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Children and young people’s mental health : policy, services, funding and education

Children and young people’s mental health : policy, services, funding and education

In the March 2015 Budget, the Chancellor of the Exchequer announced £1.25 billion of additional investment in children’s mental health 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 mental health 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 mental health services for children and young people. 17
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Children and young people’s mental health : policy, services, funding and education

Children and young people’s mental health : policy, services, funding and education

Government’s 2011 mental health strategy, No Health without Mental Health , pledged to provide early support for mental health problems, and the Deputy Prime Minister’s 2014 strategy, Closing the Gap: priorities for essential change in mental health , included actions such as improving access to psychological therapies for children and young people. The Department of Health and NHS England established a Children and Young People’s Mental Health and Wellbeing Taskforce which reported in March 2015 and set out ambitions for improving care over the next five years. The Coalition Government also pledged funding for children and adolescent mental health, detailed in the briefing. The 2015 Government has announced new funding for mental health, including specific investment in perinatal services and eating disorder services for teenagers. Additionally, the Government has committed to implementing the 2016 Mental Health Taskforce’s recommendations, including specific objectives to improve treatment for children and young people by 2020/21. The Policing and Crime Bill , currently going through Parliament, legislates to end the practice of children and young people being kept in police cells as a “place of safety” whilst they await mental health assessment or treatment.
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House of Commons Library briefing paper : Number 07196, 11 July 2019 : Children and young people’s mental health :   policy, services, funding and education

House of Commons Library briefing paper : Number 07196, 11 July 2019 : Children and young people’s mental health : policy, services, funding and education

The 2015-2017 Government announced new funding for mental health, including specific investment in perinatal services and eating disorder services for teenagers. Additionally, the 2015 Government committed to implementing the recommendations made in The Five Year Forward View for Mental Health (February 2016), including specific objectives to improve treatment for children and young people by 2020/21. The Policing and Crime Act 2017 included provisions to end the practice of children and young people being kept in police cells as a “place of safety” whilst awaiting mental health assessment or treatment. In December 2017 a Green Paper on children and young people’s mental health was published for consultation, which set out measures to improve mental health support, in particular through schools and colleges. The Green Paper set out three key proposals: • To incentivise and support all schools and colleges to identify and train a Designated
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House of Commons Library: Briefing paper: Number 07196, 1 August 2018: Children and young people’s mental health – policy, services, funding and education

House of Commons Library: Briefing paper: Number 07196, 1 August 2018: Children and young people’s mental health – policy, services, funding and education

In July 2016, NHS England published its plan for Implementing the Five Year Forward View for Mental Health , setting out how the NHS will put the recommendations from the Mental Health Taskforce into practice. For 2016/17 NHS England announced that £149m was awarded to Clinical Commissioning Groups (CCGs) to fund improvements in CAMHS. In addition, in September 2016 NHS England announced that it had “reprioritised spending” to free up an extra £25m to go to CCGs to spend on CAMHS. In order to receive the extra funds, CCGs will need to provide details of how they will reduce average waiting times for CAMH treatments by March 2017.
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Children and young people’s mental health : policy, CAMHS services, funding and education

Children and young people’s mental health : policy, CAMHS services, funding and education

In response, the Government provided £7 million of additional funding, allowing NHS England to provide 50 additional CAMHS specialised tier 4 beds for young patients in the areas with the least provision—46 of these beds have now opened. NHS England has also introduced new processes for referring to and discharging from services, to make better use of existing capacity. A key objective of these actions is to help prevent children and young people from being referred for treatment long distances from home, except in the most specialised cases. 21
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Leeds Children and Young People s Continuing Care Policy 2011

Leeds Children and Young People s Continuing Care Policy 2011

Some children with complex difficulties including behavioural problems, whose needs cannot be met in Leeds through continuing care processes, may be referred to the Joint Agency Decision and Review Panel (JADAR). This is a joint panel, which includes representation from the Local Authority Children Services (Children and Young People’s Social Care and Education) and the local Health Service. The panel offers advice about the health care, social care and education of children with the most complex difficulties in Leeds, where two or more of the agencies are having difficulty in placing and managing the child. Further details about the responsibilities of the panel are contained in the JADAR Terms of Reference (Joint Children’s Placement Decision and Review Panel “Joint Panel” Governance arrangements and terms of reference, December 2010)
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Access and waiting times in children and young people’s mental health services

