Children and Young People’s Mental Health Coalition: What can we do to develop a mental health system that works for children, young people and families?

As part of our series of independent think pieces on children and young people's mental health, Zainab Shafan-Azhar and Charlotte Rainer from the Children and Young People’s Mental Health Coalition and Kadra Abdinasir from Centre for Mental Health explore what can we do to develop a mental health system that works for children, young people and families.

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The prevalence of mental health problems in children has risen steadily in recent years, with one in six children aged 7 to 16 now experiencing a mental health problem in compared to one in nine in 2017. There has also been a significant increase in the number of young people experiencing a mental health problem – in 2022 one in four 17-to-19 year olds had a mental health problem compared to one in six in 2021 (Ibid). 

This increase in need corresponds with a period of austerity and growing levels of inequality in the country. For example, one in four children with a mental health problem live in a household that has experienced a reduction in income in the past year (NHS Digital, 2022). The Covid-19 pandemic and subsequent cost of living crisis has further exacerbated many of these inequalities and brought racial disparities into sharp focus.

Despite this growing prevalence, many children and young people face difficulties in accessing timely support with their mental health. Estimates from the Children’s Commissioner for England show that of the estimated 1.4 million children with a mental health problem, less than half (48 per cent) received at least contact with NHS Children and Young People’s Mental Health Services (CYPMHS) in 2021/22. The pandemic created additional pressures, and there are concerns that demand will outstrip capacity.

Many young people and families also struggle to get their voices heard by services. Those from marginalised backgrounds or with complex needs often experience the greatest barriers in accessing help, likely due to cultural insensitivity, social stigma, inadequate recognition of mental health needs, discrimination and more. 

As a result, we have seen a raft of measures introduced in recent years to expand access to mental health support most notably through education settings and NHS CYPMHS. Whilst positive progress has been made, less attention has been paid to addressing the structural and health inequalities that drive mental health problems in the first place. 

The evidence base on social determinants of poor mental health is now well established, yet there has been little observable implementation of work done to tackle these with the aim of prevention. We believe we need to urgently re-balance the system and take action to tackle the early determinants of children and young people’s mental health. In order to achieve this, high quality prevention and early intervention should be at the heart of the mental health system. 

So, what could this look like? 

Firstly, tackling disparities and risk factors in the early years and childhood are some of the most effective preventative measures that can be taken. This should include taking action at a local and national level to address child poverty and tackling all forms of racism, discrimination and exclusion. Adverse Childhood Experiences (ACEs), such as abuse and neglect, can also have a harmful and lasting impact on young people’s lives. Without action to address these inequalities, other efforts to improve mental health will not be effective in creating change.

Secondly, mental health and wellbeing should be central to the environments that children and young people occupy. For example, it is estimated that over the course of their education, children and young people spend around 7,800 hours at school. Educational environments, timetables, lessons and cultures all have an effect on the mental health of children and young people. But education settings can also be good for mental health. Where the culture builds trust, allowing responsive relationships between staff, families, and children to flourish, these can be protective factors against poor mental health. 

Whole education approaches to mental health and wellbeing are central to a school’s and college’s ability to both promote positive mental health and identify needs at an early stage.  Such approaches refer to a setting wide approaches with support and input across different areas of the school for the promotion of children and young people’s mental health. Positive progress has been made implementing these approaches, but they are not yet fully embedded across all education settings. To ensure there are educational environments where all children and young people thrive, then whole education approaches need to be fully implemented. 

Services providing mental health support in the community also play a crucial role in addressing needs at an early stage, preventing escalation and the potential for later, more costly referrals to specialist services. There has been growing consensus for easy to access services based in the community, such as the early support hub model. Early support hubs offer easy-to-access, drop-in support on a self-referral basis for young people with mild to emerging mental health problems, up to the age of 25.

Services of this kind have been found to deliver excellent outcomes for young people and provide an effective gateway of support for young people facing the greatest mental health disparities. Whilst these services exist in some areas of the country, we need to build on these successful examples so that young people can access early support wherever they live. 

Currently, there exists a gap between research and full implementation. Studies suggest that it can take nearly 20 years between when health research is conducted and when it’s applied in practice. This stifles our ability to understand what works, implement more effective practices and promote innovation within children and young people’s services. It is important for further research to investigate what works for children and young people, however the gap between the publication of research and the implementation of policy must be reduced. 

While there has been a raft of measures introduced over the past decade to improve mental health outcomes for children and young people, policies and strategies introduced to date have not been ambitious enough to create the scale of change that is needed. What is more, a gap in accountability and scrutiny arrangements makes it challenging to determine if previous commitments have been acted on. 

To address these challenges, we want to see the development of a comprehensive cross-government mental health strategy that builds on the above proposals. This strategy should set out a vision for change from prevention and promotion of good mental health through to more effective and compassionate inpatient and crisis care. A cross-government oversight group should be established to ensure progress and implementation are monitored and reported on. This should include ministers, key officials, lived experience representation and experts from across the sector.

Locally, the ongoing establishment of integrated care boards and partnerships presents a critical opportunity to ensure that there is a seamless pathway and strengthened support for all those aged 0 to 25 and their families. In particular, the offer an opportunity to address some of the continuous fragmentation we see between services such as health, education, children’s services, justice and the voluntary and community sector.

To foster joined up working around mental health, Centre for Mental Health recently launched the Mentally Healthy Councils Network. The network seeks to create a learning community for elected members, council staff (including in public health, social care and more) and others in and around local government. The Centre will be supporting local champions (elected or otherwise) to come together, learn, influence and innovate through training and forums. 

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This article and views reflected within it were provided and written by Zainab Shafan-Azhar and Charlotte Rainer from the Children and Young People’s Mental Health Coalition and Kadra Abdinasir from Centre for Mental Health.