Heads up: Rethinking mental health services for young people at risk of harm

1 August 2022

By Charlotte Rainer and Dr Huong Le

Launched in September 2021, the Commission on Young Lives (COYL) is seeking to re-imagine the systems of support which prevent marginalised children and young people from falling into violence, exploitation, and the criminal justice system, and to support them to thrive. The Commission is ambitious in its aims and is led by former Children’s Commissioner, Anne Longfield.

We know that young people from marginalised groups have particularly high levels of mental health need, often undiagnosed and frequently exacerbated by the trauma they have experienced. Therefore, any work to improve outcomes for these groups of young people cannot ignore mental health.

Centre for Mental Health and The Children and Young People’s Mental Health Coalition supported the Commission on their fourth thematic report which focuses on mental health. We worked with the COYL to assess the extent of mental health need among children and young people, to explore what is and what is not working well in terms of mental health services, and to identify recommendations to improve the provision of mental health support for all children, particularly the most marginalised.

Increased mental health need

Over recent years, the number of children and young people with mental health difficulties have rapidly increased, and this has been further fueled by the Covid-19 pandemic. NHS Data shows that one in six 6 to 16 year olds now have a probable mental health condition compared to one in nine in 2017.

However, even before the pandemic, it was well-established that children and young people from marginalised groups show a higher risk of poor mental health. This includes young people from racialised communities, lower socioeconomic backgrounds, young people with SEND, those who have been in contact with the criminal justice and care systems as well as LGBTQI+ communities. For example, children in the poorest 20% of households are four times more likely to experience a mental health problem; and more than half of children with special educational needs and disability (SEND) have a probable mental health problem, compared with 12.% of those without SEND. As a result, these groups became the main focus of the current report.

Barriers to support and care

Successive governments have sought to tackle the crisis in children and young people’s mental health. Mental health support has been expanded in education settings through new Mental Health Support Teams, and the Government and NHS England have set targets to improve access to NHS-funded support. The Department of Health and Social Care has also committed to develop a new cross-government, 10-year plan for mental health and wellbeing as part of their commitment to ‘level up’ and address unequal outcomes and life chances across the country.

However, significant challenges still exist. Decades of underinvestment in services for children and young people’s mental health has left big gaps in provision and wide variations in support from one area to another. In particular, NHS Children and Young People’s Mental Health Services (CYPMHS) has faced chronic issues with high thresholds for support, long waiting times and shortages in workforce, coupled with a lack of investment in early support services in the community and patchy provision of support across education settings.

In particular, we found that mental health services as they are currently being delivered are not working for the most marginalised and vulnerable children and young people. The mental health system is not set up to support complexity, meaning that where young people have multiple needs that may be particularly severe in one area, they often don’t meet the clinical thresholds for support. Consequently, these children ricochet around services, not receiving the help they need until crisis point.

Children from these groups also hold negative perceptions of mental health services because they have had previously bad experiences of statutory services. As a result, they often are labelled ‘hard to reach’, when in fact it is services that are not meeting their needs.

What is working well?

Both young people and mental health professionals we spoke to as part of our research placed great value on early intervention support and the support provided outside of clinical settings. The report draws attention to some emerging models of best practice, where community-led, co-produced services are being placed at the heart of work to support the mental health of children and young people from marginalised groups. Many of these services place emphasis on reaching children and young people where they are at and on building consistent, trusted relationships. In the report we highlight a range of services, all with common characteristics, including:

  • Being based in the community, meaning they reach young people where they are
  • Providing non-judgmental and non-stigmatising support
  • Being youth-centered and based on the needs of young people
  • Emphasising the importance of trusted relationships
  • Being culturally representative and responsive.

For example, based in Southwark, The Nest is a youth-centered service that offers early intervention and prevention support for emotional issues and low-level mental health concerns. The service is available for children and young people at the point of need, without the need for a professional referral, and has a regular programme of drop-in sessions for children, young people and their families to speak to a member of staff without the need for an appointment. Two in three referrals to the Nest are from racialised communities, which mirrors Southwark’s demographic makeup. The Nest contributes to addressing the inequity of access; not just by increasing access and contributing to de-stigmatisation but also by providing a template for other services to improve their access. Of the young people accessing support through the Nest, 73% said they feel happier and 78% reported an increased sense of wellbeing.

Another model explored in the report includes the work of Partisan, a culturally sensitive organisation who are representatives of the communities they work with. Based outside of clinics, a team of Psychotherapists and Clinical and Community Psychologists work with children, young people, families and communities. They are highly flexible in their approach and believe in sharing psychologically informed ideas with teams on the ground who have relationships with people in their communities. Their work has helped to build trusting therapeutic relationships with young people and successfully integrate wellbeing support into the community space.

What next?

While significant progress has been made by successive governments in expanding access to mental health support, the report makes clear that the mental health system in its current form is not working and calls for a new system of mental health support for children and young people. From preventative to targeted support, through to a reformed NHS CYPMH service, the Commission makes a range of recommendations to put children and young people’s mental health at the heart of decision-making.

The report recommends:

  • A commitment from the next Prime Minister to fund an immediate £1bn children and young people’s mental health wellbeing recovery programme to improve the quality and effectiveness of mental health care and support, with guaranteed appointment and treatment times. Whilst this will be locally determined, it will fit within a national guarantee that all children and young people requiring CYPMHS treatment are seen within a 4-week period, with guaranteed next day emergency appointments for children at risk of serious self-harm and suicide
  • Guaranteed mental health assessments for children and young people at points of vulnerability. This would mean an automatic assessment and guaranteed mental health package for children entering care and automatic assessments for children and young people at risk of exclusion from school, who go missing, at the point of arrest, or are involved in violence or crime. It would include a guarantee of assessment by education psychologists for any child at risk of exclusion.
  • A national implementation programme to embed a whole school and college approach to mental health and wellbeing across all education settings in the country. This should include a commitment from Government to provide a funding package for Mental Health Support Teams beyond 2023/24 to ensure that all schools have access to this vital additional support by 2030. • An ambitious programme of drop in mental health hubs delivered in the community.
  • A national ‘Programmes on Prescription’ scheme in every area. The roll out of a major funded programme of social prescribing for mental health wellbeing that enables GPs and health professionals to pay for sports and arts sessions, music, drama, activities, youth clubs, outings, and volunteering programmes to improve young people’s confidence, self-esteem, and skills and make friends.
  • A major recruitment programme with ambitious targets to build the children and young people’s workforce required to meet this expansion of services. It is vitally important to ensure that this workforce is diverse and culturally competent.
  • Wellbeing and mental health training and support for all professionals working with children and young people.
  • Improving the mental health and well-being of young people at risk of harm and being involved in the criminal justice system should be measured as a core aspect of NHS equality targets.

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