Access and waiting times in children and young people’s mental health services

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 young people who do not meet the criteria for specialist services. Where these services are in place, those referring young people are not always aware of them.
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Young People s Experiences with Health Services: Final Report

Young People s Experiences with Health Services: Final Report

In addition to identifying the general principles of best practice, the review includes examples of creative and innovative processes, universal health prevention strategies and targeted initiatives that have been shown to increase youth access and participation, and enhance health education and positive health and wellbeing outcomes. The terms ‘best practice’ and ‘what works’ are used here to inform a range of areas where there is potential to improve the health service experiences for young people. These areas include policy and program development, funding and resources allocation; collaborative and interdisciplinary practice; clinical guidelines and referral pathways; professional training and education; consumer, family and community education; and service integration. The NSW Association of Adolescent Health (NAAH) has noted the lack of research literature that explores these concepts, particularly in the youth health field, and claims ‘there are no ready answers and no straight and narrow, uncontroversial path through the small amount of literature that exists’. NAAH first published the Getting It Right: Models of Best Practice report in 1999, subsequently updating it in 2003 and 2005. In reporting on the components that constitute a better practice approach to youth health, the following principles were noted: addressing inequalities, providing access and participation, building supportive environments, balancing approaches, coordination, collaboration, and building the infrastructure. Each of these components was described together with the elements required to initiate the best approach to providing youth health services based on the available evidence at the time 156 .
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Future in mind. Promoting, protecting and improving our children and young people s mental health and wellbeing

Future in mind. Promoting, protecting and improving our children and young people s mental health and wellbeing

In the Department for Education we want all children and young people to have the opportunity to achieve and develop the skills and character to make a successful transition to adult life. Good mental health is a vital part of that. The challenges young people face are hugely varied – from stress and anxiety about exams to incredibly serious and debilitating long-term conditions. Everyone who works with children and young people 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 mental health. 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 young people. I believe success in this area comes from Government departments working closely together. We want to make sure young people no longer feel that they have to suffer in silence, that they understand the support that’s available for them and that they see mental health services as something that can make a real difference to their lives.
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Improving children and young people’s mental health services

Improving children and young people’s mental health services

5 The government faces significant challenges in transforming children and young people’s mental health services, as part of its commitment to parity of esteem between physical and mental health services. The government acknowledges that historically mental health services have been seen as of secondary importance to physical health services. Its periodic survey of the prevalence of mental health conditions among young people allows it to estimate overall need, but historically it has treated far fewer young people than this. In 2015, the most up-to-date estimate indicated that only around one-quarter of children and young people who needed support from mental health services could access those services. The government has endorsed a vision for improving support for children and young people’s mental health, set out in Future in Mind. Delivering this vision will require coordinated action across different parts of government – for example, health, education, local government and justice – and between national and local bodies. Each of these has its own priorities, funding challenges and accountability arrangements. Experience in other sectors also suggests that raising the profile of mental health support and services and reducing the stigma of mental illness may uncover previously unidentified further demand (paragraphs 1.3, 1.7, 1.10 to 1.12, 2.28, 3.18, 3.22 to 3.24 and Figures 4 and 18).
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Are the Children Well? A Model and Recommendations for Promoting the Mental Wellness of the Nation s Young People

Are the Children Well? A Model and Recommendations for Promoting the Mental Wellness of the Nation s Young People

