Special Report: NHS pledges to improve children's mental health

In the same week that a committee of MPs slammed the NHS for failing children with mental health problems, the NHS published its Long-Term Plan which pledges to prioritise child and adolescent mental health services.

In its report into mental health services for children and young people, the Public Accounts Committee said that although the government has committed to providing ‘parity of esteem’ between mental and physical health services, it is still unclear what it means by this in practice.

Furthermore, the report said the government has no comprehensive, long-term plan for how it will fulfil its commitment to implement Future in Mind, which set out a cross-sector vision for how to support children and young people’s mental health.

"In 2017–18 only three in 10 children and young people with a mental health condition received NHS-funded treatment, and many more faced unacceptably long waits for treatment," said the report.

Committment to funding

As the committee published its report, NHS England published its Long-Term Plan which dedicates a section on children and young people's mental health services under a broader heading 'A strong start in life for children and young people'.

The Long-Term Plan states: "We are delivering on our commitments to expand mental health services for children and young people."

"Under this Long Term Plan, the NHS is making a new commitment that funding for children and young people’s mental health services will grow faster than both overall NHS funding and total mental health spending," it added.

The plan outlines how the Five Year Forward View for Mental Health set out plans for improving mental health services so 70,000 more children and young people will access treatment each year by 2020/21. Access is rising in line with NHS plans and, in 2017/18, around 30.5% of children and young people then estimated to have a mental health condition were able to benefit from treatment and support, up from an estimated 25% two years earlier.

Over the next five years, the NHS will use the funding to continue to invest in expanding access to community-based mental health services to meet the needs of more children and young people so that by 2023/24, at least an additional 345,000 children and young people aged 0-25 will be able to access support via NHS funded mental health services and school or college-based Mental Health Support Teams.

The plan goes on to say that the goal over the coming decade is to ensure that 100% of children and young people who need specialist care can access it.

Crisis care

The Long-Term Plan specifically focuses on crisis care, eating disorder services and transition. It pledges to boost investment in children and young people’s eating disorder services over the next five years, and says it is "on track" to deliver the new waiting time standards for eating disorder services by 2020/21.

"As need continues to rise, extra investment will allow us to maintain delivery of the 95% standard beyond 2020/21," says the plan.

Children and young people experiencing a mental health crisis will be able to access the support they need through expanding timely, age-appropriate crisis services. Not only will this improve the experience of children and young people, but it will also reduce pressures on accident and emergency departments, paediatric wards and ambulance services.

The NHS also promises a new approach to young adult mental health services for people aged 18-25 will support the transition to adulthood, acknowledging that between the ages of 16-18, young people are more susceptible to mental illness, undergoing physiological change and making important transitions in their lives. The structure of mental health services often creates gaps for young people undergoing the transition from children and young people’s mental health services to appropriate support including adult mental health services.

Therefore the current service models will be extended to create a comprehensive offer for 0-25 year olds that reaches across mental health services for children, young people and adults. The new model will deliver an integrated approach across health, social care, education and the voluntary sector.

New services for children who have complex needs that are not currently being met, including a number of children who have been subject to sexual assault but who are not reaching the attention of Sexual Assault Referral Services, will be developed in selected areas. This will enable 6,000 highly vulnerable children with complex trauma, consultation, advice, assessment, treatment and transition into integrated services.

Gaps in data

The Long-Term Plan also reiterates proposals outlined in the Children and Young People’s Mental Health Green Paper that mental health support for children and young people will be embedded in schools and colleges. Over the next five years the NHS will fund new Mental Health Support Teams working in schools and colleges which will be rolled out to between one-fifth and a quarter of the country by the end of 2023.

The Public Accounts Committee acknowledged that there is now a welcome focus on improving NHS mental health services for children and young people, but warned that there are still significant gaps in the data to monitor progress.

The report highlighted:

- Recently published figures show that one in eight (12.8%) five to 19 year olds have a mental health disorder.

- The number of five to 15 year olds who suffer from an emotional disorder has risen from 3.9% in 2004 to 5.8%.

- The recurring issues with recruitment and retention of NHS staff remain unchanged.

- The government’s inability to increase the number of mental health nurses is a roadblock to progress in this area.

The committee highlighted that new and important ways of supporting young people’s mental health through prevention and early intervention, particularly in schools, are now being developed through the work outlined in the Children and Young People's green paper.

"The government must make urgent headway on all these fronts if it is to provide the mental health services and support that young people need," the report warned.

