A whole household approach to young people’s mental health: A ‘must know’ guide for local councillors

• Councils have a range of duties and responsibilities to promote the health and wellbeing of young people in their area. This includes the prevention of mental illness and the promotion of mental health and, as appropriate, assessment and treatment under the Mental Health Act.
• Councils are also responsible for providing targeted support for children and young people in care, those with special educational needs and disabilities (SEND) and those supported by youth offending teams.
• Councils can collaborate with NHS commissioners and providers, schools and colleges, and the voluntary and community sector to provide a range of mental health support for young people from universal services through to specialist mental health care.
• Family and household circumstances can have a major influence on young people’s mental health and wellbeing. Councils should find ways to reduce known risk factors and invest in initiatives that promote protective factors.
• A whole household approach to young people’s mental health recognises the important roles that parents, carers or siblings can play in supporting young people’s mental health.
• Promising approaches share common goals and principles. They set out to offer a wider range of support, make the system easier to navigate, avoid the ‘cliff-edge’ of support ending at age 18, share resources for young people and families, and support families to create mentally healthy homes.
• Local leaders can champion a whole household approach to young people’s mental health. Engaging young people and families is important for addressing inequalities in mental health. Young people and families benefit from the opportunity to contribute to the design and delivery of services across the mental health pathway.
• As part of a whole-household approach, young people said they want: support for parents and the whole family, to strengthen the relationship between young people and their parents/carers and to foster a nurturing environment in the household.
• Within the complex commissioning landscape, councillors can act as useful navigators for community stakeholders, young people and families. They can hold commissioners across agencies to account for delivering services which meet local needs.

Unitary and upper tier councils have statutory responsibilities to provide support for people experiencing mental health problems, including care assessments and planning, crisis intervention, advocacy, and the provision of a number of roles, such as Approved Mental Health Professionals who are directly involved in the safety and support of people in urgent mental health distress. They directly commission a range of services related to mental health and wellbeing. Key services include public health, social care, drug and alcohol support, and others which affect population wellbeing and access to support.

In carrying out their duties, these councils should:

• produce and publish Joint Strategic Needs Assessments (JSNAs) and Local Health and Wellbeing Strategies (LHWS) in collaboration with NHS commissioners
• commission public health services to promote the mental health of young people and their families
• support maternal and infant mental health through health visiting services and provide therapeutic substance misuse and sexual health services
• ensure that children and adults’ services work together to commission and deliver support to young people transitioning from child to adult services, up to the age of 25
• work with local NHS commissioners to jointly commission mental health support for children and young people within their local area
• provide for and promote the welfare of children in care, including a duty under the Children Act 1989 to safeguard and promote the welfare of the children they look after
• work with partners to support children and young people with special educational needs and disabilities (SEND). Read the Special educational needs and disability Must Know guide for further information
• other local authority services may provide mental health support for young people including youth services, probation services, and family hubs. Many of these services are often delivered as part of the local authority’s early help (or early intervention) offer.

Councils at district level might not have statutory responsibilities to deliver public health services or social care, but they still hold several key functions which affect community health and wellbeing. They are responsible for housing, leisure, culture, green space and environment, benefits, and licensing. There are strong links between housing and mental health. Poor mental health can make it difficult for people to manage housing issues and conversely problems with housing, including homelessness, can worsen people’s mental health outcomes. Councils should work closely with local housing and mental health service providers to put in place measures to prevent mental health problems arising and deliver joined up support to those experiencing mental health difficulties.

District councils are closely involved with community-based activities and neighbourhood management, where health is promoted and prevention takes place, so are well placed to bridge communities with wider mental health systems and decision making.

The mental health spectrum

Mental health is best thought about in terms of being on a spectrum (Figure 1). At any one time, all young people will be somewhere on the spectrum. Young people and families require different kinds of information, advice, and support across the spectrum.

Councils have a part to play across the spectrum. 

Rates of probable mental disorders have increased since 2017. In 2020, one in six (16 per cent) children aged five to 16 years were identified as having a probable mental disorder, increasing from one in nine (10.8 per cent) in 2017. The increase was evident in both boys and girls.[1]  

The period of transition

Research finds that most adult mental health problems have their roots in childhood and adolescence. Half of mental health problems first emerge by the age of 14, and three quarters by age 24. The period of transition can be a difficult and uncertain time for young people due to the various moves they experience within education, employment, and living circumstances. 

For young people with emotional or mental health needs, this can be a particularly challenging time. Without the right support in place, many young people ‘fall through the cracks’ between child and adult services. However, well coordinated care and support, can protect young people’s mental health.

