services are deemed inappropriate for specialist treatment. The proportion of rejected referrals was rising until 2015, and due to low response rates in areas with previously high rates of rejection we cannot be sure that there has been any real improvement in 2018. A conservative estimate of the number of rejected referrals in the latest year is 55,800, but the true number will be higher than this due to providers that did not respond. There is also wide variation between providers, with some rejecting approximately half of all referrals and some reporting that they rejected fewer than one per cent of youngpeople referred this year. There is no consistent measure of how many youngpeople are not accepted into treatment making it difficult to compare across providers. Some may only offer certain tiers of services, include a wider category of youngpeople in their response or filter referrals to other services in ways that result in them not being recorded as ‘rejected.’ The most common reasons provided for rejecting a referral were that the young person’s
Providers were asked to list the top three reasons why referrals in their area were rejected or were deemed inappropriate. There is no standardised data collection in this area and so the reasons given were diverse. The Education Policy Institute has grouped these into headings, as explained in the methodology section above. As shown in Figure 1.4, the most common group of reasons was that they did not meet the eligibility criteria for specialist CAMHS. As our Commission identified in 2016, this is often because these thresholds for access are very high, sometimes due to a lack of capacity within specialist services. There are also not always appropriate early intervention services in place to help those youngpeople who do not meet the criteria for specialist services. Where these services are in place, those referring youngpeople are not always aware of them.
healthservices. The Department believes that the ambitions set out in the Forward View and the Green Paper will help deliver a step-change in improvement in support to children and youngpeople. The latter introduces a new approach in schools, including the creation of new mentalhealth support teams. However, the balance between pace, funding and need to test approaches means that the Green Paper will only be rolled out to 20–25% of the country by 2023 (paragraphs 1.10, 1.12, 1.16 and 2.23, and Figure 4). 7 The government has not set out and costed what it must do to achieve Future in Mind in full. Future in Mind identified 49 proposals on themes such as resilience and early intervention, access and workforce development. However, the current programmes to take this forward will not deliver its proposals in full. Our analysis highlighted that the programmes do not have explicit objectives for some proposals, particularly those related to vulnerable groups. The government has not yet identified what actions and budget it will need to implement each proposal in Future in Mind, what progress it has made so far, and what further work is required to deliver it in full (paragraphs 1.11 to 1.13 and 2.2, Figures 4 and 5).
In the March 2015 Budget, the Chancellor of the Exchequer announced £1.25 billion of additional investment in children’s mentalhealth over the next five years (with the addition of previous announcements of £150 million for eating disorders, this has been presented as a total of £1.4 billion over the five years from 2015-16). Of the additional funding announced in March 2015, £1 billion is to be provided to start new access standards for children and adolescent services, which the 2015- 2017 Government anticipated would see 110,000 more children cared for over the next Parliament. The 2015 Government also committed to investing £118 million by 2018-19 to complete the roll-out of the Children and Young People’s IAPT (Improving Access to Psychological Therapies) programme, to ensure talking therapies are available throughout England. Alongside this, £75 million will be provided between 2015 and 2020 to provide perinatal and antenatal mentalhealth support for women. The Department for Education will also invest £1.5 million to pilot joint training for designated leads in CAMHS services and schools to improve access to mentalhealthservices for children and youngpeople. 17
• NHSBN conducted a data collection exercise that invited all providers in the above sectors to quantify and describe the shape and nature of their CYP MH workforce. The data collection took place between February and April 2019 and used data relating to 2018 calendar year. The data collection targeted quantifying the total size and shape of the CYP MH workforce, as well as analysing workforce demographics, skills and competencies.
In the March 2015 Budget, the Chancellor of the Exchequer announced £1.25 billion of additional investment in mentalhealth. £1 billion will be provided over the next five years to start new access standards for children and adolescent services, which the Government anticipates will see 110,000 more children cared for over the next Parliament. The Government has also committed to investing £118 million by 2018-19 to complete the roll-out of the Children and Young People’s IAPT programme, to ensure talking therapies are available throughout England. Alongside this, £75 million will be provided between 2015 and 2020 to provide perinatal and antenatal mentalhealth support for women. The Department for Education will also invest £1.5 million to pilot joint training for designated leads in CAMHS
In the Department for Education we want all children and youngpeople to have the opportunity to achieve and develop the skills and character to make a successful transition to adult life. Good mentalhealth is a vital part of that. The challenges youngpeople face are hugely varied – from stress and anxiety about exams to incredibly serious and debilitating long-term conditions. Everyone who works with children and youngpeople has a role in helping them to get the help they need. That is why I am so pleased to be the first minister in the Department for Education with a specific responsibility for child and adolescent mentalhealth. And why I wanted the department to work closely with the Taskforce to look at how we can make a better offer to children and youngpeople. I believe success in this area comes from Government departments working closely together. We want to make sure youngpeople no longer feel that they have to suffer in silence, that they understand the support that’s available for them and that they see mentalhealthservices as something that can make a real difference to their lives.
