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Better support for children’s mental health but most vulnerable wait too long for help

Improvements in mental health services have resulted in more timely identification, referrals and support, a joint inspection report has found.

The inspection by Ofsted, Care Quality Commission, HM Inspectorate of Constabulary and Fire & Rescue Services and HM Inspectorate of Probation found that more children with mental health needs are getting the right support at the right time because local agencies are learning from past failures.

As the COVID-19 pandemic has impacted on children and young people’s mental health tremendously and placed increased pressure on services, building on this success is vital.

Ofsted’s Chief Inspector Amanda Spielman said: “Children’s mental health has taken on a much higher profile in recent years, even before the pandemic, and services have been steadily improving. However, while we saw some excellent partnership work to better support children with mental ill health in the areas we visited, we know this will not be the experience of every child.”

“Single points of contact, accessible services and strong joint working make a real difference for children. But it’s also vital that each partner recognises their own role, and knows when to seek specialist advice, so that children get the right support at the right time. Given the added pressures that the pandemic is placing on mental health services, it would be tragic if these improvements were lost when they are needed more than ever,” she added.

The report follows inspections of six local authority areas and looks at how partners are working together to help children with mental ill health. The inspections carried out between September 2019 and February 2020, prior to the COVID-19 pandemic.

The inspectorates found that restructures of child and adolescent mental health services (CAMHS), along with a concerted effort by agencies to work together, has broadened the help available for a range of mental health needs, resulting in more timely identification, referrals and support.

In many cases, professionals are knowledgeable and can recognise the signs of mental ill health. A single point of access for specialist advice on mental health is helping professionals respond more effectively, as are co-located services and improved involvement of voluntary and community sector organisations.

However, the report notes that while much progress has been achieved, this good work is not universal. The inspectorates state that some agencies need to get better at identifying children suffering from mental health problems. In some cases, professionals are still focusing on presenting issues, and not looking beyond them for possible risks of mental ill health. This is the case for some staff in emergency departments, GPs, police and social workers, even in circumstances where a child has self-harmed or behaves in a way that indicates they have suffered trauma. Too often, a child’s mental health problem is first picked up when they enter the youth justice system, the report warns.

Justin Russell, Chief Inspector of Probation, said: “It remains of considerable concern that a referral to a youth offending service is often the first time a child’s mental health needs are identified and addressed. This alone demonstrates that change is crucial, and I welcome the findings of this report demonstrating the efforts being made to diagnose children at the earliest opportunity and tailor support to their individual needs.”

Schools have an important role to play in supporting children’s mental health, however they cannot do it alone. Schools that are supported well by partners enable children to get specialist help when they need it. There is wide variation in the quality of support that children receive from school nurses. Nursing services in half of the areas visited did not have the systems in place nor the capacity to identify children with mental health problems, meaning that opportunities to spot signs of mental health problems early on were missed.

Many police forces in the areas visited in the inspections have well-developed training and support for officers to identify and support children with mental health problems, but this is not consistent in all areas. There were too many examples seen by inspectors of children being kept in custody overnight and who were not helped to get the support that they needed with their mental health.

Despite improvements in partnership working being made in some areas, specialist CAMHS are still limited in some areas and resources are overstretched. Some of the most vulnerable children have to wait far too long for their mental health needs to be identified and to get access to specialist services. This includes children with autism, ADHD, some children in need, on child protection plans, and children in care.

Victoria Watkins, Deputy Chief Inspector of Primary, Integrated and Children’s Health Services at CQC said: “When we published ‘Are we listening?’, our review of children and young people’s mental health services in 2018, we noted that good care was more likely to be seen where local services were working together. Encouragingly, these joint inspections with Ofsted found strong partnership working, with the needs of the child at its heart. This is a testament to the tireless effort of people working in the system to improve the experience of children and young people with mental health needs.”

“Unfortunately, as we reported in 2018, some young people still wait too long for their needs to be identified or to access the mental health support that they need. There is still also a risk that people working with children and young people focus on immediate issues, such as seemingly disruptive or challenging behaviour, and miss the opportunity to address any mental health needs that might also be present.”

“It’s vital that we build on the progress made and good practice we have seen, and hold onto these lessons as the whole health and care system continues to respond to the pandemic and any impact it has on services,” she concluded.

‘Feeling heard’: partner agencies working together to make a difference for children with mental ill health


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