Improving Children And Young People’s Mental Health And .
BRIGHTFUTURESImproving childrenand young people’smental health andemotional wellbeingFindings from the LGA’s peerlearning programmeReportImproving children and young people’s mental health and emotional wellbeing1
BRIGHTFUTURESHelping children and young people to fulfil theirpotential is a key ambition of all councils, but ourchildren’s services are under increasing pressure.Join our call to government for fully fundedchildren’s services.www.local.gov.uk/bright-futures #gettingthebest
ForewordChildhood is a very precious time. It is a timefor growth, development, exploration anddeveloping the foundations for adulthood. Butwe know all these important elements can bedamaged by the development of a mentalhealth disorder or poor mental health as achild or young person. At this vital time of life,it is imperative that services work together tomake sure children are getting the best – notjust getting by.This peer learning programme has provideda fantastic opportunity for councils to sharegood practice and seek new solutions to localissues. We’d like to thank all the councils fortaking part and for sharing their thinking andlearning experience, so that other councils,and ultimately children, can also benefit.We know that early help in mental healthcan prevent symptoms escalating and givechildren the tools to cope with and managetheir condition. More early help, and moregeneral help for mental wellbeing, can reducethe pressure on acute care so that it has thecapacity to help the most vulnerable. Thelearning from the programme to recognisethe range of issues affecting a child’s mentalhealth, rather than focusing on a mentalhealth disorder and treatment, resonates withcouncils’ public health approaches. Engagingthe wider children’s workforce to support themental health of all children and young people.We were pleased that the peer learningrecognised the important role of localcouncillors in championing children’s healthand wellbeing. The Local GovernmentAssociation (LGA) has been a supporter ofthe Mental Health Champions Network andwe hope that councillors across the countrycontinue to advocate on behalf of theirchildren’s mental health.We hope that the experiences of thecouncils that took part in their peer learningprogramme will help other councils looking atthe support they give to children and youngpeople facing issues with their mental health.Councillor Anntionette BrambleChair of the LGA Children and YoungPeople BoardCouncillor Ian HudspethChair of the LGA Community Wellbeing BoardImproving children and young people’s mental health and emotional wellbeing3
ContentsIntroduction5Background7The LGA peer learning programme9What we learnt12Taking a holistic view of children and young people12Hearing young people’s voices, and that of their parents15Developing mental health confidence and capabilityin the wider children’s workforce18Strengthening the role of local councillors in championingchildren’s emotional health and wellbeing22Delivering services in times of organisational change,external change and resource pressure23Conclusions26Appendix: The Thrive Approach294Improving children and young people’s mental health and emotional wellbeing
IntroductionGood mental health is just importantas physical health. Having goodmental wellbeing does not meanthat you don’t ever suffer fromsetbacks and difficult emotions,but that you have the resilience tocope, which in turn helps childrenbecome thriving, happier adults.The consequences of not tacklingproblems can be lifelong. 11 per cent of young people aged 10 to17 report low subjective wellbeing whichequates to approximately 550,000 childrenin England.2According to NHS Digital’s 2018 NationalChildren’s Mental Health Prevalence data: More than 75 per cent of adults who accessmental health services had a diagnosabledisorder prior to the age of 18.5 one in eight children and young peoplehave one or more mental health disorders emotional disorders have become morecommon, whilst all other types of disorder,such as behavioural, hyperactivity andother less common disorders, haveremained similar in prevalence since 199 a quarter of girls aged 17 to 19 have amental health disorder, and of this quarter,over half has self-harmed or attempted totake their own life.Other sources of data show that: Less than a third of the 338,000 childrenreferred to child and adolescent mentalhealth services (CAMHS) last year receivedtreatment within the year. Another 37 percent were not accepted into treatment ordischarged after an assessment, and afurther 32 per cent were on waiting lists atthe end of the year.11Children’s Commissioner (2018) Children’s mental healthbriefing In 2016, the NHS estimated that itsupported 25 per cent of children andyoung people with a mental healthcondition. The aspiration is to reach35 per cent by 2020/21.3 The average waiting time in 2016 frombeing referred to local NHS CAMHS tobeginning treatment was 94 days.4 Self-harm among girls aged 13-16increased by 68 per cent between 2011 and2014, rising from 45.9 to 77 per 10,000.6 Between 2010 and 2017, the number ofgirls aged under 19 admitted to hospitalfor anorexia increased from 1,050 to2,025.7 Whilst girls are more likely to