The report states that most young people with a mental health condition do not get the treatment they need, and under current NHS plans "this will still be true for years to come, while many face unacceptably long waits for treatment".

Turned away

The NHS’s Five Year Forward View for Mental Health (Forward View) aims to increase the proportion of children and young people with a diagnosable mental health condition who access NHS-funded treatment from an estimated baseline of 25% to 35% by 2020–21, the committee states. However, it warns that this would still leave two-thirds of young people in need without NHS treatment.

Similarly, the Green Paper plans to introduce new mental health support in schools will only cover up to a quarter of the country by 2022–23. The NHS estimates that just 30.5% of children and young people with a diagnosable mental health condition accessed NHS-funded treatment in 2017–18.

Prevention and early intervention in mental health problems is thought to reduce the need for more specialist services and reduce future costs. Yet children and young people are being turned away from NHS services because their condition is not considered severe enough to warrant access to overstretched services. The report warns that there is a clear risk that young people reach crisis point if they do not get help but the NHS has limited sight on what happens to children and young people turned away from NHS services.

As a result, the Public Accounts Committee recommends that between April 2019 and April 2022, the Department of Health and Social Care and NHS England should provide annual updates to the Committee on the number of young people who:

* request or are referred for treatment
* whose requests/referrals are accepted; and
* who subsequently receive treatment, and how long they had to wait;
* the proportion of young people with a diagnosable condition who receive NHS-funded mental health services;
* waiting times across the range of children and young people’s mental health services.

Expanding the workforce

According to the committee, getting the right workforce in place is the biggest barrier to the government’s ambitions for children and young people’s mental health services and NHS England says that workforce is the single biggest risk to achieving its Forward View ambitions, and other stakeholders have raised similar concerns.

Health Education England has limited information to develop its mental health workforce plan, which include an ambition to increase the children and young people’s mental health workforce of around 11,300 by a further 4,500 staff. It still has no data specifically for the children and young people’s mental health workforce to measure progress against expansion plans.

As part of the annual update to the committee, the Department, NHS England and Health Education England should report on its progress in expanding the children and young people’s mental health workforce, the report adds.

Further, the committee highlights that tackling mental health issues among children and young people requires significant cross-departmental co-operation, but current approaches do not ensure that this co-operation happens in practice. While the government is committed to delivering the cross-departmental vision set out in Future in Mind, it has not set out the actions and budget required to deliver it in full, or any measurable objectives or targets.

It urges the Department to lead on co-ordinating a comprehensive, practical and long-term cross-departmental plan which sets out how the government will achieve the improvements to children and young people’s services and support, as envisaged in Future in Mind, by April 2019.
Parity of esteem

As part of its cross-government planning, the government should prioritise specific improvements in prevention and early intervention, including, and in addition to, the work currently being undertaken on the outcomes of the Green Paper, taking an evidence-based approach.

The report says that significant weaknesses with data hamper the NHS’s understanding of progress against its current improvement programmes. At the start of the Forward View, the NHS lacked the necessary baseline information to measure progress against its plans, for example, on the number of children and young people receiving NHS treatment.

Therefore, the government should set up a robust baseline, and monitor progress on children and young people’s mental health services in the ten-year plan for the NHS, reliably measure patient outcomes and fully evaluate approaches in the Green Paper pilot areas to inform the national roll-out of services, including information from outside the NHS.

Finally, the committee warns that while the NHS has committed to achieving ‘parity of esteem’ between mental and physical health services, it has not defined what the practical, meaningful outcomes are in terms of access to services, waiting times, or patient outcomes. It calls on the government to set out clearly what it wants to achieve for children and young people’s mental health services, including defining clearly what ‘parity of esteem’ means in practice, the criteria it will use to measure progress and what data/information it requires.

Devastating for life chances

Public Accounts Committee Chair, Meg Hillier MP, said: “Children and young people with mental health conditions are being failed by the NHS. Provision is far below required levels and many people who do get help face long waits for treatment.

“This can be devastating for people’s life chances; their physical health, education and work prospects.

“The NHS must accelerate efforts to ensure it has the right staff with the right skills in the right places. But there is a broader role for government in better supporting children and young people.

"Effective action on prevention and early intervention can help young people more quickly, as well as relieve pressures on health services.

"We will be keeping a close eye on the real-world impact of the measures proposed in the government’s 10-year plan for the NHS," she concluded.

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