A more joined-up approach is needed to supporting children with mental health difficulties, says Saffron Cordery
“Wider public services, in particular public health and social care, play a crucial role in supporting children and young people and their families and helping to prevent ill health and avoid deterioration." Saffron Cordery, deputy chief executive, NHS Providers
NHS Providers, the membership body representing NHS organisations that provide services to patients, has warned that the NHS is falling “desperately short” of providing mental health care and support to young people who need it.
Writing in HSJ, Saffron Cordery, deputy chief executive of NHS Providers, said that “more joined up” thinking and action was needed at a system level to meet the needs of children and young people effectively.
NHS Providers’ most recent survey of trusts found that 88% of mental health and learning disability trust leaders, and 97% of combined mental health and community trust leaders, said they were worried or very worried about their capacity to meet demand over the next 12 months. Several highlighted challenges with children’s services in particular.
One trust leader told the survey that children’s mental health and autism services locally and nationally were in “a dire state”. In the past, wrote Cordery, trust leaders have highlighted the “massive impact” of cuts to children’s services provided by local authorities, such as health visiting and school counselling, over several years. Although there had been efforts to provide care closer to home and “a significant growth in the overall number of children and young people being seen by mental health services,” service providers were “still coming up desperately short when it comes to connecting all individuals to the care and support they need where and as soon as they need it.”
Although many trusts were working with schools, GPs and their partners in local authorities and the voluntary sector to deliver more joined-up services to meet the needs of those at crisis point or earlier, national policies and funding “don’t always work in support of those efforts,” Cordery wrote.
While additional funding announced in 2021 had gone some way to addressing some of the challenges facing children and young people’s mental health services, the impact of the funding had been reduced in areas where it was “ad hoc, time limited and too narrowly focused,” she added. Service design for children and young people required “strategic planning and delivery across multiple agencies and communities” while a lack of suitable social care provision was one of the “key reasons for trusts not being able to meet demand for children and young people’s mental health services.”
The pandemic had had a “profound impact” on children and young people across the country, she wrote, which included worsening inequalities. “This need is likely to become more pressing in the face of a cost of living crisis that we expect to be deep and prolonged, given the well-known effects of poverty on children’s health and life chances,” Cordery wrote.
In future, building an “appropriate bed base and a safe therapeutic environment, alongside increased community-based provision” and workforce investment were all key to ensuring high quality care was accessible to children and young people as close to home as possible. Corddiffery added: “Achieving this depends on sustainable levels of investment over the long term, with a firm focus on the enablers of expansion and transformation – data and digital, workforce, and capital.”
Trust leaders have also stressed the need to focus on how to shift resources upstream, she wrote. This would enable them to “deliver a far more proactive and holistic model of care that is coordinated, multi-agency, and community-based to help prevent children and young people becoming unwell.” Such a shift would enable “early access to support” for children who do become unwell. “Wider public services, in particular public health and social care, play a crucial role in supporting children and young people and their families and helping to prevent ill health and avoid deterioration,” she added.
Saffron Cordery of NHS Providers is right to draw attention to the shortcomings in mental health services for children and young people. At a time of rising rates of mental ill-health among young people, we need to think again about how we structure and organise services. There needs to be a focus on early community-based intervention, to avoid mental ill health progressing to crisis, and a systematic effort to connect health and social care to provide services focused on the child.