The cost of the status quo as it pertains to the mental health of young people is high. The burdens borne by the individuals directly affected by poor mental health, and their families and friends, are essentially incalculable. From a policy-making perspective, however, it is often useful to quantify total economic costs, including social costs. Competing interests vie for limited funds, and one way to prioritize spending is to estimate the price of leaving the current system as it is—―business-as-usual.‖ When estimating the burdens that are associated with various injuries, illnesses, and risk factors, the two most common metrics are direct costs, and healthy years of life (a measure that reflects both premature death, and years lived with a disability). To count direct and indirect costs, we need to consider both what society currently spends on mental health treatment and prevention, and what it spends now, and in the future, due to the inadequacy of these efforts. To illustrate, when a child’s mental health challenges are not properly addressed, costs include not only those associated with unsuccessful attempts at treatment, but also may encompass expenses for special education services, and a parent’s lost productivity due to the child’s greater need for care.
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Access to children and young people’s mental health services: 2018

Access to children and young people’s mental health services: 2018

Unfortunately, in the past a proper understanding of the existing patterns of demand and service provision has not been possible due to the lack of regular, reliable, and consistent reporting of mental health demand and service access. Policy makers have pledged to improve the collection and publication of mental health data to inform debate and lead to more informed policy making. But promises about improved data and accountability have not, so far, been matched by the delivery of consistent and transparent data reporting. The Education Policy Institute has sought to improve the understanding of children's mental health prevalence and access issues by securing data from individual service providers and publishing this, as far as possible at a consolidated national level. This latest report looks at the increased demand for children's mental health services; what
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Inpatient provision for children and young people with mental health problems. July 2017

Inpatient provision for children and young people with mental health problems. July 2017

One aspect which has received less attention in recent years is inpatient care. Also known as ‘Tier Four’ services, these are facilities for children and young people with mental health problems who require hospital admission. These can be separate facilities or part of a larger facility that includes units for adults or outpatient services. The Education Policy Institute has analysed the literature and available data to establish what is currently known about the state of inpatient mental health services for children and young people. Information in this report is derived from national datasets including the NHS Digital monthly Mental Health statistics and the NHS England Five Year Forward View for Mental Health Dashboard. We have also included data provided by NHS England on request, and information from the existing literature.
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Children and Young People s Mental Health Services Workforce Report for Local Authorities

Children and Young People s Mental Health Services Workforce Report for Local Authorities

• This bespoke report outlines the Local Authority findings from a national stocktake of the Children and Young People’s mental health (CYP MH) workforce across England. The project was commissioned by Health Education England (HEE) and undertaken by the NHS Benchmarking Network (NHSBN). The project builds on a previous study undertaken by the NHSBN for HEE in 2016.

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The effectiveness of interventions aimed at improving access to health and mental health services for looked after children and young people: a systematic review

The effectiveness of interventions aimed at improving access to health and mental health services for looked after children and young people: a systematic review

Research on LACYP is distributed across a wide range of bibliographic databases in the fields of health, social science and social care (Clapton 2010). Our approach to capturing relevant material was to search 18 key bibliographic databases from these fields. In the first stage, we used search terms relating to the population, such as looked after child/children’, ‘children in care’, ‘foster care’ and ‘care leaver’. These databases were Applied Social Sciences Information and Abstracts (ASSIA), Australian Family and Society Abstracts, British Educational Index (BEI), Campbell Collaboration C2 Library, Current Education and children’s services Research in the UK (CERUK Plus), ChildData, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL Plus), EMBASE, Health Management Information Consortium (HMIC), International Bibliography of the Social Sciences (IBSS), JSTOR, Medline, PsycInfo, Social Care Online, Social Services Abstracts, Social Work Abstracts and Zetoc. The full search strategy is available from the full report informing NICE guidance (Jones et al., 2010). Searches were limited to 1990 onwards and were not restricted by language, study type or place of publication. The combined search output at the end of this stage was 20,000 records on the population of LACYP. This population database was then searched using terms for service use and access (Jones et al., 2010). The search terms were drawn up by the first four authors, based on papers included in a previous correlates review, which broadly examined factors associated with outcomes among LACYP (Jones et al., 2011) and knowledge of the review topic. This process resulted in 5114 retrieved citations (excluding duplicates).
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Mental Health of Children and Young People in England, 2017

