Services for young people

Memorandum submitted by YoungMinds

1. YoungMinds is the UK's leading charity committed to improving the emotional well being and mental health of children and young people by ensuring these issues are placed firmly on the public and political agenda. We achieve this though the provision of research, lobbying, influencing policy and campaigning. Driven by the experiences of children, young people, parents and carers we also raise awareness and provide expert knowledge through training, outreach work, and publications.

2. Executive Summary

2.1. A universal progressive approach is required to engage with vulnerable young people who require a targeted or specialist service. This is because access via a universal setting is les stigmatizing, but ensures that young people receive the help they need.

2.2. Participation work can be a good way for young people’s services to meet Government priorities for volunteering, but it also helps development user focused services; and young people develop a range of skills and make friends.

2.3. There isn’t a one size fits all service for young people. Therefore agencies need to work together to plan, commission, and deliver high quality services. This partnership must include the voluntary sector.

2.4. The voluntary sector has a big part to play in providing services for young people. These services are often more young person friendly, more flexible and have participation built in. Many young people do not or can not access statutory mental health services, so voluntary sector services are often a lifeline to young people. Unfortunately, they are very vulnerable to funding cuts. So it is important that local agencies appreciate the importance of the voluntary sector, and commission these services.

2.5. Child and adolescent mental health services (CAMHS), including those provided by the voluntary sector, are particularly vulnerable to funding cuts. In the past when the NHS had to balance their books, many CAMHS services closed as they were a soft target for cuts. Mental Health problems cost the state £105 billion a year, so in this economic climate it makes sense to invest in services that tackle mental health problems at an early stage.

3. The Relationship between Universal and Targeted Services for Young People

3.1. We believe that there should be a universal progressive or proportionate universalism approach to services. By this we mean that relevant services should be easily accessible via a universal setting, but once in the service they should be referred to services which meet their particular needs. For this to happen there needs to be a joined-up approach to the commissioning and delivery of services. There also needs to be shared pathways so all services know where to refer young people with particular difficulties or conditions. So for instance, young people who may require counselling are referred to a local youth information, advice and counselling (YIAC) service, or relevant counselling service, but those young people who need a more specialist service such as an early intervention in psychosis service, or those who need specialist mental health services are referred on as required.

3.2. We believe that a universal progressive approach is better overall as it enables young people and their families to access appropriate services, but via a universal setting. This approach is important as universal services are more easily accessible and carry less stigma, however services should also be targeted at vulnerable young people who need a more targeted, or a specialist approach.

4. How Services for Young People can meet the Government’s Priorities for Volunteering, including the role of the National Citizen Service.

4.1. Many young people are involved in participation work connected to various local services. This work may not always be thought of as volunteering, but young people give their time for free in order to give something back for the help they have received, and/or improve services for the benefit of other young people. Participation work helps improve local services, and gives something back to the community, but it also helps young people develop useful skills to help with their future employment. It also enables young people to meet others in similar situations and gives them the opportunity to make friends, and provide support for each other.

5. Which Young People Access Services? What do they want from these services? And what is their role in Shaping Provision?

5.1. A report from Youth Access has shown that the young people accessing YIACS (Youth Information Advice and counselling services) are very similar to those accessing specialist CAMHS (Youth Access, 2010). This is because voluntary sector services are often more acceptable to young people as they carry less stigma than statutory services, their approach is more flexible, is user focused and generally has participation built in as standard. Youth Access have found that YIAC services have seen an increase in demand, and the young people they are now seeing have more severe and complex mental health needs than in the past (Youth Access, 2010). This suggests that young people are not or can not access statutory child and adolescent mental health services (CAMHS) and are turning to voluntary sector services for help.

5.2. Young people will have a range of needs depending on their age and their circumstances. For instance, they may require quite basic help such as finding somewhere to live, help with education, information about health, drugs, sexual health, through to needing counselling for a range of issues, and access to specialist services because of serious mental health problems.

5.3. High quality services for young people need to be available from early teenage years onwards. Young people have told us that they want help when they first need it, rather than waiting until they experience a crisis. Preventing emotional distress from escalating into serious, entrenched mental health problems is both practical and financially astute. Therefore, there is a need to provide high quality services to children under 13 as well as help throughout the teenage years. For instance getting children off to a good start in life and being securely attached to a main carer is crucial. As is building resilience in children which can help them cope with difficult situations. Services to support younger children and families can be delivered through universal providers such as Sure Start Children’s Centres, and schools, with links to targeted or specialist services as required.

