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Too many young people only get mental health care in crisis as 'services not working together'

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Too many children and young people reach “crisis point” because services are not working effectively together so that they receive timely mental health support, according to regulators.

National, regional and local action is required to ensure local services work together to support children and young people’s mental health needs, the Care Quality Commission has warned.

“We heard from too many young people who felt they could only access care at a crisis point”

Paul Lelliott

The Royal College of Nursing said the CQC’s new report revealed a “troubling picture” of a mental health system “buckling” under the pressure of waiting lists, staff shortages and gaps in services.

The regulator examined care, how needs were identified and how services worked together, in 10 areas across England. It also spoke with over 1,300 people via focus groups and interviews, including young people, carers and professionals, and looked at how individuals moved through mental health services.

As a result, CQC said it was calling for changes to how local bodies worked together to support and care for children and young people with mental health needs.

For example, commissioners and providers across education, councils and health needed to work with NHS Digital to “drive cross-sector improvement” in the quality and availability of information.

“It is one of the biggest health problems in the UK but underfunded fragmented services are letting down children and young people”

Fiona Smith

In addition, sustainability and transformation partnerships needed to collaborate with organisations “beyond” traditional health and social care including schools, police and probation services.

It also said national bodies needed to “champion and enable” such changes by ensuring their work did not reinforce the boundaries between services that led to care and access “feeling fragmented”.

The Department of Health and Social Care, Health Education England, NHS England and NHS Improvement “must recognise and build on the examples of good, person-centred care that exist”, it added.

The CQC also called for Ofsted and inspectorates of independent schools to recognise and assess how schools support children and young people’s mental health.

Meanwhile, the CQC highlighted that government proposals, such as establishing dedicated mental health support teams in schools, were welcome.

It also described the funding commitment in the Five Year Forward View for Mental Health as a “significant intervention” and an “important signal” that it was a system-wide priority to address.

However, unless the pace of delivery accelerated, it would not be enough to achieve the scale of change needed to protect children and young people from “unnecessary distress and avoidable deterioration”, warned the CQC.

Care Quality Commission

Dr Paul Lelliott

Paul Lelliott

Among its recommendations, CQC is calling for Jeremy Hunt to use the inter-ministerial group on mental health to guarantee greater collaboration across government departments in how their policies prioritise the mental health needs and wellbeing of children and young people in England.

The CQC noted that it had committed to working with other regulators, like Ofsted, on joint inspections to consider the quality of care across whole systems.

Dr Paul Lelliott, the CQC’s deputy chief inspector of hospitals and lead for mental health, said: “Children and young people deserve to have their mental health needs and wellbeing put at the heart of every decision, be that planning, commissioning or resourcing.

“Currently, this is not the reality everywhere and we heard from too many young people who felt they could only access care at a crisis point because local services are not working together,” he said.

But he added: “Despite the pressure the system is facing, we saw dedicated staff across the country who embodied this vision and whose work presents an opportunity to transform and improve the experience of children and young people with mental health needs.”

“We all need to act now and to act together. If we do not, we risk letting down children and young people across the country and undermining their potential in adult life,” stated Dr Lelliott.

Royal College of Nursing

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Fiona Smith

Fiona Smith, professional lead for children and young people at the RCN, said: “This report reveals a troubling picture of too many children reaching crisis point in a mental health system that is buckling under the pressure of long waiting lists, staff shortages and gaps in service provision.

“At least 10% of children and young people are affected by poor mental health,” she said. “It is one of the biggest health problems in the UK but underfunded fragmented services are letting down children and young people.”

She said: “Calls to increase the number of people trained in mental health awareness, improve data collection and to change how local bodies work together to support children and young people are welcome.

“But unless we have the right number of children’s mental health nurses and school nurses, they will not get the right support and consistent care they need,” warned Ms Smith.

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