THE COMMISSION ON YOUNG LIVES has published its fourth thematic report, Heads Up: Rethinking mental health services for vulnerable young people. The report looks at the growing crisis of mental health problems among children and young people in England, and puts forward proposals to redesign young people’s mental health services, particularly for those at risk of harm.
The report, co-authored with the Centre for Mental Health and the Children and Young People’s Mental Health Coalition (CYPMHC}, reveals a profound crisis in children and young people’s mental health services in England and a system of support that is buckling under pressure. Speaking with professionals who work with children, and to children and families themselves, the Commission has heard about young people who have barely returned to school since Covid, the increase in the regularity and extreme nature of many young people’s mental health problems, and how self-harm and suicide attempts are a much more regular feature of school and college life.
The report warns that failing to support some young people with mental health problems could lead to more behavioural incidents at school, a rise in exclusions, and more children becoming at risk of grooming and exploitation. The report says a rising tide of poor mental health has the potential to expose even more children to exploitation, crime and offending.
The report does recognise how some children’s mental health services have widened the support they provide following increased investment. It also highlights the positive work being done by many organisations, charities, and community groups to provide support to children with mental health problems, including programmes that divert them away from crime. However, it argues that Children and Young People’s Mental Health Services (CYPMHS) is still losing the battle against rocketing demand for help and failing to meet the needs of thousands of children in crisis:
The Commission has also been shocked to hear from those working with young people about how often those suffering from serious mental health conditions are unable to receive treatment in some areas until they have made multiple suicide attempts ‘with serious intent’. It has heard traumatic stories of teenagers who have attempted suicide but still not received an immediate referral for help, and from teaching staff in schools and colleges who are seeing a large increase in the number of their students attempting suicide.
Many children from marginalised groups have negative perceptions of mental health services because they have previous bad experiences of other statutory services. Clinical models devised to help young people often feel outdated, uncomfortable, and overly medicalised to children themselves.
Young Black men are less likely to seek formal mental health support through doctors, counsellors, or psychologists and racialised communities are also more likely to report more dissatisfaction with mainstream mental health care. Many families, particularly those living in racialised communities, have a deep distrust of statutory services. Too many of the parents the Commission has spoken with were not receiving the non-judgemental care they wanted in a community environment they trust.
The report makes a number of recommendations, including:
- A commitment from the next Prime Minister to fund an immediate £1billion mental health wellbeing recovery programme for children and young people to improve the quality and effectiveness of mental health care and support, with guaranteed appointment and treatment times as part of a wider post pandemic commitment to them. Whilst this will be locally determined, it will fit within a national guarantee that all children and young people requiring CYPMHS treatment are seen within a four week week period, with guaranteed next day emergency appointments for those at risk of serious self-harm and suicide.
- Guaranteed mental health assessments for children and young people at points of vulnerability. This would mean an automatic assessment and guaranteed mental health package for children entering care and automatic assessments for children and young people at risk of exclusion from school, who go missing, at the point of arrest, or are involved in violence or crime. It would include a guarantee of assessment by education psychologists for any child at risk of exclusion.
- A national implementation programme to embed a whole school and college approach to mental health and wellbeing across all education settings in the country. This should include a commitment from Government to provide a funding package for Mental Health Support Teams beyond 2023/24 to ensure that all schools have access to this vital additional support by 2030.
- An ambitious programme of drop-in mental health hubs delivered in the community.
- A national ‘Programmes on Prescription’ scheme in every area. The roll out of a major funded programme of social prescribing for mental health wellbeing that enables GPs and health professionals to pay for sports and arts sessions, music, drama, activities, youth clubs, outings, and volunteering programmes to improve young people’s confidence, self-esteem and skills and to make friends.
- A major recruitment programme with ambitious targets to build the children and young people workforce required to meet this expansion of services. It is vitally important to ensure that this workforce is diverse and culturally competent.
- Wellbeing and mental health training and support for all professionals working with children and young people.
