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Transforming Children and Young People’s Mental Health Provision: a Green Paper

Presented to Parliament by the Secretary of State for Health and Secretary of State for Education by Command of Her Majesty

We know that our mental health and wellbeing are vital to our ability to thrive and achieve. One in ten young people has some form of diagnosable mental health condition and we know that children with a mental health problem face unequal chances in their lives, particularly where childhood mental health issues continue into adulthood.

As the Prime Minister has said, this is one of the burning injustices of our time. This Government is committed to ensuring our children and young people, and their families, get the support they need at the right time from the NHS, schools, colleges, local authorities and our dedicated partners in the voluntary sector.

As part of this longstanding commitment, we have already laid strong foundations for a step- change in the quality and scale of support available through improving and expanding NHS mental health services for children and young people.

To deliver on the ambitious vision set out in 2015’s Future in Mind and 2016’s Five Year Forward View for Mental Health, we have:

  •  legislated for parity of esteem between physical and mental health;
  •  committed to make an additional £1.4 billion available for children and young people’smental health over five years;
  •  committed to recruit 1,700 more therapists and supervisors, and to train 3,400 staff already working in services to deliver evidence-based treatments by 2020/21;
  •  committed to ensure that an additional 70,000 children and young people per year will obtain support from mental health services by 2020/21;
  •  improved services for eating disorders, with an additional £30 million of investment, 70 new or enhanced Community Eating Disorder Teams, and the first ever waiting times for eating disorders and psychosis;
  •  funded eight areas to test different crisis approaches for children and young people’s mental health and testing New Care Models for Mental Health; and
  •  published cross-agency Local Transformation Plans for children and young people’s mental health for every area of the country.

This green paper builds on Future in Mind and the ongoing expansion of NHS-funded provision, and sets out our ambition to go further to ensure that children and young people showing early signs of distress are always able to access the right help, in the right setting, when they need it.

We know that half of all mental health conditions are established before the age of fourteen, and we know that early intervention can prevent problems escalating and have major societal benefits. Informed by widespread existing practice in the education sector and by a systematic review of existing evidence on the best ways to promote positive mental health for children and young people, we want to put schools and colleges at the heart of our efforts to intervene early and prevent problems escalating There is clear evidence that schools and colleges can, and do, play a vital role in identifying mental health needs at an early stage, referring young people to specialist support and working jointly with others to support young people experiencing problems. Around half of schools and colleges already have a dedicated lead for mental health. 61% of schools currently offer counselling, and 90% of schools and colleges offer staff training on supporting pupils’ mental health and wellbeing.

We want to ensure that all children and young people, no matter where they live, have access to high-quality mental health and wellbeing support linked to their school or college. Some children and young people will always need additional support from more specialist services within and beyond the NHS. When a need has been identified, young people should be assessed quickly, and referred to the most appropriate support. We know from the Care Quality Commission’s recent report that although quality of care is in places good, waits can often be too long.

As the next step in our reforms, we will therefore support local areas to adopt an ambitious new collaborative approach to provide children and young people with an unprecedented level of support to tackle early signs of mental health issues. This approach has three key elements:

1. We will incentivise every school and college to identify a Designated Senior Lead for Mental Health to oversee the approach to mental health and wellbeing. All children and young people’s mental health services should identify a link for schools and colleges. This link will provide rapid advice, consultation and signposting.
2. We will fund new Mental Health Support Teams, supervised by NHS children and young people’s mental health staff, to provide specific extra capacity for early intervention and ongoing help. Their work will be managed jointly by schools, colleges and the NHS. These teams will be linked to groups of primary and secondary schools and to colleges, providing interventions to support those with mild to moderate needs and supporting the promotion of good mental health and wellbeing.
3. As we roll out the new Support Teams, we will trial a four week waiting time for access to specialist NHS children and young people’s mental health services. This builds on the expansion of specialist NHS services already underway.

We will roll out our new approach – incorporating all three pillars, including Designated Senior Leads for mental health in schools, creating Mental Health Support Teams and reducing waiting times – to at least a fifth to a quarter of the country by the end of 2022/23. We will start with a number of trailblazer areas, operational from 2019, which will be supported by robust evaluation so that we understand what works. The precise rollout will be determined by the success of the trailblazers, and securing funding after 2020/21, the end of the Government’s current spending period. This will be part of future spending review decisions.
This mix of provision will look very different in different areas, and we do not believe there is a single model that should be implemented nationally. The trailblazer approach to the initial phase of implementation will allow us to test how best to deliver this new service through local innovation and differentiation, and understand how its benefits can extend to all children and young people, including the most vulnerable. We will invite a range of areas to develop and evaluate different models of delivering the teams, at the heart of a collaborative approach. The aim will be for trailblazers to provide implementation support to other areas as the additional resource rolls out.

There are also wider opportunities to improve children and young people’s mental health and we need to continue with the focus on joined up working. We will do more to help schools support pupils with their mental health. A whole school approach, with commitment from senior leadership and supported by external expertise, is essential to the success of schools in tackling mental health. Mental health awareness training is a part of this. We will ensure that a member of staff in every primary and secondary school receives mental health awareness training.

We committed in our manifesto that every child will learn about mental wellbeing. Through the engagement process now underway for deciding next steps for Personal, Social, Health and Economic Education (PSHE), and Relationships and Sex Education (RSE), we will decide on the most effective way to deliver this. We will look at how mental health and wellbeing can support healthy relationships and how best to secure good quality teaching for all pupils through PSHE, and will consult on draft statutory guidance on RSE and potentially PSHE.

In addition to learning about how social media can have both positive and negative impacts on mental health as part of the curriculum, we also want to keep children and young people safe online and ensure that they are protected from potentially harmful effects to their mental health. We will convene a working group of social media and digital sector companies to explore what more they can do to help us keep children safe online, aligning with work underway through the Department of Digital, Culture, Media and Sport’s recently published Internet Safety Strategy. The Chief Medical Officer will also produce a report on the impact that technology has on young people’s mental health.

The proposals set out in this document, most significantly our approach to joint working between schools and colleges and the NHS, represent an ambitious new approach to helping all children and young people live happy and fulfilling lives. We welcome your views, through the public consultation, on how we can best make this exciting vision a reality.