The impact of COVID-19

Emerging research suggests that the Coronavirus pandemic is having a negative impact on young people’s mental health. Disruption to sleep, education and household pressures, such as financial instability, are having a damaging effect on young people’s mental health.[1]

Analysis from 'Centre for Mental Health' suggests that 1.5 million children and young people under the age of 18 could need new or increased mental health support due to the pandemic. This relates to a range of problems including depression and anxiety, Post-traumatic stress disorder (PTSD), trauma, and complex bereavement.[2]

Some groups of children and young people have been unequally affected both directly by the virus and morbidity, and by its economic impact. Among these groups are families where there are physical disabilities or learning disabilities, families facing financial uncertainty and/or poverty, and families from racialised communities.

A survey by NHS Providers revealed that mental health services for children and young people report under growing pressure and increasingly overstretched during the pandemic, despite significant support and investment. Additionally, young people's eating disorder services report an unprecedented demand for support. According to an analysis of data from NHS England, there has been a doubling of urgent and routine referrals to eating disorder services in the year between March 2020 to March 2021.

What the evidence tells us

Research shows there is a strong link between parental mental health and young people’s mental health.

A national prevalence study found that the rates of mental health problems are highest for children and young people living with a parent with poor mental health and for those living with a parent in receipt of disability related income.[3] Analysis by the Children’s Commissioner for England estimates that 2.3 million children grow up in a ‘vulnerable family background’, and 900,000 children live with parents who have a mental illness.[4] Over a third (38.2 per cent) of children living in families with the least ‘healthy functioning’ had a mental health problem.[5]

While studies demonstrate the importance of working with families and households, most mental health services still focus on treating the individual.[6]

Centre for Mental Health and Leaders Unlocked ran two workshops with 20 young people aged 16 to 25 to gather their views on mental health support, including whole-household approaches.

Young people said they need:

Improved knowledge and awareness

• families and professionals should normalise conversation about mental health challenges
• young people should be equipped with more skills and knowledge to look after their mental health.

Support in education and in the community

• mental health support should be available in schools, colleges, and universities
• trusted adults who are involved in young people’s lives at transition points (eg, teachers) should provide sensitive and compassionate support
• positive role models in the community can help young people engage with support and help advocate for young people’s mental health
• young people should have access to ‘safe spaces’ when they aren’t doing well, where they can share without fear of being judged or dismissed
• access to leisure facilities and green space is important for young people’s mental health
• young people require access to community-based mental health support which provides flexibility and choice in the type of support they receive
• effective careers advice in schools and colleges is a necessary part of supporting wellbeing during the transition into adulthood.

Access to services that work for them

• access to counselling is important for young people
• young people should receive tailored support when transitioning from child to adult mental health services
• mental health advice, information, and support for young people and families must be culturally competent and appropriate for diverse communities
• services working with both adults and children should consider family circumstances and responsibilities.

As part of a whole-household approach, young people said they want:

Support for parents and the whole family

• mental health awareness raising and challenging stigma within families is important
• young people benefit when parents/carers and other family members establish their own positive relationships with mental health professionals
• services should equip parents/carers with the skills they need to listen to young people’s concerns
• advice and support could be delivered digitally and should focus on being accessible and easy to use.

Positive parent/child relationship

• strengthening the relationship between young people and their parents/carers emerged as a key theme
• the approach should aim to foster a nurturing environment in the household
• services should encourage parents/carers to model healthy behaviours, promote positive hobbies and avoid unhealthy/risky behaviours themselves (smoking, binge drinking
• It is also important to recognise that some young people do not want their parents/carers involved in their mental health care. This decision should be based on young people’s thoughts and wishes.

Community action

• parent/carer groups in the community can provide valuable peer support and access to advice and further help
• where parenting courses or family-based interventions are offered, those delivering them should reflect the communities they are serving
• it is important to build trusting relationships between families, the community, and services.

Young people and families benefit from the opportunity to contribute to the design and delivery of services across the mental health pathway. Their involvement can make sure that help is accessible and acceptable, that it meets the needs of diverse communities, and that resources and information are effective and easily used to support mental health in the home. Engaging young people and families is especially important for addressing inequalities in mental health.

Local councils can demonstrate leadership through:

• meaningful consultation during strategy design and refresh – hearing from young people about the support the need and the outcomes they want
• standing committees of young people who scrutinise and inform plans at every stage. These can be based within a community partner organisation or directly run by the council
• parent/carer and young person representation on Health and Wellbeing Boards
• working with young people to co-design resources and information, especially digital resources
• developing ways for parents/carers and young people to take on peer support roles in local systems
• ensuring that parents and carers are supported and offered active roles in school-based mental health programmes, for example as parent mental health champions.

Councils can also adopt specific initiatives, for example MH:2K, which facilitate youth leadership from the outset, helping young people to identify the mental health issues that they see as most important, engage their peers, and work with decision-makers and researchers to make recommendations for change.