- Improving the mental health and well-being of young people at risk of harm and being involved in the criminal justice system should be measured as a core aspect of NHS equality targets.
Anne Longfield, Chair of the Commission on Young Lives, said: “The children’s mental health emergency in England is so profound that we face a generational threat to our country’s future national prosperity and success. The scale of the problem is growing, rocket-boosted by the pandemic and the system is buckling under pressure and unable to cope with the explosion in demand for help.
“Thousands of vulnerable children are falling through gaps in the mental health support system, boosting the chances of those resourceful, manipulative, and ruthless criminals and abusers who are so good at grooming them.
“I am particularly worried that we will see an increase in school exclusions of children with mental health problems who are not receiving the support they need. Some of these children will be at greater risk of harm.
“The overall response from the Government to this children’s mental health crisis has so far been too slow and inadequate, and we are failing to support hundreds of thousands of children with mental health problems. It is shocking to hear that some young people who attempt suicide still do not receive an immediate referral for help and are discharged without any extra support.
“The next Prime Minister will have an opportunity to show they care about tackling this children’s mental health emergency. I would like both candidates in the Conservative leadership contest to commit to an immediate £1billion mental health wellbeing recovery fund for children and young people. This should include a guarantee that all requiring CYPMHS treatment are seen within a four week period, with guaranteed next day emergency appointments for children at risk of serious self-harm and suicide.
“Young people have told us what help they need. Unless we rethink and improve access to mental health support, we risk putting the post-Covid generation of vulnerable children in even greater danger of exploitation, abuse, and poor life chances. A generation of young people is struggling and as a society we have a moral duty to respond.”
Centre for Mental Health chief executive Dr Sarah Hughes, said: “Children and young people’s mental health is at risk from the after-effects of the pandemic, the cost of living crisis and the ongoing effects of endemic racism and inequality. We need action now to protect the mental health of those at greatest risk, including the poorest and the most marginalised children in society.
“Expanding mental health support for children and young people is essential. But alongside it we need to reduce child poverty, support young families, make schools mentally healthier and rebuild youth services.”
Steve Chalke, the founder and leader of Oasis, which hosts the Commission on Young Lives, said: “Children and young people’s mental health services just aren’t working for many of those who desperately need help. I regularly meet children and their families who are struggling with serious mental health problems but are on long waiting lists for treatment, can’t even get a referral or don’t trust that they will get the kind of help they need.
“Government needs to put in the right resources, and we need to have an urgent rethink about the kind of support we provide in communities and through schools. Until we tackle the drivers of youth crime, including underlying psychological and mental health issues, we will continue to fail children and young people at risk of being excluded, exploited and criminalised.”
Amy Dicks, Policy Manager at The Children’s Society, said the charity was supportive of the commission’s recommendations. “Even before the pandemic, many children and young people were being turned away by overstretched mental health services or facing unacceptable delays in accessing vital help”, she said. Now this situation has got worse still, with successive lockdowns causing enormous harm to children’s mental health and placing even more strain on frontline services which are also struggling to recruit and retain staff.
“Through our frontline support, we see more young people needing help with issues like anxiety, depression and self-harm, and being vulnerable to grooming and exploitation by predators. Worryingly, we are yet to see the full long-term impact of the pandemic. Urgent action is needed to ensure all children whose mental health has suffered due to Covid get the help they need – but also to address a worrying longer-term trend, with our Good Childhood Research finding that children’s happiness had declined in the decade before the pandemic.
“We need to see government investment not just in crisis support, but also in walk-in hubs offering children immediate early support before issues escalate. Specialist services must offer better help to vulnerable groups including children in care, migrant children and children affected by poverty, exploitation and abuse.
“The roll-out of mental health support in schools must be accelerated and schools must be supported to recognise changes in children’s behaviour may be a sign of trauma and problems in their lives, and to offer help, with exclusion a last resort. Only with decisive action and investment will we begin to turn around the long-term decline in our children’s well-being and address the severe damage caused by Covid.”
* Read the report Heads Up here.
* Source: Commission on Young Lives