Why Children & Young People's mental health services need to be information rich

Children and Young People’s Mental Health Services

Executive Summary

CCGs are charged with taking the lead to develop Local Transformation Plans (LTPs) for children and young people’s mental health services. The LTPs must contain trajectories for investment, activity and workforce. The difficulty is that children and young people’s mental health services have only recently started to collect better data. There are also multiple commissioners and providers that adds to the complexity of the task. Mental Health Strategies can help. We have developed a modelling tool that enables all of the local information to be brought together into one single model. Demand, capacity and patient/client flow can be analysed and forecasts made for the next five years. In this way the case for investment can be made and then the impact tracked so as to make sure more children and young people receive the care they need.

To move forward local services will need to address the following questions:

  • How can commissioners and providers meet increased levels of need through both population growth and the evidence of increased mental health problems for some groups of young people?
  • How can the CCG, local authority and NHS England agree a transformation plan with realistic trajectories for the number of Children & Young People treated, workforce and investment?
  • How does each provider of local services manage waiting times for assessment, signposting and treatment, as well as DNA and cancellation rates?
  • What investment yields the greatest increase in capacity to help Children & Young People?
  • How do service providers work together to ensure pathways that work smoothly for each individual child or young person?

How can workforce capability and capacity be increased (especially within the IAPT services)?

A clear priority!

Over the last few years there has been a Health Select Committee report, a taskforce commissioned by the Government, a policy from NHS England and the Department of Health (Future in Mind) and a statement from the Prime Minister in January 2017 to highlight the importance of children and young people’s mental health – which announce a thematic review into what is and isn’t working.

Consensus on what needs to be done

Following the work of the taskforce there is strong support from the voluntary sector, such as Young Minds, professionals such as nurses and psychiatrists, as well as NHS England, for the objectives set out in Future in Mind:

  • Promoting resilience, prevention and early intervention
  • Improving access to effective support – a system without tiers
  • Care for the most vulnerable
  • Accountability and transparency
  • Developing the workforce

Future in Mind also lists a number of challenges:

  • Significant gaps in data (one year on the Health Minister says “huge lack of CAMHS data”
  • Treatment gap, 25 to 35% of Children &Young People with a diagnosable mental health problem access help
  • Increasing referrals and waiting times for mental health services
  • Complex commissioning arrangements, local authority, CCG, NHSE
  • Variable crisis, out of hours and liaison services for Children &Young People
  • Highly vulnerable children not having their needs met
  • Workforce capacity and capability

… leading to frustration

Independent charities such as Young Minds, along with professional organisations such as the RCN, are arguing that the priority given to children and young people’s mental health by Government is not being turned into reality on the ground. Two independent reviews - These are our children – (Chair Dame Lenehan) and Time to Deliver (Commission on Children and Young Peoples Mental Health) have found significant shortfalls in delivery through Freedom of Information requests:

  • Less than half of CCGs could give full information on how much money they spend on Children &Young People’s mental health services
  • 64% of CCGs had not increased expenditure in this area
  • 70% of Children &Young People who had self harmed did not subsequently receive medical or psychological help (National Morbidity Study)
  • Mental health services turn away 23% of Children & Young People

Increasing need

The last formal national morbidity study was carried out in 2004. This found that 1 in 10 Children & Young People had a diagnosable mental disorder. The limited evidence since this study was published shows a likely increase in mental health problems, especially for girls and young women. Lessof et al (2016) in a study led by education found an increase in psychological distress for girls in year 10 between 2005 and 2014. There is evidence that mental health problems in adults started when they were children – 75% before the age of 18. There is a strong case for intervening early and meeting needs in childhood.

NHS England now taking action

NHS England have now included Children &Young People’s mental health services as a significant part of performance monitoring for CCGs. This is reported via NHS Digital and the Five Year Forward View  Dashboard. The monitoring information relates to current priorities. For example:

  • Number of Children & Young People being referred and receiving treatment (policy to increase)
  • Number of inpatient bed days and number >50 km from home (policy to decrease)
  • % of CCGs compliant with the 6 Improvement and Assessment Framework transformation indicators (policy to increase, especially funding with 50% of the waiting on increasing resources). To be compliant Health and Wellbeing Boards must sign off.
  • % of CCGs compliant with crisis services milestones.

Moving forward – becoming data and information rich

Children &Young People’s mental health services will struggle to move forward without becoming data and information rich. Much of the data may already be there but not currently being turned into useful information. Mental Health Strategies have developed a demand and capacity flow model that can help provide a single coherent model that pulls all available data into one place. It is then possible to see how C&YP use the whole system at the moment.

The next stage is to look to the future and test ‘What if’ scenarios to see how changes will impact for C&YP over the next five years. These scenarios might include both investment and changing the way pathways currently work. They can also include changes in workforce and the way that individual services operate. All realistic scenarios can be pulled together into a single, optimised model, to see how changes can best help children and young people in the future. The overall model can then be adapted until local stakeholders are satisfied that they are getting the maximus possible benefit from investment and service transformation.

Some Stats from NHS Digital [DN infographic]

141,894 C&YP in contact with C&YP mental health services at the end of November 2016

20, 454 referrals in last quarter

1,237 open ward stays for under 18 at the end of Nov 16 – 266> 50km from home

286 detained under MHS at end of Nov 16

178 bed days in quarter for under 16s on adult wards (906 for children under 18)