‘Raising the bar:

What needs to be done to improve

mental health outcomes for children

and young people?’

Sarah Brennan Chief Executive

YoungMinds Strategy

– A capacity to enter into, and sustain, mutually satisfying

and sustaining personal relationships

– Continuing progression of psychological development

– An ability to play and to learn so that attainments are

appropriate for age and intellectual level

– A developing moral sense of right and wrong

– A degree of psychological distress and maladaptive

behaviour within normal limits for the child’s age and

context

What is Mental Health?

• Children and Young People’s Health Outcomes Strategy

• Mental Health Strategy & Implementation Framework

• CYP IAPT

• PbR Development

• Health and Social Care Bill

• SEN and Disability Green Paper

• Education Act 2011

• OFSTED 2012 framework for school inspection

• CMO Report

• NHS Mandate

• Closing the Gap

• Tier 4 Review

• Crisis Care Concordat

CYP Mental Health: Policy Context

At any one time around 1.3 million

children will have a diagnosable

mental health disorder.

Although effective treatments are

available only 25% of those who need

such treatment receive it.

The British Medical Association report,

Growing Up in The UK, highlighted that the highest

number of children ever recorded in the UK

were referred to local authority care,

mainly for abuse and neglect.

Given NICE guidance states around 60% of looked

after children have some level of emotional or

mental health problem what is being done to

tackle this issue?

Recent headlines, Old problems

Recent headlines, Old problems

Investment in mental health services

2009/10 (1)

Total NHS Budget of £104,000,000,000 of which

£11,260,000,000 Total mental health budget

£10,490,000,000 Adult mental health services

£770,000,000 Child & Adolescent mental

health services

• 7% total budget spent on CAMHS

• (1) From: Programme Budgeting estimated Eng. Gross expenditure

for all progammes DH 2009/10.

Which Agency Commissions What?

Simple local overview

Developing context continues….

• Efficiency savings impact:

– Dramatic affect on tier 2 services nationally

– YM FOI found 34 of 51 local authorities reduced

CAMHS budgets since 2010. Some altogether

– LA v Health funding varies widely

– Pushing thresholds towards crisis end

– Specialist CAMHS reporting overwhelmed (tiers

3&4)

• Two thirds of JSNAs do not have a section that specifically addresses children

and young people’s mental health needs

• One third of JSNAs did not include an estimated or actual level of need for

children and young people’s mental health services in their area

• Estimated need based on: hospital admissions data; rates of referral to CAMHS

and calculation by mapping national levels of children and young people’s

mental health disorders onto local population size

• The most commonly used data for generating an estimate of prevalence of

need was from the study of children and young people’s mental health

conducted by Green et al at the Office for National Statistics in 2004.

• This study was undertaken almost ten years ago and prior to the recession and

other significant social and cultural changes which are likely to have had an

impact on children and young people’s mental health

Commissioning – developing JSNA’s – what info do they use?

Children

& young

people

with mental

health or

emotional

needs

Who pays? NHS pays NHS pays

Tier 2

Services

Tier 3

Specialist

CAMHS

Tier 4

Inpatient

Care

T

H

R

E

S

H

O

L

D

T

H

R

E

S

H

O

L

D

CAMHS Care Pathways

U n i v e r s a l S e r v i c e s

Un

ive

rs

al

Se

rv

ice

s

The mental health spectrum

Flourishing Moderate

mental

health

Languishing Mental

disorder

From: Huppert Ch.12 in Huppert et al.

(Eds) The Science of Well-being

Number of symptoms or risk factors

The effect of shifting the mean of the

mental health spectrum

Flourishing Moderate

mental health Languishing

Mental disorder

From: Huppert Ch.12 in Huppert et

al. (Eds) The Science of Well-being

Number of symptoms or risk factors

50% adults with lifetime mental health problems experience

symptoms before 14 years of age.

75% adults with lifetime mental health problems experience

symptoms before their mid 20s.

Less than 50% were treated appropriately at the time.

(Taken from Mental Health Strategy 2011 DH)

Why early intervention in Children and

Young People’s mental health?

What works – resilience (A. Hart & D. Blincow)

• Help with the ‘basics’: housing, play, safety, transport

• Sense of belonging: at least one constant, stable

relationship; help to make sense of the world; provide good

times and positive experiences

• Help with learning: mentors; getting organised; life skills;

highlight achievements; raise aspiration through planning

• Coping: problem solving; calming down; fostering interests;

understanding boundaries; laugh; be brave; rose tinted

glasses; sense of self – instil hope; build empathy &

responsibility; foster talent

Making the most of limited resources:

• Develop responses for critical times in cyp development and

onset of mental health problems with greatest gains.

• Systemic approach and whole system funding, bring cyp

commissioning together with social care and education

• Ensure the local JSNA appropriately assesses cyp resilience

and mental health needs and high risk groups

• Influence and nurture key local champions

• Invest in successful interventions reducing high cost end

services (tier 4 services, long term adult care)

• Early intervention works (Outcomes from Early Intervention in

Psychosis, Urgent Help team Sussex)