This report summarises the current state of knowledge about the quality and accessibility of mental health services for children and young people. It draws on existing research and evidence, as well as input from children and young people, and the findings of our inspections of specialist child and adolescent mental health services.
These sources indicate that children and young people’s mental health is marked by variation. There is variation in the needs of children in different circumstances and at different stages of their development. There is variation in the availability and quality of services. And there is variation in the way different parts of the system are commissioned, funded and overseen.
Society’s understanding of what constitutes a mental health problem has changed over time. Some of the traits and behaviours that may be considered a mental health problem today may not have been seen in the same way a few decades ago, and more children and young people are being diagnosed with some types of mental health problems than in the past.
Those who work with children and young people – in schools, GP practices and A&E, for example – do not always have the skills or capacity to identify mental health problems or help children and young people access the right support at the right time. Heavy workloads, difficulty in recruiting and retaining staff, and gaps in knowledge and skills all contribute to a situation where services miss opportunities to support children and young people’s mental health and detect mental health problems.
When children, young people, their families and carers first try to access help for a mental health problem, many struggle to get timely and appropriate care. The availability of services provided by schools, local authorities, and voluntary and community organisations varies from one part of the country to the next, depending on what is commissioned locally, and there are gaps in our understanding of the quality and availability of some of these services. Children and young people in vulnerable circumstances, such as children in care and those with a learning disability, can find it particularly hard to access care.
For those children and young people who need more intensive and specialist care, there are significant challenges in accessing services. There are long waiting lists for many of the services that provide specialist mental health care in the community, and the imbalance between demand and capacity in inpatient care means that children and young people cannot always find an appropriate bed in an inpatient ward close to home.
The system as a whole is complex and fragmented. Mental health care is planned, funded, commissioned, provided and overseen by many different organisations, that do not always work together in a joined-up way. Poor collaboration and communication between agencies can lead to fragmented care, create inefficiencies in the system, and impede efforts to improve the quality of care.
As a result, too many children and young people have a poor experience of care and some are simply unable to access timely and appropriate support. Most services are rated as good or outstanding and across all services there are examples of good and outstanding practice, but there is also variation in the quality of care.
In the next phase of our review, we will explore why this is the case and what could be done to make it easier to improve access and quality. We will visit 10 local areas to carry out fieldwork, where we will ask how we can ensure that all partners make their unique contribution and work together so that children, young people, their families and carers have timely access to high-quality mental health care.