Mental Health Service Models for Young People

In 2015, the government committed five years of extra funding for children and young people’s mental health services (CYPMHS). All areas of England were required to submit plans outlining how they will improve their services by 2020.

This POSTnote describes some of the new models of CYPMHS and examines the challenges to their effective implementation.

Overview

  • The Office for National Statistics estimates that nearly one in four Children and Young People (CYP) show some evidence of mental ill health.
  • It is estimated that between £70-100 billion is lost each year in the UK due to poor
    mental health.
  • New models of CYP mental health services are currently being developed across the
    country to suit the unique needs of local areas. They include whole-system, schoolsbased, community-based and other models, and involve integrating services from across the statutory and voluntary sectors.
  • Issues with implementing new service models include data monitoring, recruiting
    and retaining staff and funding.

Full document available here

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Changes in severity of psychosocial difficulties in adolescents accessing specialist mental healthcare in England

In England, clinicians and professional organisations report that higher numbers of adolescents with more severe psychosocial difficulties are accessing specialist services | Journal of Adolescence

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A lack of national data on patterns of access to specialist services means there is limited information to inform policy. We examined whether severity of psychosocial difficulties in adolescents accessing mental healthcare has changed over time. Adolescents seen in specialist child mental healthcare in 2009 vs. 2014 were matched on demographics and problem types using propensity score matching; final sample N = 2776 adolescents. We found:

  1. stability over time in overall severity of difficulties,
  2. an increase in severity of young women’s emotional problems,
  3. a decrease in adolescents’ conduct problems. The findings suggest the intriguing possibility that the criteria for accessing mental healthcare are not universally rising, but rather the patterns in access to specialist services may mirror epidemiological changes in severity of psychosocial difficulties in the population.

Full reference: Edbrooke-Childs, J. et al. (2017) Changes in severity of psychosocial difficulties in adolescents accessing specialist mental healthcare in England (2009–2014). Journal of Adolescence. Vol. 60 (October) pp. 47-52

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

Specialist mental health care in England

The state of care in mental health services 2014 to 2017| Care Quality Commission (CQC) 

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Image source: http://www.cqc.org.uk

This report describes how CQC inspectors found that the majority of services are caring and compassionate towards their patients. However, the report also identifies several areas of concern: difficulties around accessing services, physical environments not designed to keep people safe, care that is over-restrictive and institutional in nature, and poor recording and sharing of information that undermines the efforts of staff to work together to make sure that people get the right care at the right time.

Full report: The state of care in mental health services 2014 to 2017

Additional links: CQC press release | NHS Confederation

A healthy State of mind: Improving young people’s mental fitness

This report argues for reform of the mental health system to provide greater support for the majority of young people who will not receive treatment from specialist CAMHS whilst ensuring that those in desperate need of clinical intervention receive immediate help | Localis

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The current mental health system is failing children and young people. Whilst in almost all areas of health and care reform the dominant trend is to encourage people to be more independent and resilient, in Child and Adolescent Mental Health Services (CAMHS), something has gone badly wrong.

There is a current tendency for many young people to not register on the radar when they try to deal with their problems. Instead of receiving sustained support for their mental health, they bounce around different tiers of services without sustained support. Even after being treated for severe mental health difficulties they often again fall off the radar until they reach another crisis. There needs to be a better focus on addressing the challenges that young people face in their mental wellbeing or, as we prefer, mental fitness, rather than solely concentrating on the presence of clinically diagnosable mental health disorders. Such a focus would provide agency for young people to – with the support of the wider community – better develop resilience before the involvement of specialist services whilst ensuring that those with severe mental health needs are provided with immediate specialist support.

Delivering mental health transformation

This report focuses on progress and challenges in improving children and young people’s mental health services in England, particularly for minority or vulnerable groups. | National Children’s Bureau (NCB)

This report is based on the views of 49 professionals working with children and young people, primarily from the voluntary, community and social enterprise sector (VCSE) who responded to an online survey in autumn 2016.

NCB were funded by the Department of Health, NHS England and Public Health England to gather information from the sector on what needs to happen for the Government’s vision for improved mental health services to be realised for all children, particularly those who are vulnerable, have poorly understood needs, or who face particular challenges accessing the support they need. The information was primarily gathered via an online survey.

The report shares concerns raised by the sector about the system not meeting demand. This relates not just to waiting lists but the amount of time services are able to dedicate to each service user.

Full report: Delivering mental health transformation for all children Findings from engagement with the children and young people’s voluntary sector in Autumn 2016.

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