tank has urged today.

In a report entitled ‘A healthy state of mind’ Localis warns despite a recent £1.4bn cash boost to help improve Child and Adolescent Mental Health Services (CAMHS) an estimated 555,623 young people aged 5 to 18 with a diagnosable mental illness will not receive NHS-funded community mental care by 2020/ 2021.

The research indicated more than half of all CCG areas (58%) will miss the government’s stated target of 35% of young people with diagnosable conditions receiving treatment from specialist services by the end of the decade.

However, the problem of lengthy waiting lists is exacerbated because too many public service professionals - lacking the confidence to support young people at an early stage in dealing with mental health issues - refer their charges to CAMHS – forcing specialists to identify the needles in an ever-increasing haystack.

Local activity to remedy the problem should focus on training and support for non-specialists such as GPs; improvement in the quality and sharing of data; better efforts to improve the experience a young person receives when first making contact; dramatically expanding the variety of access points available to young people seeking information and guidance on digital platforms that can be researched anonymously and in a way that doesn’t patronise them.

At national level, the report urges the government to ensure that a mandatory module on mental health is included in initial teacher training and to give clarity on how free mental health training will be rolled out to every secondary school in England.

Additionally, the report urges the government to support the provision of school-based support services by putting them on a statutory footing by allowing councils to centrally retain up to 6.5% of pupil premium allocations and updating current academy funding agreements to make it compulsory for academies to provide school-based support services.

Localis chief executive, Liam Booth-Smith, said: “We are at risk as a nation of failing an entire generation of vulnerable young people who need specialist support.

“Currently the system is bedevilled by months-long waiting lists because it fails to differentiate between young people in crisis and those close to it – a situation that makes vulnerable young people feel like nobody cares and nothing can be done.”

“A challenge of this scale demands fundamental reform at both local and national level to ensure our mental health system for young people quickly provides help for those in crisis and offers support at an earlier stage to those who feel they need it.”

Amanda Kelly, Managind director of iMPOWER, said: “This report provides a sensitive yet dispassionate analysis of the failings of our mental health services.  Put simply we are failing our children and young people on a massive scale.  Whilst it is wonderful to see planned improvements to mental health provision clearly referenced in all 3 of the main political parties’ manifestos, the time for talk is over.  We need action and we need it quickly.  Our collective failure to deal with the well documented issues, rehearsed again compellingly in this report, is storing up issues that will continue to be manifest as these young people grow and take their place in the world.  We don’t have a crystal ball but what we do know with certainly is that we will be judged on how we treat the most vulnerable in our society.  Our track record and, based on the findings in this report, when we are judged we are with good reason, likely to be found wanting.”

ENDS

Press enquiries:

Sian Penny, Localis

0870 448 1530 / 07809 297269 / sian.penny@localis.org.uk

Notes to editors

The report identified key barriers to enabling young people to improve their mental health and to giving young people greater independence to take responsibility for enhancing their mental wellbeing and resilience.

These were: -

• •                     The first point of contact for young people is often very poor, setting both negative expectations of the quality of support they will receive and their own understanding of the severity of their condition. (An estimated 60% of GP referrals are inappropriately referred to CAMHS  and between 21% and 29%  of children and young people referred to CAMHS overall are inappropriately referred.)
• •                     A one size fits all approach means many young people do not wish to access services that still carry a socially unflattering stigma. (22% of appointments in CAMHS were not completed in 2014/15, either through cancellation or not being attended by the child or young person. )
• •                     Despite school-based interventions being one of the most cost effective and proximate to a young person’s everyday life hardly any Local Transformation Plans are set to commission school-based services. (Whilst 75% of local transformation plans mention school-based approaches to mental health, only 40% refer to school-based counselling and only 3% plan to commission these services. )
• •                     Even vulnerable children in the care system cannot be sure of an appropriate level of service. Despite it being a statutory duty, many local authorities are not ensuring the completion of the important Strength and Difficulties Questionnaire designed to assess a young person’s risk of poor mental health (62 councils are currently below the national average completion rate of 75%. )
• •                     58% of CCG areas are not on course to hit their target of treating 35% of young people who are clinically diagnosed with a mental health condition. (Based on our projections 117 out of 203 CCG areas will not meet the government’s target.)

Report recommendations

To create a radical shift in mental health services and policy towards mental fitness that encourages greater independence for young people, the report made six recommendations:

Recommendation 1: Following on from recommendations from both the Health Select Committee and the Carter Review, the Department for Education should ensure that a mandatory module on mental health is included in initial teacher training.

Recommendation 2: Following from the Prime Minister’s announcement that every secondary school in England will be provided with free mental health training, government should provide guidance on how it plans to roll this out in order to provide clarity for school leaders.

Recommendation 3: Schools forums in every local area should be provided with the powers to select a lead mental health co-ordinator to encourage a local strategy for school-based mental health services. This co-ordinator should:

• •                     sit on Health and Wellbeing Boards to ensure school-based mental health services are considered in the production of Joint Strategic Needs Assessments
• •                     work with CCGs to ensure that any revised local transformation plans include provision for school-based mental health services

Recommendation 4: Through the passing of the Children and Social Work Act 2017, government should use the requirement for governmental approval on any professional training standards that Social Work England establishes to ensure that mental health is incorporated in social work training.

Recommendation 5: Government should support the provision of school-based support services. This can be achieved by:

• •                     5.1 Providing local authorities with the statutory duty to provide school-based support services for all young people between 11 and 18 who attend state maintained schools. Councils should be allowed to centrally retain up to 6.5% of pupil premium allocations to fund such services. These funds would provide a starting point even for areas that would require additional money from local CCGs to provide such services.
• •                     5.2 Government should revise current academy funding agreements to make it compulsory for academies to provide school-based support services. Academies may opt into taking advantage of the economies of scale offered by the local authority or may wish to independently commission their own services.

Recommendation 6: NHS England should accelerate their investment into 3,000 practice-based mental health therapists, to provide GPs with support and extra confidence in helping young people with mental health needs directly within the GP clinic.