5.4. There is also a lot of concern about the number of young people who do not access mental health services, despite having a diagnosable mental health problem. Epidemiological data shows that 1 in 10 children and young people have a mental disorder, but about a half does not access any service, and only a fifth access specialist CAMHS (Ford et al, 2005). There are a number of reasons why young people do not access mental health services. The YoungMinds Stigma Survey, and Stigma Evidence Review highlight how this is likely to be connected to the stigma associated with mental health services (YoungMinds, 2010a & 2010b). We also know that many young people often prefer to talk to a professional such as teachers, or school nurse about their mental health problems rather than seeking specialist help (Green, et al., 2005). The YoungMinds Children and Young People’s Manifesto tells us that this may be in part because GPs, who are the gatekeeper to specialist NHS services, do not always take young people’s problems seriously (YoungMinds, 2009). So young people may not think there is any point in going to their GP. They then run the risk of disconnecting with services and not seeking help until their problems have become a crisis.

5.5. Our Very Important Kids Project (VIK) is funded by the Big Lottery. The project involves thousands of children and young people campaigning to improve mental health services raise awareness about the importance of children and young people’s mental health and wellbeing and increase young people’s participation in service design and delivery. They work closely with commissioners and CAMHS teams to improve service provision. Our VIK staff, who operate across the nine English regions provide advice and training on how to involve young people in service design and delivery and training for service providers, including GP’s and mental health practitioners on issues including early intervention, identifying mental health problems in young people, and developing new projects focussing on the vital importance of patient feedback. One of our VIK workers has recently successfully worked with a group of young people from our VIK group in the recommissioning of CAMHS in Hampshire. The young people took part in a rigorous process to assess those who had tendered to provide the service.

5.6. Young people can make a big contribution to developing services, and can help improve outcomes both for themselves and other young people. However, participation is not an easy option. Young people, especially those with mental health problems need to be supported. Young people have been telling us very clearly for a long time about what the problems are, and what needs to change, but their views are rarely acted upon (Lavis & Hewson, 2010). If we want young people to continue to participate, then services need to act on what they are hearing and feedback on what action they have taken to respond to young people’s ideas to improve services.

6. The Relative Roles of the Voluntary, Community, Statutory and Private Sectors in Providing Services for Young People

6.1. All of these services, especially the voluntary and statutory services are important in providing mental health services for young people. Young people have a range of needs, and each will respond to different approaches. One size does not fit all, so therefore it is imperative that there is a range of services available to support these needs. We believe that there should be an integrated approach to planning, commissioning and the delivery of these services. To ensure that this happens services need to be able to work in partnership. All stakeholders need to be aware of local provision, including the voluntary sector. This is particularly important as the voluntary sector plays a vital role in providing services for young people, but often statutory services are not aware of their contribution, which results in practitioners not referring young people to them.

6.2. NHS CAMHS services often only see young people until they are 16 or in some places 18. This often results in very vulnerable young people not receiving any services as they may be too young or not ill enough for adult mental health services. The problems associated with making the transition to adult mental health services, can put young people off accessing services until they are in crisis. So for many young people voluntary sector services are a lifeline during this time.

6.3. Young people often have to endure long waits until they receive any specialist mental health support. So the information and support that they access from other sectors can be really helpful. For instance, many voluntary, statutory, and private sector organisations provide good quality information on their websites. For instance, YoungMinds provides a range of information and support via its website – www.youngminds.org.uk . We produce booklets for a range of different audiences; we have produced films made by young people for young people. YoungMinds’ My Head Hurts microsite aims to empower young people and their families by providing information about the evidence base for particular conditions, and information about their rights, and how to make a complaint – www.myheadhurts.org.uk . Our Very Important Kids website was created by young people for young people. It includes information about the project, a blog to help young people communicate with each other, and how young people can get involved in campaigning to improve mental health services. - http://www.vik.org.uk/

7. The Training and Workforce Development Needs of the Sector

7.1. The young people from our VIK project tell us that they are often treated very badly by professionals such as GPs. They report that their concerns are not taken seriously, and that many of the professionals they have seen often put their problems down to normal teenage behaviours. One young person told us that when she went to her GP because of mental health problems, she was told that she should phone the Samaritans. This lack of knowledge often results in young people not being referred on to specialist mental health services, and can put them off seeking help. So there is a need for all professionals working with young people to receive training in children and young people’s development and mental health. Professionals also need to have the skills to work with young people in an appropriate and sensitive way.

