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Are we listening?

Review of Children and Young People's Mental Health Services...

This report describes the findings of our independent review of the system of services that support children and young people’s mental health. It draws on evidence gathered from fieldwork in 10 health and wellbeing board areas in England, during which we spoke with children, young people, parents, families, carers and staff working across the system, reviewed local policies and plans, and tracked how individual children and young people moved through the system. In total, across phase two of our work, we spoke with more than 1,300 people through focus groups and one-to-one interviews.

The commitment and dedication we saw of so many people working across the different services that support children and young people’s mental health must be celebrated. In every one of the 10 areas we visited, we found examples of good or innovative practice. We came across countless passionate people, working hard to support the children, young people, parents, families and carers in their care.

But we also found a complex and disjointed system that produces disjointed support. Different parts of the system do not work together well. Different commissioners and service planners do not always collaborate when they work to identify the needs of local people and plan services to meet those needs. Different services and teams do not always take a joined-up approach to planning and providing care, or sharing information and decisions about care and support. And different parts of the system are regulated and overseen by different agencies and government departments.

In services, we found symptoms of a system under pressure, from schools to the voluntary sector and to specialist child and adolescent mental health services. Long waiting lists, inappropriately high eligibility criteria, and gaps in service provision all make it harder for children and young people to access the right support at the right time. Decisions about funding or service provision in one part of the system have adverse unintended consequences for other parts of the system, and can drive demand in emergency departments as children, young people, their parents, families and carers find they have to reach crisis point before they are able to get help.

We saw many creative solutions where people working locally were overcoming some of the barriers to high-quality, person-centred care and support. Different approaches worked in different places, and for different children. Sometimes, things that worked in one local area did not work well in another. But where we saw good or innovative practice we saw many common themes, such as good communication and collaboration between different teams and services.

Most importantly, we saw that putting the child or young person at the centre, and putting their interests above the competing cultures, systems and processes of the organisations involved in their care, makes it easier for staff and teams to work together to provide joined-up care and support.

Drawing on good practice offers an important opportunity for local commissioners and providers across the education sector, the NHS, local authorities and the third sector to deliver improvements and join up their services. But their local action alone is not enough. Good practice in local systems happens despite how services are structured, commissioned and overseen, not because of it. Those working locally will not achieve their full potential to support young people until the complexity and fragmentation of the system is addressed.

If we are to see a significant and sustainable improvement in the quality and accessibility of mental health support for children and young people, then it must become a national priority. If national bodies, regulators and government are serious about improving the services that support children and young people’s mental health, then we must remove the barriers to improvement and enable progress – and we must do so together.