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What good could look like in integrated psychological services for children, young people and their families

Preliminary guidance and examples of practice

Demand for psychological wellbeing services for children, young people and their families far outstrips capacity. Current services are over-stretched and fragmented, which leads to duplication, complex referral systems, long waiting times and young people falling through the net. There are also great inequalities that result in the most vulnerable people being more disadvantaged.

We need to rethink psychological services to nurture a cohort of children and young people who have good emotional health and wellbeing. Providing support for all those who need it requires system transformation focused on integration and prevention. We must reduce the level of need, and increase the capacity within the system.

Building resilience in children, families and communities
The limited resource available to support the psychological wellbeing of children and young people is concentrated in services that provide help when problems have already arisen, like CAMHS. Furthermore, within those services, resource is focused towards cases with more severe and complex psychological difficulties. Work has been done to improve the effectiveness and efficiency of services, but we must reduce demand by keeping children and young people healthy and tackling the risk factors that lead to mental health conditions.

Reducing demand can be best achieved by investing in primary prevention, for example interventions that address poverty and social inequality; health promotion, for example in schools or maternity settings; and early intervention. Community psychology can also be extremely beneficial. This approach encourages whole communities to shape their own environments to be psychologically safe, to build resilience and promote healthy lifestyles for children and young people. This community led approach is likely to lead to better and sustained psychological wellbeing.

Recognising, harnessing and increasing capacity
Effectively supporting children and young people’s psychological health and wellbeing means changing our understanding of what is considered a ‘mental health intervention’ and how they should be delivered. Increased capacity in the system could be best achieved by investing in workforce development, changing the way the workforce works to be more flexible, and by actively engaging young people and families to help themselves and others.

Key to meeting demand is effective planning, developing and monitoring the psychological workforce to ensuring that there is a high standard of clinical leadership and sufficient staff with the right skills, including specialist therapy skills and those with the flexibly to create tailored interventions. We can also change ways of working by deploying psychological professionals in a way that enables the benefits of using psychological science to be disseminated as effectively and broadly as possible.

There is untapped potential to positively impact children and young people’s psychological wellbeing among those in closest contact with them – their parents, schools, youth workers, and residential care staff. This systemic approach has the potential to create significant and sustainable change.

Integrated provision
Integration between services and sectors will be key in achieving these aims. Integration means a unified, holistic system where services are delivered by organisations working in partnership with shared vision and values, infrastructure and resources, thus removing duplication and revealing gaps. The benefit for the child or young person is an integrated care pathway that enables seamless access to different interventions.

This requires health professionals in physical health care settings to consider the whole child and also pay attention to the psychological wellbeing of their parents or carers. It requires mental health professionals to think about the physical health needs of the child, young person and family sitting in front of them, and to feel that it is part of their responsibility.

As well as integration across mental and physical health, true integration means better links between community and specialist services, between different agencies, across traditional age barriers and across the whole system. The key to building an integrated service is the development of collaborative relationships across the system.