The NHS’s new 10-year plan includes a very welcome emphasis on children and young people, and particularly their mental health.
Funding for children’s mental health services will grow faster than both overall NHS funding and total mental health funding; waiting times will be introduced for accessing services; crisis care will be improved; and community-based support expanded.
With one in eight children experiencing at least one mental health disorder, and almost a third of those still on waiting lists after a year, extra funding should help councils’ children’s services – which, at the moment, are increasingly having to step in to support vulnerable young people.
As it stands, clinical commissioning groups (CCGs) in England spend an average of 14 per cent of their overall budget on mental health, but just 0.9 per cent on child and adolescent mental health services (CAMHS).
It is imperative that the additional funding is actually spent on CAMHS. The National Audit Office confirmed last November that NHS England cannot be certain that all the £1.7 billion funding allocated by government for CAMHS since 2015 has been spent as intended, or that data on CCGs’ expenditure on children’s mental health is reliable.
NHS England has said that it is only in the current financial year that it expects CCGs to spend their allocations on the purposes for which they were originally intended. This is one of the reasons why, given councils’ responsibility for the wellbeing of children in their area, the LGA has been calling for health and wellbeing boards – as the statutory bodies where local government, CCGs and the community come together – to have overarching governance of how funding on children’s mental health is allocated locally.
The NHS Long Term Plan also pledges to improve crisis care, and to invest in and expand community-based support, with at least an additional 345,000 children and young people able to access support by 2023/24.
While we support improved crisis care, we do need to see preventative principles applied to children’s mental health. We cannot continue to withhold access to treatment until a child deteriorates to a level where they are deemed to have a clinically severe enough need. Investment is needed in early intervention therapies for children so they don’t deteriorate to the level where they require more medicalised and crisis-based interventions. This makes sense, both from the perspective of cost and of children’s wellbeing.
The NHS Long Term Plan includes the new mental health units. Each will be responsible for a cluster of around 20 schools and colleges, depending on their size. While improving links to schools is welcome, the LGA has been calling for the new units to work with councils as well, so that children who have been excluded, are home-schooled or move school frequently can also access this additional support.
We continue to call for independent counsellors in all secondary schools, a call that has been supported by young people themselves when asked what mental health support they need. We also need more co-production of services with young people, to determine the type and location of support they need.
These calls are reflected in the LGA’s Bright Futures campaign on children’s mental health, and you can find out more at www.local.gov.uk/bright-futures-camhs
The NHS Long Term Plan could go further, to recognise the wider role that local government and other services play in delivering the Government’s healthy child programme and influencing the health of children and young people more widely.
A joined-up approach to supporting children’s health is crucial to delivering the plan and to creating future generations of healthy and happy adults.
A place for us
Ahead of February’s Children’s Mental Health Week, first visited The Hive in north London to find out more about local services for vulnerable children and young people
For 18 of the young people who had Christmas dinner at The Hive last December, this was their only festive celebration.
But that’s what The Hive does: it provides a place for young people to make the trusted connections they don’t always have elsewhere, and helps build the confidence and self-belief that creates a healthy mind.
The Hive opened in Camden in 2015, following a design process that put young people at its centre. More than 500 were interviewed about their access to mental health services, leading to the establishment of a young people’s board – still in place today – to guide the development of the new service.
The centre is a partnership between Camden Council, two NHS trusts, the Brandon Centre, the Anna Freud Centre, and Catch22, a not-for-profit business with a social mission, which designs and delivers services that build resilience and aspiration in people and communities.
The Hive is open to anyone aged between 16 and 25 with a Camden postcode or GP. It offers a space where young people can just drop in to sit, chat and use the free Wi-Fi. There are activities every afternoon and support available for anyone needing help with education, employment, housing, sexual health and substance misuse.
What The Hive really offers, however, is a support network, a place to talk about the difficulties and challenges in a young person’s life, and – for those who need it – more direct engagement, with one-to-one counselling and therapy.
Katie Clayton and Peter Day, the clinical leads for the service, say the biggest issue they see is social isolation: “Because of family breakdown, many of the children have no adults in their life they can turn to – no support networks. The most vulnerable come to us first.”
The role of the centre is to help tackle problems before they reach crisis point, by helping young people to use their own resilience skills to manage their situation. For those who need it, there is help managing what is, at times, a perplexing system of appointments and referrals.
It’s a solution that works. Whether because of word of mouth or more referrals by GPs, teachers or mental health professionals, demand has gone up over the past three years – a picture that is reflected across providers in Camden, where the level of diagnosis and the level of risk has increased at a time when resources are stretched.
As Jennie Mackeith, Strategic Commissioning Manager, Camden Council, explains though, much of what can be achieved doesn’t necessarily cost. It’s important to keep a flexible approach. The Hive is part of Camden’s wider Minding the Gap service, offering support for young people transitioning between children’s and adult services to reduce the risk of disengagement.
“Of course there are challenges, but the great strength is our collaborative approach,” she says.