This service is for children and youngpeople who have complex health needs from the ages of 0- 19 years. Assessments are carried out on an individual basis to address whether the child or young person is eligible to receive the service and if so, what level of support is required.
resilience) and life skills and effective coping mechanisms when dealing with bereavement, grief and relationship loss. The important role of family and school in supporting attainment of life skills was identified along with recommendations for online information on mentalhealth and wellbeing and suggestions to improve quality of and access to healthservices. The literature review highlights the need for bisexual specific youth research and health promotion resources, as well as more inclusive organisational policies, programs and practices to address issues of being ‘invisible’ for youngpeople who identify as lesbian, gay, bisexual, transgender and intersexual (LGBTI). In addition, the inadequate representation for youngpeople identifying as bisexual was shown to contribute to a range of mental, social and sexual health concerns and further marginalisation from healthservices. In conclusion, a positive and holistic concept of health requires a model of health practice that addresses both the impacts and determinants of health problems. The review considers an extensive body of theoretical and evidence-based literature that confirms the need for a paradigm shift in how we conceptualise adolescent health and wellbeing. Several writers at a global level posit the need to draw together recent developments in biology and
The main Roycroft Clinic opened in September 2000, as a result of a £1.4 million investment by Newcastle City Health Trust. The result was the development of an eighteen-bed medium secure adolescent unit that replaced the former six-bed interim unit (the Roycroft unit). The Roycroft Clinic was noted as one of three
In contrast to informal sources of help, professional sources of help often involve engaging with a person who is a stranger. It was very clear from the qualitative data collected in Study 11 that high school students did not like to share their most personal experiences with strangers. Students reported that they would be ‘afraid’, ‘too shy’, and ‘embarrassed’ to talk to a professional who they didn’t know. Lack of trust and not knowing how to talk to a stranger about personal issues were also problematic, which was evident through responses such as ‘lack of trust, I don’t really like them’, ‘wouldn’t know what to say’, ‘hard to talk to a stranger about my problems’, and ‘I wouldn’t know how to talk about personal things with a stranger’. Students in Study 7 confirmed that difficulty trusting professional sources of help and embarrassment were barriers to seeking professional help. Students were scared and shy about talking about their problems with a stranger, and did not want to share their emotions and personal experiences with someone they did not know and with whom they had not built a relationship. Such concerns inhibit professional help-seeking, suggesting that efforts to increase young people’s use of mentalhealthservices may benefit by strategies aimed at developing trusting and supportive relationships with professionals before the need arises, as well as providing opportunities for youngpeople to practice verbalising to others their personal and emotional issues.
youth-friendly, integrated service hubs and networks that provide free or low-cost evidence-based interventions and support to youngpeople aged 12–25 years . Each local headspace centre was directed by a lead agency on behalf of a local partnership of organisations responsible for providing more integrated and coordinated responses for youngpeople across primary care, mentalhealth, alcohol and other drugs, and social, educational and vocational issues. The key aim was to improve mentalhealth outcomes for youngpeople through greater access and engagement, earlier intervention, more holistic care, and better service integration . Between 2006 and July 2014, 67 headspace centres were opened and services were provided to almost 125,000 youngpeople in metro- politan, regional and rural/remote areas across Australia. Bipartisan government support meant that the number of headspace centres steadily increased, with around 85 centres established by early 2015, and plans to increase to up to 110 centres across Australia in 2016/17 . The psychological services delivered by headspace were often funded via the Better Access program (57.4%) and infre- quently via ATAPS (7.8%) .
Whilst the data gathered indicated some geographic variations and also some differences amongst young refugees and asylum seekers that were related to their migration status, across the different sample areas, and in both the individual interviews and the focus groups, there was considerable consistency in some of the prominent issues and concerns raised by youngpeople. For this reason, the following material does not attempt to break down the information by either focus group or interview but rather, presents a discussion of the key themes emerging from the data overall. Any differences between those who had experience of using CAMHS/statutory mentalhealthservices and those without are noted under the
surveyed felt that the Internet had helped a little or a lot with a mentalhealth, alcohol, or other substance use problem, and that 85% of youngpeople surveyed would recommend it to a friend or family member. In addition, 94% felt somewhat satisfied or very satisfied with the information provided online. The study illustrated that a general Internet search served as the primary gateway to access information about mentalhealth and well-being, but once this initial search phase was complete, peer support groups and forums proved less popular than mentalhealth and generalist websites. The survey respondents were less in favor of online journals, reading other people’s stories, or accessing fact sheets, but general information and question-and-answer forums were popular. 24 The paper argued that youngpeople are using
of alternative services in terms of effectiveness and cost, focusing on those services that are most prevalent. For example, comparing intensive day treatment with home treatment or intensive outpa- tient treatment. It might be simpler in the first instance to design studies for services of specific disorders or symptoms (e.g. eating disorders, early onset psychosis) in order to compare data across sites. It may not be feasible to conduct a randomised controlled trial of these interventions due to difficulties in obtaining consent when one of the alternatives is inpatient care and problems with treatment fidelity. Implementing prospective comparative systems of audit are an alternative. By this we mean the prospective col- lection of data across several centres, which will include baseline measurement at admission along with demographic data. Out- comes should be measured using a few standardised robust instru- ments, for example the HoNOSCA system which has both clinical (Gowers 1999) and user rated versions (Gowers 2002). This would allow comparisons to be made of the differential effect of these services for children compared with adolescents, and between the different diagnostic categories.