havedepression, eating disorders, or self-harm,boys aged 15-19 remain twice as likely tocommit suicide.82345678The Children’s Society (2018) The Good Childhood Report2018. London: The Children’s SocietyNHS (2016) Implementing the Five Year Forward View.Redditch: NHS England https://tinyurl.com/hjljojk [lastaccessed 23 August 2018]The Children’s Society (2017) Stick with us. https://tinyurl.com/y77js3du [last accessed 23 August 2018]The Children’s Society (2016) Priorities for improvingchildren’s mental health services. https://tinyurl.com/ycf77ful[last accessed 23 August 2018]NHS (2017) Worrying rise in reports of self-harm amongteenage girls in UK https://tinyurl.com/y9wxqvtc [lastaccessed 23 August 2018]Sarah Marsh (2018) Eating disorders: NHS reports surge inhospital admissions. London: The Guardian. https://tinyurl.com/ybsqpoy4 [last accessed 23 August 2018]Brittany Bokzam (2017) Mental health data shows starkdifference between girls and boys London: The Guardian.https://tinyurl.com/ybexqkpf [last accessed 23 August 2018]Improving children and young people’s mental health and emotional wellbeing5
Our Children and Young People’s MentalHealth and Emotional Wellbeing PeerLearning Programme was designed to lookat how to prioritise early help and free upacute care for the most vulnerable in orderto achieve change; supporting councils andtheir local partners to learn from each other,and from other councils across the country.By giving eight councils and their partners anopportunity to take part in two learning daysand a visit to another council, the hope is thatthey now have the knowledge to tackle theirlocal issue so that more children and youngpeople can get the help they need.Woven through the issues brought to theprogramme – from engaging with schoolleaders about emotional wellbeing, toimproving services for children and youngpeople in mental health crisis – five themesemerged that all areas can learn from: The value of taking a holistic view ofchildren and young people and thechallenges they were facing. This wasdemonstrated by Lewisham’s projectlooking at reducing school exclusions, andLincolnshire’s project reviewing servicesfor young people with very complex needswho were often placed out of county.Surrey’s project, and their visit to the‘NewStart’ programme in Birmingham, alsoaddressed this issue, exploring the potentialfor a greater role for schools in meeting theemotional wellbeing needs of young people. Hearing young people’s voices, andresponding through service codesign. Surrey’s visit to Saltey Academyin Birmingham illustrated the value ofcombining quantitative and qualitativeinformation on young people’s experiences,and Kirklees’ visit to North Tyneside,where they had worked with participationcharity Involve, highlighted the potentialof involving young people as ‘citizenresearchers’ in planning new serviceapproaches. The contribution of the wider children’sworkforce to supporting the mentalhealth of children and young people.6This was a prime issue for DurhamCounty Council. They linked up withCheshire East Council’s EmotionallyHealth Schools project to understand howspecialist support for schools can helpgive them confidence to support youngpeople who turn to them for advice andhelp. Warwickshire visited the SurreyExtended Hope service to learn about howcombining an alternative provision schoolwith a residential facility could providean umbrella service for young peopleexperiencing a mental health crisis. The role of local councillors inchampioning children’s emotional healthand wellbeing. Two of the eight councilsincluded councillors as part of their projectgroup. In discussions it was clear thatthis was helping to keep the issue on theagenda and commanding attention. TheMental Health Champions Network couldbe a useful resource for councils working inthis area: www.mentalhealthchallenge.org.uk/champions Delivering services in times oforganisational change, external changeand resource pressure. The programmeheard several examples of the challengesof delivering in the current context, but italso provided examples of where crisishad prompted radical change, includingworking across boundaries in complexsystems. Barnsley’s visit to ForwardThinking Birmingham demonstrated howan integrated service offer can improveaccess and pathways for young peopleacross the spectrum of need.While only five of the eight councils had apeer visit or conversation, all of those whoparticipated beyond the first learning daywere able to make some progress on theissue they had brought with them. Many usedthe programme to bring impetus and freshideas to their local decision-making groupsin addressing a challenge which had been amatter of concern for some time. The learningdays also identified some helpful questionswhich had opened up conversations andcould be useful in other settings.Improving children and young people’s mental health and emotional wellbeing
