Children and young people’s mental health services
3.22. Mental health problems often develop early and, between the ages of 5-15, one in every nine children has a mental disorder . Half of all mental health problems are established by the age of 14, with three quarters established by 24 years of age . Prompt access to appropriate support enables children and young people experiencing difficulties to maximise their prospects for a healthy and happy life. While the latest prevalence survey has shown only a modest increase in diagnosable problems since 2004 – from 10.1% to 11.2% – this overall figure includes concerning rates of mental distress particularly amongst late teenage girls .
3.23. We are delivering on our commitments to expand mental health services for children and young people. 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 our 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.
3.24. 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. This means that children and young people’s mental health services will for the first time grow as a proportion of all mental health services, which will themselves also be growing faster than the NHS overall.
3.25. Over the next five years, the NHS will therefore continue to invest in expanding access to community-based mental health services to meet the needs of more children and young people. 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. Over the coming decade the goal is to ensure that 100% of children and young people who need specialist care can access it.
3.26. Over the next five years, we will also boost investment in children and young people’s eating disorder services. The NHS is on track to deliver the new waiting time standards for eating disorder services by 2020/21. Four fifths of children and young people with an eating disorder now receive treatment within one week in urgent cases and four weeks for non-urgent cases. As need continues to rise, extra investment will allow us to maintain delivery of the 95% standard beyond 2020/21.
3.27. Children and young people experiencing a mental health crisis will be able to access the support they need. Expanding timely, age-appropriate crisis services will improve the experience of children and young people and reduce pressures on accident and emergency (A&E) departments, paediatric wards and ambulance services. Evaluations of urgent and emergency care services for children and young people in Vanguard sites found that, on average, 83% of children and young people referred to crisis and liaison services were seen within four hours. Children and young people who received intensive community follow-on support subsequently made less use of crisis services compared to less integrated services. With a single point of access through NHS 111, all children and young people experiencing crisis will be able to access crisis care 24 hours a day, seven days a week.
3.28. Mental health support for children and young people will be embedded in schools and colleges. The Children and Young People’s Mental Health Green Paper set out proposals to improve mental health support in schools and colleges. Over the next five years the NHS will fund new Mental Health Support Teams working in schools and colleges, building on the support already available, which will be rolled out to between one-fifth and a quarter of the country by the end of 2023. These school and college-based services will be supervised by NHS children and young people mental health staff and will provide specific extra capacity for early intervention and ongoing help. Teams will receive information and training to help them support young people more likely to face mental health issues – such as Lesbian, Gay, Bisexual, Transgender (LGBT+) individuals or children in care, and as they are rolled out, we will test approaches to support children and young people outside of education settings. The NHS work with schools, parents and local councils will reveal whether more upstream preventative support, including better information sharing and the use of digital interventions, helps moderate the need for specialist child and adolescent mental health services. It will thereby test approaches that could feasibly deliver four week waiting times for access to NHS support, ahead of introducing new national waiting time standards for all children and young people who need specialist mental health services.
2.29. In selected areas, we will also develop 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. For 6,000 highly vulnerable children with complex trauma, this will provide consultation, advice, assessment, treatment and transition into integrated services.
2.30. A new approach to young adult mental health services for people aged 18-25 will support the transition to adulthood. 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. We will extend current service models 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, such as the evidenced- based ‘iThrive’ operating model which currently covers around 47% of the 0-18 population and can be expanded to 25 year olds. In addition, NHS England is working closely with Universities UK via the Mental Health in Higher Education programme to build the capability and capacity of universities to improve student welfare services and improve access to mental health services for the student population, including focusing on suicide reduction, improving access to psychological therapies and groups of students with particular vulnerabilities.
90. NHS Digital (2018) Mental Health of Children and Young People in England, 2017 [PAS]. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-youngpeople-in-england/2017/2017
91. Kessler, R., Berglund, P., Demler, O., Jin, R., Merikangas, K., & Walters, E. (2005) Lifetime prevalence and age of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry. 62 (6), 593–602. Available from: https://doi.org/10.1001/archpsyc.62.6.593
92. NHS Digital (2018) Mental Health of Children and Young People in England, 2017 [PAS]. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2017/2017