Mental health services still subject to huge regional variation Children’s Commissioner Report finds

A new report from the Children’s Commissioner’s team details the current trends around children and young people’s mental health services. The number of young people being referred for treatment has increased to 734,00 from 498,000. Average wait times from referral to starting treatment has increased to 40 days with huge regional variability, from 13 days to 80 days in some areas. Interestingly the measures are around having one-contact and the number of young people having more than one-contact drops dramatically. The more worrying statistic is that the number of cases closed before treatment starts has increased with nearly a third of referrals not progressing to treatment with a huge range from 5% in the best performing NHS areas to 50% in the worst performing.

The number of children admitted to inpatient mental health wards has fallen, though there seemed to be delays in the system with inpatient admission only considered after multiple A&E appearances. More emphasis on earlier intervention was requested by those spoken to. The number of children detained under the Mental Health Act has fallen to 869 for 2021-22 with 71% of these being girls.

The Children’s Commissioner makes 10 recommendations:

1. The Major Conditions Strategy, the replacement for the Mental Health Strategy, must have a core focus on the needs of children.
2. Integrated Care Partnerships, once established, should prioritise the needs of children.
3. Schools should become the fourth statutory safeguarding partner of the new Integrated Care Partnership.
4. Recommendations 10-14 of the Family Review on improving local integration should be adopted by the Department for Education, the Department of Health and Social Care, the Department for Levelling Up, Housing and Communities, the Home Office, and the Ministry of Justice.
5. The Department for Health and Social Care rolls out Mental Health Support Teams to every school by the end of 2025.
6. The Department for Education, the Department for Health and Social Care and the Ministry of Justice should develop a joint commissioning strategy for integrated, secure therapeutic care for children with mental health and welfare needs, who may also have offended.
7. The number of young people falling between the Mental Health Act detention and secure welfare accommodation should be able to access a resolution process instead of the High Court. The data around young people subject to Deprivation of Liberty authorisations should be collected and included in the DfE Children Looked After return. 
8. NHS England should continue to fund the role of Family Ambassadors to ensure they have a fuller evidence base and conduct a review into family visiting to look at environment, activities and access to wards can be developed further.
9. The EEF and What Works Wellbeing should carry out research in effective provision of education in inpatient settings and the DfE, Department of Health and Social Care and NHS England should establish a network in which to share the good practice. 
10. NHS England needs to collect more data around children in hospital with mental health issues to allow improved understanding of the quality of care and sufficiency of provision. 

Paul Whiteman, general secretary of school leaders' union NAHT, said:

“These worrying findings chime with the experiences of our members, who have seen the damaging impact of the pandemic and cost-of-living crisis on children exacerbate long-standing concerns around young people’s wellbeing and mental health. School leaders and their staff work tirelessly to identify mental health needs and support children’s well-being, but they are not mental health specialists and they need to be able to draw on the expertise and support of specialist services.
"It is unfair on staff and pupils for schools to be left to struggle to paper over the cracks left by an unacceptable postcode lottery in early support and mental health treatment in which many children face long waits for treatment or are told their problems are not bad enough to warrant help. We welcomed the introduction of mental health support teams working with schools, but the government must speed up their roll-out and go further by investing in counselling services in all schools. The government must also fund easy-access mental health support services in every community offering early support to children with emerging issues, while also investing more in treatment and crisis services so all children get help when they need it.”