BackgroundThe current period of child and adolescentmental health services (CAMHS) reformbegan with the recommendations of theChildren and Young People’s Mental HealthTaskforce in its ‘Future in Mind’ report(2015). This report resulted in a 1.4 billioninvestment in children and young people’smental health services over five years from2015 to 2020.9Each NHS clinical commissioning group(CCG), with local partners, was required toproduce a ‘local transformation plan’ (LTP)outlining the local improvements they wantedto prioritise. In order to unlock the investment,LTPs needed to be signed off by the relevantlocal health and wellbeing board. A designated ‘senior lead’ for mental health inevery school. This would be a trained teacheror senior leader, tasked with supporting theschool to adopt a whole-school approach tomental health, identify young people at risk,and work as a link person within the school torelevant local services. Mental health support teams. These teamsof professionals would support childrenand young people with low to moderateneeds in schools. Each team would beoverseen by local NHS CAMHS and wouldsupport a cluster of local schools. A four week waiting time standard foraccess to specialist NHS children andyoung people’s mental health services.Since the introduction of LTPs, furtherchanges in NHS strategic planning, includingthe Five Year Forward View for MentalHealth and the emergence of sustainabilityand transformation partnerships (which insome areas have led the LTP process) havechanged the way LTPs are coordinated insome areas.As of January 2019, 25 ‘trailblazers’ have beenannounced, launching 59 mental health supportteams in 2019. Of these, 12 trailblazers willalso trial a four-week waiting time. Each unit isexpected to work with an average cluster of 20schools and colleges. The new approaches willbe rolled out to at least a fifth to a quarter of thecountry by the end of 2022/23.The Department of Health and Social Care(DHSC) and the Department of Education(DfE) have recently turned their attention tohow schools and the NHS can better worktogether to identify and support childrenand young people at risk of mental ill health.Their Green Paper ‘Transforming Childrenand Young People’s Mental Health Provision’,published in December 2017, outlined threekey initiatives the departments wish to pilotover the coming years.In the 2018 Budget, Government announcedthat as part of the 20.5 billion for the 10 yearNHS funding package, the NHS will investup to 250 million a year by 2023/24 intonew crisis services, including: 24/7 supportvia NHS 111; children and young people’scrisis teams in every part of the country;comprehensive mental health support inevery major A&E by 2023/24; more mentalhealth specialist ambulances; and morecommunity services such as crisis cafes. TheNHS will also prioritise services for childrenand young people, with schools-based mentalhealth support teams and specialist crisisteams for young people across the country.9HM Government (2015) Deputy PM announces billionpound boost over five years for children’s mental healthservices ealth-services [last accessed 23 August 2018]Improving children and young people’s mental health and emotional wellbeing7
Why is local governmentimportant in this agenda?Beyond schools and the NHS, councils havean important role to play in promoting goodmental health for children and young people.They have responsibilities in their early yearsprovision, public health, children’s socialcare, education, and are conveners andcoordinators of local multi-agency working forchildren and young people. Since February2018 we have been actively raising the profileof local government in children and youngpeople’s mental health to decision makersat both a local and national level with BrightFutures, our campaign calling for CAMHS tobe prioritised: www.local.gov.uk/bright-futurescamhsLocal government has a crucial role to playin the announced reforms in schools and theNHS to ensure their success.Reforming the way we promote positivemental health and wellbeing for children andyoung people, and support those copingwith mental ill-health is complex. Coordinatedand ambitious work will be required acrossmany services and policy areas. Our Childrenand Young People’s Mental Health PeerLearning Programme set out with the explicitintention of working with senior leaders inlocal government to bring together strongplace-based teams. Comprising a range ofprofessionals from across the system theyworked in partnership to make progresson some of the most pressing children andyoung people’s mental health concerns intheir local area.8Improving children and young people’s mental health and emotional wellbeing
The LGA peer learningprogrammeAs a result of the issues identified above, wedesigned the ‘peer learning’ programme tohelp support councils and their local partnersto learn from each other, and from othercouncils across the country, about approachesto improving outcomes for children andyoung people’s mental health and emotionalwellbeing. The Children’s Society facilitated theprogramme on the LGA’s behalf.health and wellbeing in County Durham andthen access their support in making it ameaningful and measurable reality?Essex: Is there a way to deliver a flexibleapproach to transitions from CAMHS to adultmental health services?10All councils in England were invited to applyto join the programme and to identify:Kirklees: How can we use a co-productionapproach with children, young people,parents and carers to gain insight fromthem and reduce waiting times?an issue or theme which they were findinghard