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 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 CAMHSservices and schools to improve access to mentalhealthservices for children and youngpeople. 17
The 2015-2017 Government announced new funding for mentalhealth, 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 MentalHealth (February 2016), including specific objectives to improve treatment for children and youngpeople by 2020/21. The Policing and Crime Act 2017 included provisions to end the practice of children and youngpeople being kept in police cells as a “place of safety” whilst awaiting mentalhealth assessment or treatment. In December 2017 a Green Paper on children and young people’s mentalhealth was published for consultation, which set out measures to improve mentalhealth 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
At a national level, the pilot programme very much demonstrates the potential added value of providing schools and NHS CAMHS with opportunities to engage in joint planning and training activities, improving the clarity of local pathways to specialist mentalhealth support, and establishing named points of contact in schools and NHS CAMHS. At the same time, the evaluation has underlined the lack of available resources to deliver this offer universally across all schools at this stage within many of the pilot areas. Given the pilots show that additional resources would need to be allocated locally to deliver the offer universally across all schools, further work is needed to understand how sustainable delivery models can be developed. 60
In July 2014, NHS England published a report on Tier 4 CAMHSservices. NHS England took on responsibility for the national commissioning of Tier 4 services in April 2013, and the report assessed the current provision of services and areas for improvement since national commissioning began. The report found that distribution of Tier 4 services is not even across the country; in some areas of the country inadequate provision of inpatient services means that children and youngpeople are admitted to services a long way from home. The report also found evidence of people being admitted inappropriately to CAMHS inpatient services, because of a lack of lower-level community provision. 33
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 EducationPolicy 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.
2.22 HealthEducation England told us that it did not spend the full amount of Forward View funding planned by the Department of Health & Social Care (the Department) and NHS England in both 2016-17 and 2017-18. The Department and NHS England had earmarked £38 million, in each of these years, to train the children and young people’s mentalhealth workforce. HealthEducation England did not spend £29 million (77%) of it in 2016-17 and £9 million (23%) in 2017-18. HealthEducation England told us the main reasons for this were: insufficient time to prepare for recruiting trainees; that the 2016-17 funding was provided too late in the year to allow it to recruit the required number of training places for that year; and difficulty in matching the funding (on a financial year basis) with the training places (academic year basis). The Department and NHS England returned the underspend to HM Treasury, in line with normal funding arrangements. Challenges in recruiting new, and training existing, staff include the need to fit in training on top of existing work, and some staff are required to travel long distances for training and supervision. Although NHS England provides funding to providers to allow them to cover staff undertaking training, local stakeholders told us that they cannot always find replacement staff, leading to higher workloads for the staff not in training, and the funding is not sufficient to cover the cost of more expensive agency staff.
In most cases, LAs did not specify why these services were no longer offered; one explained that two school-based programmes had previously been funded by ‘external grants that have been since been cut as part of central government cuts for local government.’ In other cases, they may have been deemed ineffective, or other services may have taken their place; many LAs, however, specified in their responses if services they no longer provided or commissioned had been taken over by another agency. Nine authorities reported increasing investment in specific services addressing young people’s mental and emotional wellbeing, while others mentioned the general increase in CAMHS investment via Clinical Commissioning Groups and transformation plans.
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).
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 ChildrenServices (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)
White British children were about three times more likely to be identified with ASD than Black or Asian children. Research on variation by ethnic group is mixed, and migration status may compound the relationship (Becerra et al., 2014). The higher rate of diagnosis in White British children has been thought to relate to greater treatment and service access. England’s survey of mentalhealth in adults found White British people with a common mental disorder to have higher levels of treatment access than people of other ethnic groups (Lubian et al., 2016). Recent research has also found that members of minority ethnic groups may hold more self-stigmatising views of autism (Papadopulous, 2016). This could be a factor shaping higher levels of social desirability bias in reporting of symptoms in children with minority ethnic parents. Almost all the children in the sample identified on the spectrum were recognised as having special educational needs, and they make up a sizeable minority of the special educational needs group as a whole (one in seven). The survey data indicates the extent to which schools and educationservices may have autistic pupils in their communities.
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 youngpeople with mentalhealth 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 EducationPolicy Institute has analysed the literature and available data to establish what is currently known about the state of inpatient mentalhealthservices for children and youngpeople. Information in this report is derived from national datasets including the NHS Digital monthly MentalHealth statistics and the NHS England Five Year Forward View for MentalHealth Dashboard. We have also included data provided by NHS England on request, and information from the existing literature.