Young people’s mental health and wellbeing has become a national priority over the last decade. This followed longstanding concerns over the complexity of the children and young people’s mental health system, the lack of timely and accessible support, and young people being turned away from services without help. The Government has implemented several measures to guide local planning and implementation.

1. Does your local area provide tailored mental health support to young people up to the age of 25?
2. What support does the local system provide for young people who do not meet the threshold for secondary mental health care but who have emerging mental health difficulties?  
3. What support do young people and families receive in your local area to prevent mental health difficulties?
4. Does your local area offer mental health support digitally or remotely?
5. What mental health support is offered to children with SEND locally? How integrated is mental health provision within your SEND local offer?
6. What mental health support is available to children and young people experiencing mental health inequalities? For example, support for those from racialised or LGBT+ backgrounds, living in poverty and those with disabilities.
7. What opportunities are there for children, young people, and families to inform decision-making and the design of mental health services?
8. Does your local area offer peer support and training opportunities for parents and carers on young people’s mental health?
9. What support is provided to parents and carers of young people who use mental health services in your area?
10. What training and support is available for foster carers and adoptive parents around young people’s mental health?
11. How is the transition from child to adult mental health services experienced by young people in your area?
12. How easy is it parents and carers to access the right information, advice, and guidance about local mental health support?

Key policy documents

1. Supporting Families 2021 to 2022 and beyond: A policy paper (2021)
2. The NHS Long Term Plan (2019)
3. Transforming Children and Young People’s Mental Health Provision: a Green Paper (2018)

Government guidance

1. Promoting the health and wellbeing of looked-after children: a statutory guidance for councils, clinical commissioning groups and NHS England. Department of Health and Department for Education
2. The SEND code of practice: 0 to 25 years provides guidance for councils, education settings and health bodies on the special educational needs and disability (SEND) system for children and young people aged 0 to 25
3. Prevention Concordat for Better Mental Health and consensus statement 

Key data sources

1. Public Health England: Fingertips tools Children and Young People's Mental Health and Wellbeing Profiling Tool provides local data across a number of indicators.
2. NHS Digital: Mental Health of Children and Young People Survey. This survey series provides England’s best source of data on trends in child mental health.
3. NHS Mental Health Dashboard brings together key data from across mental health services to measure the performance of the NHS in delivering our Long Term Plan for mental health.

Local Government Association documents

1. Improving young people’s mental health - what does a whole household approach look like? 22 March 2021, conference presentations.
2. Building resilience: how local partnerships are supporting children and young people's mental health and emotional wellbeing.
3. Improving children and young people’s mental health and emotional wellbeing: Findings from the LGA’s peer learning programme.
4. Improving transition from children to adult mental health services: Learning, messages and reflections from the LGA conference.

Resources

1. Fact sheet: Children and young people's mental health
2. Mental Health Challenge: local councils championing mental health 
3. Covid-19 and the nation’s mental health
4. Supporting mental health during Covid-19: a brief guide for councillors 

About Centre for Mental Health

Centre for Mental Health is a charity with over 30 years’ experience in providing life changing research, economic analysis, and policy expertise in mental health.

Over the last decade, the Centre’s work has expanded to include physical health, wellbeing, inequality, and multiple disadvantage across the life course.

About Leaders Unlocked

Leaders Unlocked is a social enterprise which enables young people and underrepresented groups to have a stronger voice on the issues that affect their lives.

In education, policing, health, justice and elsewhere, Leaders Unlocked partners with organisations to involve the people who matter and shape decision-making for the better.

• NHS Digital (2020) Mental Health of Children and Young People in England, 2020: Wave one follow up to the 2017 survey 
• Centre for Mental Health, Covid-19 and the nation’s mental health: forecasting needs and risks in the UK, October 2020.
• NHS Digital (2018), Mental Health of Children and Young People in England, 2017 
• Children’s Commissioner for England (2019), Childhood vulnerability in England 2019   
• Office for National Statistics (2019), ‘Children whose families struggle to get on are more likely to have mental disorders’
• ISOS Partnership and Local Government Association (2020), Building resilience: how local partnerships are supporting children and young people's mental health and emotional wellbeing  
• Public Health England (2016), The mental health of children and young people in England  
• CQC (2019), Are we listening? A review of children and young people’s mental health services 
• Department of Health and NHS England (2015), Future in Mind: Promoting, protecting and improving our children and young people’s mental health and wellbeing  
• Department of Health and Social Care (2021), Working together to improve health and social care for all: White paper setting out legislative proposals for a Health and Care Bill   
• Public Health England (2015), Promoting children and young people’s emotional health and wellbeing