Mental Health of Children and Young People in England, 2017

Parents of 5 to 16 year olds and young people aged 17 to 19 were asked whether they had been in contact with any professional services (from a list of examples) or informal sources of support in the past year because of worries about the child or young person’s mental health. Professional services included contact with a mental health specialist, GP or teachers. Informal sources of support included family and friends, the internet or self-help groups. Specialist service records were not examined in this survey. Note that while the wording of the question establishes that contact with services or support took place, the nature or extent of that contact was not established. In theory, contact could have involved a single interaction.
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Youth Work and the Power of ‘Giving Voice’: a reframing of mental health services for young people

Youth Work and the Power of ‘Giving Voice’: a reframing of mental health services for young people

young people’s mental health. The board is commissioned by the local clinical commissioning group (CCG) and members regularly attend meetings with health professionals, including commissioners and senior service managers. The board is involved in a wide range of activity; they are regularly consulted and have recently contributed to a local CAMHS needs assessment and the development of a new mental health strategy for young people. They also carry out consultations and ‘peer research’ with other young people locally, in order to represent their views. They have worked alongside CAMHS staff to organise and facilitate conferences and training for local professionals working with young people, have been involved in the recruitment and induction of CAMHS staff, and receive their own small commissioning budget through which they are able to develop resources to meet identified ‘gaps’. This has included film-making, organising events, developing a local youth mental health website, and designing leaflets and information resources for young people. More recently they have been invited to support the national CYP IAPT (Children and Young People Increasing Access to Psychological Therapies) programme which aims to transform delivery of specialist CAMHS across many parts of England. They have also been working with the newly established local Healthwatch. Members receive training and are informed and supported by the project workers to ensure they are able to participate fully.
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Mental Health of Children and Young People in England, 2017

Mental Health of Children and Young People in England, 2017

charities, academics, educators, the public and the media. Uses of the data include: informing and monitoring policy; monitoring the prevalence of health or illness and changes in health or health related behaviours in children and young people; informing the planning of services for this age group; and writing media articles. Universities, charities and the commercial sector use the data for health and social research. User needs have been gathered and considered at all points in the collection and publication of this information. This has been guided by a steering group consisting of representatives from NHS Digital, DHSC, PHE, DfE, NHS England, Anna Freud National Centre for Children and Families, academic leads in Child and Adolescent Mental Health, and academic leads in Contemporary Psychoanalysis and
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Alternatives to inpatient mental health care for children and young people (Review)

Alternatives to inpatient mental health care for children and young people (Review)

A range of mental health services, in the community or in an outpatient setting, have been developed to manage young people with serious mental health problems who are at high risk of being admitted to an inpatient unit (DOH 2004; NSF 2004). These alternative services may prevent young people from developing a dependency on the hospital environment or from being stig- matised. In addition, they may facilitate the transfer of any ther- apeutic gains to the young person’s everyday environment, thus maximising the potential for sustaining improved health outcomes (Katz 2004) and for educational attainments to be less severely af- fected (Milin 2000). Examples include early intervention services in the community for young people with first episode psychosis (McGorry 2002), assertive outreach (McGorry 2002), dialectical behaviour therapy (Miller 2002), family therapy (Lock 2005) and multi-family therapy for anorexia nervosa (Scholz 2001). The way services are organised also differs. Service configurations include the provision of multi-agency integrated home care (DOH 2004), therapeutic units based in a day unit, or multi-agency services providing intensive specialist outpatient therapy for young people with severe mental health problems (Street 2003).
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Mental Health of Children and Young People in England, 2017

Mental Health of Children and Young People in England, 2017

Most surveys measuring less common mental and neurodevelopmental conditions use short screening questionnaires to identify potential cases, these tend to overestimate prevalence. Other studies sift routine health and education data to identify recognised cases, but miss those children who were not recognised by services (Brugha et al., 2018). The last survey to have assessed the disorders covered in this report in a general population sample of children in England was the previous survey in this series, conducted in 2004. Change in rate since 2004 can be estimated because methods in those years were comparable, and our approach is less affected by changes in diagnostic criteria and clinical practice.
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