The new ‘Future in Mind’ report from the Department of Health and NHS England attracted a fair amount of attention in social media circles (#YoungMentalHealth) when it was launched on 17th March 2015.
It sets out a vision (for England) for improving mental health and wellbeing in children and young people, building on the work of the Children and Young People’s Mental Health and Well-being Taskforce, set up in 2014.
The vision and recommendations are based on a review of the evidence and consultations with stakeholder organisations, children and young people.
The report suggests that whilst there is significant variation across the country, there are real opportunities for improvement in numerous examples of good practice and existing initiatives which can be adapted to suit local needs.
In this blog, Alison Turner from the Commissioning Elf, provides an overview of the ‘Future in Mind’ report and considers how commissioners should use the findings and recommendations to improve the mental health and wellbeing of children and young people.
Resilience, prevention and early intervention
The focus here is on promoting healthy behaviours, including working with schools and providing more support for postnatal depression. There is a recognition of the role of services such as GPs and school nurses to identify and act on potential problems. As mentioned in an earlier blog, adolescence and early adulthood are considered to be the peak age for onset of mental health problems; early intervention is important to improve longer term outcomes.
Parity of esteem is prioritised in national policy and there is acknowledgment that all health services should address both the physical and mental health needs of children and young people, regardless of how they first present. There is a need to reduce the stigma associated with mental health problems and services need to respond to the needs and preferences of this particular age group, through promoting of the safe use of social media and apps, and social prescribing for example.
Access to support
The report notes that pathways are too often focused around services rather than the individual, leading to fragmentation, inconsistency and poor outcomes. It is often unclear both to professionals and individuals how they can access services. There are a number of ideas for improving access and encouraging compliance, including:
- A single point of access
- Systems to identify high risk individuals
- Pathways and governance to enable prompt decision-making
- Personal budgets to encourage greater control and choice
- Peer support to help individuals
- A whole system approach to commission inpatient care and prevent admissions
In particular, it needs to be clearer to individuals how to access services in the event of a crisis.
The focus here is on developing pathways which provide social and clinical responses for individuals who are vulnerable and with complex needs. Partnership and coordination are critical to ensure individuals are not lost in the system, through shared assessment, case management, multi-agency case reviews and multi-agency governance structures.
Models of good practice include the use of consultation and liaison teams and embedding mental health workers in community-based teams where they can reach more vulnerable individuals, e.g. people who are homeless.
Accountability and transparency
Commissioners will be aware of the fragmentation and poor quality information referred to in the report. It is suggested that a lead commissioner is agreed locally (in many cases, this is likely to be the CCG) across all services (e.g. community, residential, inpatient), with a single dedicated budget. There will need to be greater clarity of the roles and responsibilities of the various stakeholders and there needs to be a check to ensure relevant stakeholders (e.g. schools) are involved.
Currently, it’s difficult to track the flow of all funding, so it’s often not possible to confirm total current investment. However, the CAMHS minimum dataset will start in 2016, so commissioners will need to consider additional data flows to support outcomes based contracts.
The report also highlights a role for Commissioning Support Units and Academic Health Science Networks (AHSN) to support commissioners through robust intelligence and analysis.
In addition to skills, training and experience, the report emphasises the values and attitudes of staff. Training and development needs to be addressed from basic training through to continuing professional development. Multidisciplinary training can support multidisciplinary working and needs to involve a range of workers involved in delivering care and support to children and young people, including generalists and specialists. There needs to be investment in accredited training for commissioners, for example, the mental health commissioning and leadership programme offered by NHS England and AHSNs.
A vision for more co-ordination and collaboration
The report is quite detailed and written for a broad audience. From a commissioning perspective, the message which stood out most for me is the urgent need for more co-ordination and collaboration. The experience of stakeholders is that children and young people often fall through the gaps and can become lost in the transitions across services.
There are a number of other themes which run throughout the report – including greater involvement of individuals and their families/carers in decisions about their care and about the wider system of care, through self-management programmes, shared decision making, engagement and co-production.
The report recommends that lead commissioners are required to develop Transformation Plans for Children and Young People’s Mental Health and Wellbeing, however, this will not be addressed in the current Parliament. The plans would prioritise investment to meet local priorities and needs and establish collaboration across sectors.
The Commissioning Elf’s view
Martin McShane, National Director for Patients with Long Term Conditions, has acknowledged that service transformation in mental health comes with significant challenges, particularly in the current climate of financial pressures. However, he does make an important point – that improvement needs to be built on a foundation of shared vision and values across services and sectors.
Commissioners may wish to consider:
- How are the needs of local children and young people being identified?
- How can pathways be improved to focus around the individual not around services and to provide clear guidance on referrals and access?
- How are you involving community and voluntary services in the design and delivery of services?
- How do governance structures need to be improved to support collaborative working and co-ordinated care?
- What is the evidence for the current range of interventions? Where there is no clear evidence base, how are you ensuring robust evaluation to ensure the evidence base is developed?
- What arrangements are in place to help prevent admissions?
- What outcomes are important to service users and their families/carers?
- What information is needed to measure these outcomes?
- How are inequalities in access and outcomes being monitored and addressed?
Department of Health and NHS England (2015) Future in mind: promoting, protecting and improving our children and young people’s mental health and wellbeing, Department of Health.
Children and Young People’s Mental Health and Well-being Taskforce. Website last accessed, 31 Mar 2015.
The Commissioning Elf. Website last accessed, 31 Mar 2015.