to address through normal channels,and which had been highlighted in their localSTP or LTP, or in any consultation with childrenand young peopleLewisham: How can we work more effectivelywith schools to address the social, emotionaland mental health needs of pupils at riskof exclusion, in a way that prevents furtherescalation?relevant local partners from NHS, educationand the voluntary sector, depending on thetheme, to join a senior officer and a localcouncillor (such as their health and wellbeingboard chair or mental health champion) inattending the programme.Seventeen councils applied to join theprogramme, of which eight councils wereselected. The programme comprised ofparticipation in two learning days and a visitor conversation with a peer organisation. Thescope of the issues which the eight councilsand their partners brought to the programmewas wide.Barnsley: How can we improve childrenand young people’s access, and navigatingaround, services to receive timely supportwhich includes all services?Durham: How do we engage system leaders;wider workforce; children and families inthe vision for early intervention in emotionalLincolnshire: How can we create a sharedmulti-agency understanding of high needyoung people and jointly manage risk toachieve better outcomes?Surrey: What do we need/want to do tore-shape our system in Surrey to meet theemotional wellbeing and mental health needsof children and young people, includinglinking in with schools?Warwickshire: How can we provideenhanced support to children and youngpeople in crisis or with intensive supportneeds in the community to reduce occupiedbed days in tier-four settings?These issues illustrate the wide range of localgovernment’s responsibilities for children andyoung people’s mental health and emotionalwellbeing, and the spectrum of young people’sneeds according to the THRIVE model.1110 Essex Council participated in the first learning day only.11 Anna Freud Centre (2016) THRIVE Elaborated. -edition.pdf[last accessed 23 August 2018] and see the AppendixImproving children and young people’s mental health and emotional wellbeing9
Figure 1 The eight projects categorised by Thrive QuadrantThe first learning day was spent reviewingand refining the key question that eachof the eight councils and their partnerswould consider as their project during theprogramme, and action planning next steps.delivery partner to increase the consistencyof mental health support. Following theircall, the two councils have agreed to meetagain, in person, to share learning fromboth areas.Following the first learning day, good practicesources and case studies were reviewed toidentify potential ‘peer organisations’ thathad made progress on similar issues tothose identified in the eight projects. Eachproject considered written material about the‘peer organisation’ and a visit or telephoneconversation was arranged if at all possible.Kirklees went to North Tyneside whoare currently taking advantage of aparticipatory programme called MH:2Kprovided by Involve and Leaders Unlockedwhich empowers young people tobecome ‘citizen researchers’ and makerecommendations about how to improve theemotional wellbeing and mental health oflocal children and young people.The peer organisations identifiedfor the eight councils and theirpartnersBarnsley visited Birmingham to look at thecity’s 0-25 delivery model for mental healthwith a specific focus on how young peoplenavigate the system using its open accesshub and its other points of access.Durham spoke to Cheshire East who havedeveloped an ‘Emotionally Healthy Schools’programme, bringing together publichealth, schools and a voluntary sector10Lewisham reviewed materials fromBrighton and Hove and Haringey and havebegun a deep-dive into their data to betterunderstand the local context and informtheir next steps.Lincolnshire reviewed written case studiesfrom a number of other areas, includingWigan, Suffolk and Surrey, but, in the timeavailable, decided to focus on definingmore clearly their i
1 Children’s Commissioner (2018) Children’s mental health briefing 11 per cent of young people aged 10 to 17 report low subjective wellbeing which equates to approximately 550,000 children in England.2 In 2016, the NHS estimated that it supported 25 per cent of children and young people with a mental health condition. The aspiration is to reach 35 per cent by 2020/21.3 The .
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Special Interest Group (SIG) to review the evidence for approaches to improving children and young people's mental health and wellbeing. This is the report of that work. The findings and outputs will be of interest to strategic and operational leads working on children and young people's mental health. These include: local
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Changes to evaluation methods 24 Key challenges 24 Outcomes 24 Reduce risk for children and young people: Children in need 24 Reduce risk for children and young people: Referrals and re-referrals 25 Reduce risk for children and young people: Child protection plans 27 Reduce days spent in state care 30 Increase staff wellbeing 31 Reduce staff turnover and agency rates 31 Summary tables 32 .
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