Position Statement On Children And Young Peoples’ Mental Health

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.

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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.

Read the full statement here

CAMHS: learning from case reviews

Summary of risk factors and learning for improved practice for child and adolescent mental health services | NSPCC

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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

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.    

Key findings

  • 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.

Download the full report: Quality improvement in mental health

Improving young people’s mental health care

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

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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.

Tackling culture change to transform mental health services

Mandip Kaur for the King’s Fund Blog | 16th March 2017

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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.

Read the full blog post here

Integrated collaborative care teams to enhance service delivery

Henderson J.L. et al. (2017) BMJ Open. 7:e014080

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Introduction: Among youth, the prevalence of mental health and addiction (MHA) disorders is roughly 20%, yet youth are challenged to access evidence-based services in a timely fashion. To address MHA system gaps, this study tests the benefits of an Integrated Collaborative Care Team (ICCT) model for youth with MHA challenges. A rapid, stepped-care approach geared to need in a youth-friendly environment is expected to result in better youth MHA outcomes. Moreover, the ICCT approach is expected to decrease service wait-times, be more youth-friendly and family-friendly, and be more cost-effective, providing substantial public health benefits.

Read the full protocol here

Does more mental health treatment and less stigma produce better mental health?

Two articles published this week shine a revealing light on how the general public views mental health care and its practitioners | The Conversation

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Mental health problems continue to carry a heavy stigma. People who experience them are often feared, excluded, shamed and discriminated against. Overcoming that stigma is a high priority, not least because it’s a barrier to engaging people in treatments that might help them.

People suffering from mental health problems are not the only ones to experience the stigma of mental illness, however. Those who treat them sometimes share the burden. Just as the shadow of death falls on workers in the funeral industry, psychiatric stigma casts a shadow on the public image of mental health professionals.

Psychiatrists in particular have been concerned they are held in low esteem by the public and within the medical profession. This negative view of the field has significant consequences, such as making it difficult to recruit students into psychiatric training. The chronic under-funding of mental health research and treatment arguably reflects the same devaluation.

Read the full blog post here