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.
encompasses anyone working in universal children’s services (including teachers and school nurses); Tier 2 workers are the unidisciplinary specialists (such as psychologists) working in primary and community-oriented care; Tier 3 services are provided mainly by multidisciplinary teams working in outpatient (sometimes day care) services; Tier 4 provision – which equates largely with hospitalisation – is for the minority with the most complex needs (CAMHS Review, 2008). Primary-oriented care and community-oriented care are thus an inherent part of CAMHS, yet this provision is often overlooked. For many, CAMHS is synonymous with Tiers 3 and 4 or, at the very least, it begins at Tier 2. These higher tier services are often overstretched, with many having long waiting lists (Clarke et al. 2003, Etheridge 2004, CAMHS Review 2008). Moreover, in-patient (Tier 4) services are expensive, both for the service provider and for the families receiving the service (Jacobs et al. 2004).
• This bespoke report outlines the Local Authority findings from a national stocktake of the Children and Young People’s mentalhealth (CYP MH) workforce across England. The project was commissioned by HealthEducation 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.
The cost of the status quo as it pertains to the mentalhealth of youngpeople is high. The burdens borne by the individuals directly affected by poor mentalhealth, 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 mentalhealth 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 mentalhealth challenges are not properly addressed, costs include not only those associated with unsuccessful attempts at treatment, but also may encompass expenses for special educationservices, and a parent’s lost productivity due to the child’s greater need for care.
Results: Most youngpeople felt anxious, fearful and uncertain on leaving CAMHS and perceived mentalhealthservices as uncaring. Participants outlined transition procedures and drafted a range of preparation activities, centred around dedicated Transition Peer Support and a transition booklet, which should be offered to all CAMHS leavers, irrespective of discharge or transfer to an adult service. Preparation should aim to build confidence to help youngpeople take responsibility for themselves and flourish in the adult world: coping or getting through it was not enough. Some clinicians also felt anxious at transition and recognised the potential impact on youngpeople of poor communication and lack of understanding between services. Parents would appreciate help to support their offspring during the transition period. Clinicians cited lack of funding and inflexible NHS procedures and policies as potential barriers to the implementation of youngpeople ’ s ideas. Nine youngpeople took up co-research opportunities. Conclusions: Mentalhealthservices underestimate the anxiety of CAMHS leavers. Youngpeople have clear ideas about the preparation they require to leave CAMHS with the confidence to take responsibility for their own health care. Close collaboration of NHS staff and researchers facilitates the implementation of research findings.
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 healtheducation 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 youngpeople. 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 healthservices based on the available evidence at the time 156 .
Youngpeople need to be encouraged to actively build supportive relationships, both within and beyond their informal support system. Moreover, interventions should be targeted at the people who influence young people’s help-seeking, as well as youngpeople themselves. It is clear that there are many potential social influences on the help-seeking process, and this is a factor that needs to be more fully explored, particularly for younger adolescents. For example, parents must be a focus of help-seeking interventions. Parents need accurate information and training in skills that enable them to determine if their child needs help, where such help is available, and how to sensitively encourage their child to accept such help. Similarly, friends and intimate partners also have an important role at different stages of the lifespan. Professionals in regular contact with youngpeople need to be aware of their potential role in promoting mentalhealth and preventing and intervening early in the development of mentalhealth problems for youngpeople. These professionals need to be encouraged to actively build protective relationships with the youngpeople with whom they are in regular contact. Some people are in positions that are ideally suited to developing such relationships. This includes teachers, youth workers, sport coaches, social activity leaders, and possibly GPs. For youngpeople still at school the roles of teachers and schools counsellors, and their links with other supports, are critical (Rickwood, in press). For those no longer at school, youth workers and relationships developed through work and further study, are relevant.
This Guide for Referrers outlines the step-by-step process for Referrers who wish to access CAMHSservices via the CAMHS Gateway during the pilot period and has been updated to reflect changed arrangements from September 2012 to the end of March 2013. This guide takes you through the process of how to refer to the Gateway, and actions required (if any) after referral screening has taken place. We have included some notes on ‘Typical Children and Young Persons difficulties that can be referred to CAMHS Gateway’ (Appendix 2) and ‘Frequently Asked Questions’ (Appendix 3).