MH services provided in schools are some of the most accessible for CYP. This is because most CYP attend school, access to schools-based services does not require a clinical diagnosis, and schools are often the first point of contact for CYP and their families when they begin to experience MH problems. A 2017 joint report by the Health and Education Select Committees emphasised the importance of a whole-school approach to MH, MH training for teachers, and co-ordinating schools and CYPMHS. 29
Another pressing need for research is in the area of multi-cultural conceptions of illness and wellness. Cultural and linguistic competence have assumed greater importance as our nation has experienced an historic demographic shift with recent immigration. However, some observers emphasize that culture and language sensitivity is also required when considering other distinct populations, such as rural, youth, racial minority, and low-income families that may share certain features of culture. 211 Much of current practice in the U.S. context—whether targeted or universal—is based exclusively on western-European norms, and—understandably—feels foreign to people living in the United States whose heritage is elsewhere. Yet, relatively little work has been done to clarify which, if any, mentalhealth constructs are broadly held across diverse cultures, and which are predicated on traditions and understandings specific to a particular group. 212 Nevertheless, it is clear that how symptoms are expressed, how people cope with their illness, their willingness to get treatment, and what family and community supports they have, are all affected by culture. In addition, the cultures represented by the clinician and the service system play a part in how conditions are diagnosed and treated, and how services are delivered. 213 A culturally sensitive approach to intervention is essentially one which requires problem-solving skills that have only begun to be articulated in the guidance professionals receive. 214
Reviews and guidelines from the UK (NICE 2005, 2008, 2009), other European nations (Stengard & Appelqvist-Schmidlechner 2010), Canada (Zuckerbrot et al. 2007) and the USA (Olin & Hoagwood 2002, AACAP, 2009) recommend developing the capacity and quality of school- and primary care- based support for common mental disorders, with school nurses being key to this activity. However, there is relatively little research concerning school nurses and mentalhealth work. Although studies have been conducted in the UK’s constituent countries and in Sweden and France, most work in this area has been undertaken in the USA. Puskar and Bernardo (2007), Bullock et al. (2002) and DeSocio et al. (2006), for example, provide evidence that school nurses can be successfully involved in mentalhealth screening, promotion and early intervention activities.
between 18 and 24, precisely when it is needed most’ (2011: 75). The MHF finds that between 2003 and 2006 only 25% of children with a diagnosed mentalhealth disorder were accessing specialist services (MHF, 2007b); Lord Layard’s very recent report reveals no change in this, stating that of the 700,000 children and youngpeople experiencing mentalhealth problems in the UK today three quarters are receiving no treatment at all, and noting that children’s services are being disproportionately affected by current NHS budget cuts (2012). Despite the rhetoric of early intervention, those with low level problems are least likely to receive support, although there is widespread agreement that problems are ’best tackled in their initial stages’ (Joy et al, 2008: 25; Coulston 2010; Purcell et al, 2011). Youngpeople are left feeling ’extremely isolated’ (MHF, 2004: 5) and this has prompted calls for a ’radical rethink of … services for 16 – 25 year olds’ (ibid: 3; Purcell et al, 2011; Young Minds, 2006).The MHF argues that any new forms of support ‘need to be provided through universal services and located in the settings youngpeople will access’ (MHF, 2007b: 6). Their ‘Listen Up!’ report identifies an explicit role for youth work in this delivery, arguing that what youngpeople want is informal support ‘staffed by skilled youth workers with knowledge of mentalhealth issues’ (MHF, 2007a: 11), someone to talk to who will listen to them, give advice and support, and be non-judgemental (Brophy, 2006; MHF, 2007a). This is borne out within the project we researched, where the trusting relationships youth workers form with youngpeople mean they are often in the front line and are the first adult some youngpeople turn to when seeking support . This highlights the need for workers to have confidence and understanding when faced with mentalhealth issues. Supporting this, Coulston’s (2010) report highlights the ways in which youth work processes can promote positive mentalhealth and well-being, as well as suggesting a move towards addressing this in future youth work training and development. Coulston notes that:
demand on beds and provide care closer to young people's homes and communities. As the process of transforming child and adolescent mentalhealthservices continues, data on the consistent provision of these services should be collected and monitored at a national level. In addition, further training is needed for staff outside of specialist CAMHS, such as GPs, ambulance and A&E staff and the police who are likely to be first respondents to youngpeople in crisis. New models of supporting youngpeople in crisis such as street triage and crisis cafes should be replicated across the country.