3.5 In 2015-16 NHS England undertook a one-off exercise to gain assurance that local transformation plans were in line with national Future in Mind priorities. Plans for 2015-16 had to be assessed as satisfactory before CCGs could receive any additional funding. NHS England told us that it did not withhold transformation funding from any area due to unsatisfactory transformation plans, although some areas had to resubmit plans before they were considered satisfactory. After the first year, NHS England’s regional teams carried out assurance of the local transformation plans as part of its business-as-usual oversight of CCGs, and funding was provided to CCGs as part of their established funding settlement (rather than as a separate payment). NHS England also told us that each year it conducts an exercise centrally to gain assurance that local transformation plans have been refreshed. The regional teams review plans for each local area, with the assurance processes varying within and between regions. There are ‘key lines of enquiry’ issued each year to set priorities for plans, but there are no national measurable objectives relating to the quality of plans or the extent to which they meet the key lines of enquiry. 3.6 Despite NHS England’s processes to quality assure local transformation plans, its monitoring of spending and performance for children and young people’s mentalhealthservices remains at a CCG and STP level, rather than a local transformation plan level (in line with its responsibilities for holding CCGs and STPs to account for NHS spending). However, NHS England required CCGs to engage with local partners outside the NHS in developing their local transformation plans, and also required that plans were agreed by local health and well-being boards (local boards that include both local authority and CCG representation). This means there is very limited national oversight of local transformation plans in transforming children and young people’s mentalhealthservices. As part of the Forward View reporting, CCGs assessed their own performance in transforming services, including whether they had refreshed their local transformation plan and whether they had met key milestones in service transformation. By quarter 4 of 2016-17, 42% of CCGs reported via their self-assessment that they were fully confident in their own transformation.
40 of the 67 providers approached provided maximum waiting times for assessment (a response rate of 59.7 per cent). 38 providers supplied maximum waiting times for treatment (a response rate of 56.7 per cent). The average of the maximum waiting times is calculated by asking each provider for their maximum waiting time (which may be just one person and include some outliers) and calculating the mean across all providers. Some of these maximum waits are due to information not being provided to the service by referring professionals or by the family, or they could be to do with patients not being available for appointments. However, some providers stated that the maximum waits were due to high demand for the service and limited capacity. For example, one provider stated that their maximum waiting time in 2016/17 was due to a “backlog in children awaiting treatment due to historical gap in capacity”.
people in care because they have not met diagnostic thresholds for treatment or because the children are without a stable placement. The Committee said that this is contrary to statutory guidance - Promoting the health and well-being of looked-after children ( March 2015) - which states that looked-after children should never be refused a service on the grounds of their placement being short-term or unplanned. The report recommended that looked-after children are given priority access to mentalhealth assessments by specialist practitioners, with subsequent treatment based on clinical need.
Overall, more than two thirds of 5 to 19 year olds who accessed professional services for a mentalhealth reason reported waiting less than ten weeks to see the specialist. This ranged from 65.2% of those who had contact with a physical health specialist, to 93.0% of those who had contacted teachers about mentalhealth.
This section of the interview is about the child’s level of activity and concentration over the last 6 months. Nearly all youngpeople are overactive or lose concentration at times, but what we would like to know is how the child compares with other youngpeople of their own age. We are interested in how they are usually – not on the occasional 'off day'.
This approach has quality implications for other survey aims. For example, a survey of the resident population excludes those who were living in a care home (for example mentalhealth units and young offender institutions). As discussed in this publication, people living in such settings are likely to have worse mentalhealth than those living in private households, which may have an effect on the quality of the prevalence estimates produced by this survey. However, the proportion of the overall population not living in private households is so small that this would have little (or no significant) impact on the prevalence estimates for the disorders examined, as such the decision was made that the improvement in the survey’s ability to provide an estimate of the treatment gap justified this trade-off between these two survey outcomes. Details of the strengths and limitations of the results of this survey are detailed in full in the Survey Design and Methods Report.
The search yielded seven systematic reviews of parenting programmes (Barlow et al., 2004; Bakermans-Kranenburg et al., 2003; Barlow & Parsons, 2003; Barnes & Freude-Lagevardi, 2003; Barlow & Stewart-Brown, 2000; Serketich & Dumas, 1996; Cedar & Levant, 1990). Five of these reviews examined the effectiveness of behavioural and other types of structured parenting programmes for all ages of children. Two reviews focused on early preventive interventions; one covered programmes aiming to enhance positive parental behaviours across four categories (sensitivity; support; representation; and two or more of these combined) (Bakermans- Kranenburg et al., 2003); the second covered programmes aiming to improve parenting, family functioning and young children’s mentalhealth more generally (Barnes & Freude-Lagevardi, 2003). Two reviews were excluded: one summarising the literature on parenting support programmes because it
After interviews were complete, a team of eleven trained clinical raters reviewed the data to reach disorder ratings for each participant. Raters applied the diagnostic criteria for specific disorders set out in the tenth International Classification of Disease (ICD-10) (WHO, 1992) and the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) (APA, 2013). Diagnostic classification systems were not used to diagnose the feeding, sleeping and elimination disorders as this was experimental work to see what proportion of families have problems in these domains that sound as if they would plausibly justify referral to specialist services.
