Prathiba Chitsabesan: What can we do to develop a mental health system that works for children?

Prathiba is the National Clinical Director for Children and Young People’s Mental Health, NHS England, also working as a consultant in child and adolescent psychiatry in a large mental health and community trust. As part of our series of think pieces exploring children and young people's mental health, Prathiba explores what we can do to develop a mental health system that works for children.

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As a consultant in child and adolescent psychiatry, I have sadly seen first-hand the devastating impact poor mental health can have on every aspect of a child’s life. I am proud of the work the NHS has been doing with partners to take on this challenge – but I am also conscious that we still have a lot of work to do.

In this blog, I want to reflect on how far we’ve come in improving mental health care for children and young people, and what I see as our priorities for the future. I also want to use this opportunity to invite all of you to have your say and share your views on this critical issue.

The last decade has seen significant challenges but also a transformation in how we see and respond to mental health and well-being for babies, children and young people. In 2015, Future in Mind brought together clinicians, service leaders, parents, children and young people to set out a new vision for children and young people’s mental health. The 2019 NHS Long Term Plan developed this, backed with funding and commitments to workforce growth.

Thanks to this focus and the support of countless people across the sector, we now have new, evidence-based models of care including mental health support teams in schools and colleges (MHSTs), perinatal and maternal mental health services across the country, and new approaches to eating disorders.  We also have a workforce which has grown by 70 per cent since 2016, and we now publish new data to track progress on improving access, experience and outcomes.

In the service I work in at Pennine Care NHS Foundation Trust, this transformation is illustrated by a greater number of children and young people accessing mental health support within community settings, and better joint working across teams and agencies.

However, I am concerned that babies, children and young people today face unprecedented challenges to their mental health and well-being.  Mental health needs had been rising for some time when the pandemic hit, leaving a profound impact on our youth, compounded by a range of other factors including the rising cost of living and poverty, poor parental mental health and changing social pressures including via social media. One in six under-18s now face a probable mental health disorder, compared to one in nine five years agoAnd despite welcome workforce growth and commitments in the recent Long Term Workforce Plan, as a clinician working in community children’s mental health services, I am aware of increasing challenges in the recruitment and retention of staff. Our health and social care workforce is our biggest asset to delivering quality and accessible services, and we must do more to grow, support and invest in our staff.

So, how do we build on the excellent foundations we’ve laid together, and the learning we’ve gained, to create a mental health system which really works for babies, children, young people aged 0-25, the adults they will become, their families and for society as a whole?  As we look to the future, I think the following themes still hold strong, but I will be listening to the sector and to children, young people and families to hear their priorities: 

Mental health awareness

We must ensure mental health is valued equally to physical health and that we continue to tackle barriers to accessing support and care, especially for our most vulnerable children.  As we tackle stigma, young people are more readily willing to talk about their mental health. We need to ensure that both their families, and education and health professionals, can recognise symptoms and direct those who need help to the right support and care.

Prevention and early intervention

We know that mental health disorders start early: the peak age at onset of all mental disorders is between 14 and 18.  We cannot wait for children to develop mental health disorders before we intervene. By promoting strategies for mental well-being, prioritising prevention, and reducing escalation through early identification and intervention, we can help reduce distress and poor mental health for children now and throughout their lives, as well as the burden on the mental health system and other services.  We also need to pay attention to the wider determinants of health and mental health, including poverty and housing. That’s why services such as MHSTs are so valuable.  It’s also why we must continue our focus on perinatal and infant mental health and support for parenting, given the critical development that takes place in the first years of life.

Accessible services

I know there is further to go to close the treatment gap between what is needed and what is available. That will need funding and further workforce growth. However, it also means:

  • Making it easy to access services by locating them where children live, learn and feel most secure. This includes in schools and colleges; in communities; reducing inpatient care as much as possible through offering alternatives such as intensive home treatment, step down care, day hospital functions; and reducing out of area placements when inpatient care is needed.  It also includes using digital solutions, in a young person’s own environment, to increase access to support including self-help.
  • Addressing inequalities in access - developing culturally sensitive inclusive services and workforces; and identifying and addressing the specific mental health needs of children from disadvantaged backgrounds or marginalized communities, including care experienced children and young people, those in the criminal justice system and those who identify as LGBTQ+.
  • Increasing transparency on waiting times so that we have a good understanding of how long children and young people currently wait to start receiving help, and can then look at how best to support services to deliver care as in as timely a way as possible.

Integrated services and partnerships

Children and young people are at the heart of a complex web of services, carers, and communities - it really does take a whole village to raise a child.  However, we know that services for children can often be fragmented and disjointed leading to poor access, experience and outcomes. Integrated care is about co-ordinating services to support holistic and person-centred care.  Services must also be developmentally appropriate, flexible and needs based, recognising the importance of supported transitions, including into adulthood. I continue to be concerned that young adults face high rates of mental health needs and challenges in accessing care. So we need to focus on:

  • Integration of services and of workforce, so that we have people who can work across services and share skills.
  • Flexible and developmentally appropriate transitions.
  • Partnerships and collaboration, including with community organisations such as youth centres, sports clubs and religious institutions.
  • Increasing skills of wider children’s services in supporting better mental health.
  • Families, recognising the important role parents and caregivers play day to day from the earliest years in supporting their child’s well-being, emotional regulation and self care.

An example of how NHS England has recently supported integration for those with the greatest, most urgent needs is the framework to support children and young people with mental health needs in acute paediatric systems we have recently developed.

Finally, but importantly...

I believe developing an effective mental health system for children requires involving children, young people and families in its design and implementation, to ensure services meet their unique needs and address inequalities. At NHS England, we have recruited experts by experience to support the development of our national policies, while encouraging systems and providers to do the same locally to define and implement their plans for service delivery.

But we also want to hear from all of you across local authorities, partner organisations, education and families and communities. This month we have launched a new collaborative platform to gather views and feedback called Solving Together, focused on how access and waiting times for children and young people mental health services could be improved. I want to encourage as many people as possible to share creative and innovative ideas on this important issue, so please get involved on the Solving Together website.

This is an independent article. The content and views reflected within it were provided and written by Prathiba Chitsabesan,  National Clinical Director for Children and Young People’s Mental Health, NHS England.