Joint working improving children’s access to mental health services

More children with mental health needs are getting the right support at the right time, with local agencies learning from past failures, a new study finds. Given the impact of COVID-19 on children’s mental health, and increased pressure on services, building on this success is vital.

Published today [9 December 2020], the joint report from Ofsted, Care Quality Commission (CQC), HMI Constabulary, Fire & Rescue Services (HMICFRS) and HMI Probation looks at how partners in 6 local authority areas are working together to help children with mental ill health. The report is based on inspections carried out between September 2019 and February 2020 – before the COVID-19 pandemic.

The report finds that restructures of child and adolescent mental health services (CAMHS), along with a concerted effort by agencies to work together, has broadened the help available for a range of mental health needs. This has also led to more timely identification, referrals and support.

In many cases, professionals are knowledgeable and can recognise the signs of mental ill health. A single point of access for specialist advice on mental health is helping professionals respond more effectively, as are co-located services and improved involvement of voluntary and community sector organisations.

But although much progress has been achieved, this good work is not universal. Some agencies need to get better at identifying children suffering from mental ill health. In some cases, professionals are still focusing on presenting issues, and not looking beyond them for possible risks of mental ill health. This applies to some staff in emergency departments, GPs, police and social workers, even in circumstances where a child has self-harmed or behaves in a way that indicates they have suffered trauma. And too often, a child’s mental health problem is first picked up when they enter the youth justice system.

Schools have an important role to play in supporting children’s mental health, but they cannot do it alone, the report finds. Where schools are supported well by partners, children get specialist help when they need it. But there is wide variation in the quality of support that children receive from school nurses. Nursing services in half of the areas visited did not have the systems in place nor the capacity to identify children with mental health problems, meaning that opportunities to spot issues early were missed.

Many police forces in areas visited have well-developed training and support for officers to recognise and help children with mental ill health, but this is not consistent in all areas. Inspectors saw too many examples of children being kept in custody overnight and who were not helped to get the support that they needed with their mental health.

Despite improvements in partnership working being made in some areas, the report finds that specialist CAMHS are still limited in some areas and resources are overstretched. Some of the most vulnerable children have to wait far too long for their mental health needs to be identified and to get access to specialist services. This includes children with autism, ADHD, some children on child in need and child protection plans, and children in care.

Amanda Spielman, Ofsted’s Chief Inspector, said:

Children’s mental health has taken on a much higher profile in recent years, even before the pandemic, and services have been steadily improving. However, while we saw some excellent partnership work to better support children with mental ill health in the areas we visited, we know this will not be the experience of every child.

Single points of contact, accessible services and strong joint working make a real difference for children. But it’s also vital that each partner recognises their own role, and knows when to seek specialist advice, so that children get the right support at the right time. Given the added pressures that the pandemic is placing on mental health services, it would be tragic if these improvements were lost when they are needed more than ever.

Victoria Watkins, Deputy Chief Inspector of Primary, Integrated and Children’s Health Services at CQC said:

When we published ‘Are we listening?’, our review of children and young people’s mental health services in 2018, we noted that good care was more likely to be seen where local services were working together. Encouragingly, these joint inspections with Ofsted found strong partnership working, with the needs of the child at its heart. This is a testament to the tireless effort of people working in the system to improve the experience of children and young people with mental health needs.

Unfortunately, as we reported in 2018, some young people still wait too long for their needs to be identified or to access the mental health support that they need. There is still also a risk that people working with children and young people focus on immediate issues, such as seemingly disruptive or challenging behaviour, and miss the opportunity to address any mental health needs that might also be present.

It’s vital that we build on the progress made and good practice we have seen, and hold onto these lessons as the whole health and care system continues to respond to the pandemic and any impact it has on services.

Wendy Williams, HM Inspector of Constabulary and Fire and Rescue Services, said:

We know from previous inspections that responding to people with mental health needs is a complex issue that the police are faced with on a daily basis, often at a time of crisis for that individual. We are therefore pleased to see the police service is improving how its officers engage with, and respond to, children suffering with mental ill health. There are still areas we would like to see the police together with other services improve on, such as the early identification and provision of support for those children who suffer from mental ill health and are brought into police custody for other matters. We have seen where there is effective joint working with partner agencies it ensures vulnerable children are given the support they need in environments which improve, and not hinder, their well-being.

Justin Russell, Chief Inspector of Probation, said:

It remains of considerable concern that a referral to a youth offending service is often the first time a child’s mental health needs are identified and addressed. This alone demonstrates that change is crucial, and I welcome the findings of this report demonstrating the efforts being made to diagnose children at the earliest opportunity and tailor support to their individual needs.

We do not yet know the full impact COVID-19 may have had on children’s mental health, and how this will affect already over-stretched services in some areas. I urge all those who have worked together to make improvements to build on the momentum they have established – it is more important than ever that services work collaboratively for the sake of those most vulnerable in our society.

Notes to editors

This report describes findings from 6 joint targeted area inspections (JTAIs) carried out between September 2019 and February 2020, along with the Care Quality Commission (CQC), Her Majesty’s Inspectorate of Constabulary, Fire and Rescue Services (HMICFRS) and Her Majesty’s Inspectorate of Probation (HMI Probation).

The 6 local authorities inspected were Bexley, East Sussex, Milton Keynes, Plymouth, Portsmouth and Sefton.

A focused review of children and young people’s mental health services through the JTAI programme was one of the commitments made by CQC in its report, ‘Are we listening? A review of children and young people’s mental health services’ requested by the then Prime Minister in 2017. The JTAIapproach demonstrates the joined-up working expected in local systems.