This report describes the findings of our independent review of the system of services that support children and young people’s mental health | Care Quality Commission (CQC)
This CQC report indicates that many children and young people experiencing mental health problems don’t get the kind of care they deserve; the system is complicated, with no easy or clear way to get help or support.
The report makes a number of recommendations to organisations responsible for making sure that the problems with mental health services are dealt with, including:
The Secretary of State for Health and Social Care should make sure there is joint action across government to make children and young people’s mental health a national priority, working with ministers in health, social care, education, housing and local government
Local organisations must work together to deliver a clear ‘local offer’ of the care and support available to children and young people
Government, employers and schools should make sure that everyone that works, volunteers or cares for children and young people are trained to encourage good mental health and offer basic mental health support
Ofsted should look at what schools are doing to support children and young people’s mental health when they inspect
Three Royal Colleges have jointly agreed five shared principles designed to improve care and support for children and young people with mental health problems.
The Royal College of General Practitioners, The Royal College of Paediatrics and Child Health and The Royal College of Psychiatrists have issued a position statement saying that as well as the commissioning of specialist treatment, an effective child and young people’s (CYP) mental health system required:
acknowledgment that CYP mental health is everybody’s business and should be supported by a shared vision for CYP mental health across all government departments
a preventative, multi-agency approach to mental health across all ages, incorporating attention to education for young people and families, social determinants, and health promotion
a system of national and local accountability for population-level CYP mental health and well-being, delivered via integrated local area systems
training and education for the whole children’s workforce in their role and responsibilities for CYP mental health
more support, both from specialist services and other sectors, for professionals dealing with CYP who do not meet referral threshold to CAMHS.
The Royal Colleges of GPs (RCGP), Paediatrics and Child Health (RCPCH), and Psychiatrists (RCPsych) have committed to five shared principles that they hope will lead to tangible actions to improve the care and support of children and young people (CYP) with mental health problems.
The three Colleges say that as well as the commissioning of specialist treatment, an effective CYP mental health system requires:
Acknowledgment that CYP mental health is everybody’s business, and should be supported by a shared vision for CYP mental health across all government departments, particularly health, education and justice.
A preventative, multi-agency approach to mental health across all ages, incorporating attention to education for young people and families, social determinants, and health promotion. This should focus on public mental health and early intervention in CYP, including minimising the need for admission and effective crisis services to maintain CYP in their homes.
A system of national and local accountability for population-level CYP mental health and well-being, delivered via integrated local area systems.
Training and education for the whole children’s workforce in their role and responsibilities for CYP mental health.
More support, both from specialist services and other sectors, for professionals dealing with CYP who do not meet referral threshold to a Child and Adolescent Mental Health Service (CAMHS).
Following the development of the joint principles, the three Colleges have committed to a number of ongoing actions. These include ensuring the highest quality training and standards in CYP mental health; supporting the development of evidence based models of care that are focused on integration of care; and calling for greater investment and resources to be focused on developing services in CYP friendly settings that promote early intervention and resilience.
Summary of risk factors and learning for improved practice for child and adolescent mental health services | NSPCC
Child and adolescent mental health services (CAMHS) practitioners have a key role to play helping children and young people rebuild their lives following difficult early experiences such as abuse and neglect. However organisational and operational challenges can result in many vulnerable young people not receiving the help they need when they need it.
The learning from these case reviews highlights these difficulties as well as emerging good practice to resolve these issues.
Read the key issues for CAMHS in case reviews here
Quality improvement in mental health | The King’s Fund
This report explores the potential opportunities arising from the application of quality improvement approaches in the mental health sector and identifies relevant learning from organisations that have already adopted these approaches.
The authors were specifically interested in understanding how and why some mental health organisations have embraced quality improvement strategies and what has enabled them to do so. It explores what changes are needed from senior leaders to cultivate a quality improvement ethos within their organisation.
Embracing quality improvement requires a change in the traditional approach to leadership at all levels of an organisation, so that those closest to problems (staff and patients) can devise the best solutions and implement them.
Doing quality improvement at scale requires an appropriate organisational infrastructure, both to support frontline teams and to ensure that learning spreads and is taken up across the organisation.
Tools and approaches used in the acute hospital sector can be adapted for use in mental health care, including in community settings.
Success is most likely when there is fidelity to the chosen improvement method, and a sustained commitment over time.
The strong emphasis on co-production and service user involvement in mental health can be harnessed as a powerful asset in quality improvement work.
The recent QualityWatch report on emergency hospital care for children and young people outlined how young people’s use of emergency care has changed over ten years | Quality Watch
Overall there has been a 6% increase in hospital emergency admission rates across all children between 2006/7 and 2015/16. However it is important to note that the number of emergency admissions amongst 10-19 year olds actually dropped during the ten year period, indicating that the increase in emergency admissions by children are attributable to the under 10s. Whilst we need to better understand the increase in admissions for children there are also trends that need further exploration for young people. The most notable is that the older age group showed some increases in admissions associated with specific conditions such as abdominal pain and poisoning.
Strikingly, there was a 27% increase in re-admission to hospital within 30 days amongst children and young people admitted for poisoning by other medications and drugs, which is more prevalent in the 10-24 age group. These figures indicate that we may be failing to provide our young people with adequate mental health treatment prior to discharge and, more importantly, failing to provide ongoing support in the community.
Mandip Kaur for the King’s Fund Blog | 16th March 2017
Traditionally, mental health services are delivered by Children and Adolescent Mental Health Services (CAMHS) up until the age of 16 or 18 – or when a young person leaves school or college – at which point they’re expected to transition to adult mental health services. It’s long been recognised that this is a poor boundary for service transition, often having a further detrimental effect on mental health.
Forward Thinking Birmingham delivers mental health services for children and young people aged up to 25, combining the expertise of Birmingham Children’s Hospital, Worcester Health and Care Trust, Beacon UK, The Children’s Society and The Priory Group. The partnership’s vision is that Birmingham should be the first city where mental health problems are not a barrier to young people achieving their dreams. The transformational changes to the service were driven by the need to address disjointed and fragmented care provision, complicated service models, long waiting lists and rising demand. The service operates a ‘no wrong door’ policy and aims to provide joined-up care, focusing on individual needs, with improved access and choice for young people.