Children and Youth Mental Health Services: The NHS’s Five Year Plan

Introduction

Last week the NHS published its Long Term Plan for health services in England. The plan recognizes the significance of mental health challenges among children and youth (0 to 18 years), including:

  • Mental health problems often develop early and, between the ages of 5-15, one in every nine children has a mental disorder.
  • Half of all mental health problems are established by the age of 14, with three quarters established by 24 years of age.
  • Prompt access to appropriate support enables children and young people experiencing difficulties to maximise their prospects for a healthy and happy life.
  • While the latest prevalence survey has shown only a modest increase in diagnosable problems since 2004 – from 10.1% to 11.2% – this overall figure includes concerning rates of mental distress particularly among late teenage girls.

Previously, the NHS had published its Five Year Forward View for Mental Health, committing to expand its mental health services for children and youth, so that 70,000 more young people will access treatment by 2020/21. Under its Long Term Plan, the NHS is committing additional funding so that mental health services for children and youth will grow faster than both overall NHS funding and total mental health spending.

Community-based mental health services

The NHS is continuing to invest in expanding access to community-based mental health services to meet the needs of more children and young people:

  • By 2023/24, at least an additional 345,000 children and young people aged 0-25 will be able to access support via NHS funded mental health services and school or college-based Mental Health Support Teams.
  • Over the coming decade the goal is to ensure that 100% of children and young people who need specialist care can access it.

Eating disorders

The NHS is also boosting investments in children and young people’s eating disorder services. The NHS is on track to deliver the new waiting time standards for eating disorder services by 2020/21.

  • Four fifths of children and young people with an eating disorder now receive treatment within one week in urgent cases and four weeks for non-urgent cases.
  • As need continues to rise, extra investment will allow us to maintain delivery of the 95% standard beyond 2020/21.

Mental health crises

Children and young people experiencing a mental health crisis will be able to access the support they need.

  • Expanding timely, age-appropriate crisis services will improve the experience of children and young people and reduce pressures on accident and emergency (A&E) departments, pediatric wards and ambulance services.
  • Evaluations of urgent and emergency care services for children and young people in Vanguard sites found that, on average, 83% of children and young people referred to crisis and liaison services were seen within four hours.
  • Children and young people who received intensive community follow-on support subsequently made less use of crisis services compared to less integrated services.
  • With a single point of access through NHS 111, all children and young people experiencing crisis will be able to access crisis care 24 hours a day, seven days a week.

Schools and colleges

The Children and Young People’s Mental Health Green Paper set out proposals to improve mental health support in schools and colleges.

  • Over the next five years the NHS will fund new Mental Health Support Teams working in schools and colleges, building on the support already available, which will be rolled out to between one-fifth and a quarter of the country by the end of 2023.
  • These school and college-based services will be supervised by NHS children and young people mental health staff and will provide specific extra capacity for early intervention and ongoing help. Teams will receive information and training to help them support young people more likely to face mental health issues – such as LGBT+ individuals or children in care.
  • As they are rolled out, we will test approaches to support children and young people outside of education settings.

Waiting times

The NHS work with schools, parents and local councils will reveal whether more upstream preventative support, including better information sharing and the use of digital interventions, helps moderate the need for specialist child and adolescent mental health services.

  • The NHS will test approaches that could feasibly deliver four week waiting times for access to NHS support, ahead of introducing new national waiting time standards for all children and young people who need specialist mental health services.

Complex needs

In selected areas, the NHS will also develop new services for children who have complex needs that are not currently being met, including a number of children who have been subject to sexual assault but who are not reaching the attention of Sexual Assault Referral Services.

  • For 6,000 highly vulnerable children with complex trauma, this will provide consultation, advice, assessment, treatment and transition into integrated services.

Transitional-age youth

A new approach to young adult mental health services for people aged 18-25 will support the transition to adulthood. Between the ages of 16-18, young people are more susceptible to mental illness, undergoing physiological change and making important transitions in their lives. The structure of mental health services often creates gaps for young people undergoing the transition from children and young people’s mental health services to appropriate support including adult mental health services.

  • The NHS will extend current service models to create a comprehensive offer for 0-25 year olds that reaches across mental health services for children, young people and adults.
  • The new model will deliver an integrated approach across health, social care, education and the voluntary sector, such as the evidence-based ‘iThrive’ operating model which currently covers around 47% of the 0-18 population and can be expanded to 25 year olds.
  • In addition, NHS England is working closely with Universities UK via the Mental Health in Higher Education program to build the capability and capacity of universities to improve student welfare services and improve access to mental health services for the student population, including focusing on suicide reduction, improving access to psychological therapies and groups of students with particular vulnerabilities.
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