on patients with anorexia nervosa, inpatient care and community provision show similar results which has led to a debate about the value of inpatient treatment for this disorder. For youngpeople with psychosis, intensive care in the community appears to be as effective as admission. For the above reasons, any discussion of capacity within inpatient care also needs to consider the availability of appropriate care in the community. Some areas provide intensive community services which can help youngpeople avoid admission to hospital, or to be discharged from hospital back to their local community. They can track high-risk patients in the community or provide back up support for youngpeople remaining with their families or in the care of their local authority. These services are often described as ‘Tier 3 plus’ or ‘intensive outreach’ services. The Royal College of Psychiatrists recommends that “Intensive outreach services should be comprehensively commissioned by responsible commissioning groups and health boards to ensure an even distribution around the UK”. 59
suicidal intent (NHS Choices). In this study we asked about suicide attempts and non- suicidal self-harm in combination, and our prevalence estimates are likely to differ from surveys that examined these separately. The 2017 survey found that children with a mentalhealth disorder were more likely than children without to self-harm or attempt suicide. This pattern was apparent in the previous survey too. Morgan et al. (2017) found a steep increase in self-harm rates among girls in the UK between 2011 and 2014. Other recent research, based on secondary analysis of the Understanding Society survey, also found that girls (aged 14) were twice as likely as boys to engage in nonsuicidal self-harm (The Children's Society, 2018). This is consistent with our findings that girls were more likely to self-harm than boys.
Parents of 5 to 16 year olds and youngpeople 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 mentalhealth. Professional services included contact with a mentalhealth 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.
Abstract: International studies have shown that the prevalence of mental illness, and the fundamental contribution it make to the overall disease burden, is greatest in children and youngpeople. Despite this high burden, adolescents and young adults are the least likely population group to seek help or to access professional care for mentalhealth problems. This issue is particularly problematic given that untreated, or poorly treated, mental disorders are associated with both short- and long-term functional impairment, including poorer education and employment opportunities, potential comorbidity, including drug and alcohol problems, and a greater risk for antisocial behavior, including violence and aggression. This cycle of poor mentalhealth creates a significant burden for the young person, their family and friends, and society as a whole. Australia is enviably positioned to substantially enhance the well-being of youngpeople, to improve their engagement with mentalhealthservices, and – ultimately – to improve mentalhealth. High prevalence but potentially debilitating disorders, such as depression and anxiety, are targeted by the specialized youth mentalhealth service, headspace: the National Youth MentalHealth Foundation and a series of Early Psychosis Prevention and Intervention Centres, will provide early intervention specialist services for low prevalence, complex illnesses. Online services, such as ReachOut.com by Inspire Foundation, Youthbeyondblue, Kids Helpline, and Lifeline Australia, and evidence-based online interventions, such as MoodGYM, are also freely available, yet a major challenge still exists in ensuring that youngpeople receive effective evidence-based care at the right time. This article describes Australian innovation in shaping a comprehensive youth mentalhealth system, which is informed by an evidence-based approach, dedicated advocacy and, critically, the inclusion of youngpeople in service design, development, and ongoing evaluation to ensure that services can be continuously improved.
According to newly collected data, the number of referrals to specialist CAMHS has increased by 26 per cent over the last five years. By contrast, the population of youngpeople aged 18 and under increased by 3 per cent over the same period – indicating that the rate of referrals has increased substantially. The government’s 2018 prevalence survey will provide the first detailed and robust national assessment of levels of mentalhealth difficulty at clinical levels since 2004 and is due to be published this month. This will provide the best information on underlying need to add further context these referral numbers. Our data shows that between one fifth and one quarter of children referred to specialist
A range of mentalhealthservices, in the community or in an outpatient setting, have been developed to manage youngpeople with serious mentalhealth problems who are at high risk of being admitted to an inpatient unit (DOH 2004; NSF 2004). These alternative services may prevent youngpeople 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 youngpeople 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 youngpeople with severe mentalhealth problems (Street 2003).
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 Adult Health and Social Care (Scotland) Bill proposes that existing Community Health Partnerships are replaced with Health and Social Care Partnerships with joint responsibility of NHS boards and local authorities, working with third and independent sectors. This will involve integrated budgets for joint commissioning and delivery of services to meet nationally agreed outcomes. Local partners have the discretion to include services for children in these plans (already planned by some local authorities and health boards). It remains unclear what the relationship between Health and Social Care Partnerships and Community Planning Partnerships will be but it will have implications for reporting against the proposed indicators.
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
The first point of contact for a parent/carer or young person to discuss something about the care would be the Children’s Complex Nurses. If this was deemed inappropriate or the service user has any urgent worries, all the CITN teams have a team coordinator who would be the next point of contact.
national NHS forensic adolescent inpatient units providing greatly improved facilities for staff and patients. This was made up of Ward 1 (male only ward), Ward 2 (mixed gender ward) and Ward 3 (mixed gender ward). Howeve an attached 7 bedded medium secure unit (Lennox Unit) for young men with learning disability and mental illness was commissioned by the National Commissioning Group and part of the national network of Medium Secure Units for Adolescents and opened in May 2008. This is the only NHS unit of its kind in the UK.
Influences on men’s professional psychological help-seeking. The reported reluctance of males to seek help for psychological distress suggests that those who do eventually seek mentalhealth care may have been strongly influenced by others. To date, however, no research has explored the extent to which others have influenced males attending outpatient psychological services. Study 14 considered some of the influences on men’s professional psychological help-seeking in a sample of men who were currently receiving or who had received professional psychological services within the past 12 months (Cusack, Deane, Wilson & Ciarrochi, 2004). Only 3 (6%) claimed that they were not influenced by anyone else in their decision to seek help. In marked contrast, about a third claimed that they would not have sought help without the influence of others. Of the 47 (94%) who were influenced to some extent by others to seek help, 27 (57%) indicated that they were influenced by a GP or other health professional, 26 (55%) were influenced by their intimate partner, 22 (47%) by parents or other family members, 19 (40%) by friends, and 3 (6%) by a legal professional. The majority (72%) was influenced by more than one source. A few participants also reported that they were influenced by work colleagues, Centrelink staff, and a men’s group. This study confirmed the importance of already established relationships in the help-seeking process, such as relationships with a partner or GP.