7.2. All professionals need to be aware of relevant guidance. For instance, young people report that staff in A&E have little understanding of mental health issues, and are not taking notice of relevant NICE guidance, such as the self-harm guideline. This often results in them being treated as if they are time wasters, and are put to the bottom of the list because their injury is self-inflicted. We have heard of young people who have developed serious scarring because their cuts were not attended to urgently.

8. The impact of Public Service Spending Cuts on Funding and Commissioning of Services

8.1. We are concerned that the current economic climate will severely challenge partnership working, with services being reluctant or unable to pool funding for jointly commissioned services. The voluntary sector is very vulnerable to cuts in public service funding. We have already heard of some voluntary sector organisations being reduced or cut due to funding difficulties. It is likely that we will not know the full extent of public sector cuts until next year. During the cuts to services in 2006-7 when PCTs had to balance their books, a number of child and adolescent mental health services were under threat of closure or were actually closed. This is because children’s mental health services are seen as a soft target for cuts even though recent estimates have put the costs of mental health around 105 billion a year to the state, so these savings only shore up huge financial costs in the future (Centre for Mental Health, 2010).

8.2. The impact on the spending cuts is likely to increase the clinical threshold, so young people will have to be very ill before they can access mental health services. One in 10 young people, which equates to one in 3 children in every classroom have a diagnosable mental disorder. (Green, 2005). The number of young people with mental disorders has radically increased over the past thirty years (Collishaw, S. et al., 2004). It is thought that the number has levelled out recently, but there is still a significant number of young people with mental disorders who will need specialist support (Nuffield Foundation, 2009).

9. How Local Government Structures and Statutory Frameworks Impact on Service Provision

9.1. We advocate the comprehensive CAMHS model. This refers to the number of services that support children and young people with mental health needs. The whole system needs to work to ensure the smooth running of services. If specialist mental health services cut back and raise their clinical threshold as outlined above, it will mean that many ill young people will not be able to access the help and support they need, and universal and targeted level services may be left to bear the burden.

9.2. The proposed Health and Wellbeing Boards, the new commissioning arrangements and the relevant outcomes frameworks will be key to ensuring that high quality services are jointly commissioned, are based on the needs of young people, and ultimately improve their outcomes.

10. How the Value and Effectiveness of Services should be Assessed.

10.1. We believe that services should measure their outcomes to prove that they are truly effective. Services may well be evidence based, or evidence informed, but unless they measure outcomes then they cannot accurately access how much they are helping young people.

December 2010

References

Centre for Mental Health (2010) The economic and social cost of mental health Problems in 2009/10. London: Centre for Mental Health. http://www.centreformentalhealth.org.uk/pdfs/Economic_and_social_costs_2010.pdf

Collishaw, S. et al. (2004) Time trends in mental health. Journal of Child Psychology and Psychiatry, 45 (8), pp 1350-1362.

Ford, T., Hamilton, H., Goodman, R & Meltzer, H. (2005) Service Contacts Among the Children Participating in the British Child and Adolescent Mental Health Surveys. Child and Adolescent Mental Health, 10: 1, pp. 2–9

Green, H., McGinnity, A., Meltzer, H., et al. (2005). Mental health of children and young people in Great Britain 2004. London: Palgrave. See http://www.statistics.gov.uk/downloads/theme_health/GB2004.pdf

Lavis, P. & Hewson, L. (2010) How many times do we have to keep telling you? YoungMinds Magazine, 109, Dec/Jan, pp. 30-31.

Nuffield Foundation (2009) Time trends in adolescent well-being: Update 2009. London: Nuffield Foundation. http://www.nuffieldfoundation.org/sites/default/files/Time%20trends%20in%20adolescent%20well-being%202009%20update.pdf

Youth Access (2010) Under strain. London: Youth Access. http://www.youthaccess.org.uk/publications/upload/Under-Strain.pdf

YoungMinds (2009) The YoungM inds children and young people’s manifesto for change. London: YoungMinds. http://www.youngminds.org.uk/document-library/pdf/manifestonewnew

YoungMinds (2010a) See beyond our labels: YoungMinds briefing on young people’s views about mental health. London: YoungMinds. http://www.youngminds.org.uk

YoungMinds (2010b) Stigma: a review of the evidence. London: YoungMinds. http://www.youngminds.org.uk

For further information please contact Paula Lavis, Policy and Knowledge Manager, at 48-50 St John’s Street, London EC1M 4DG. Telephone 0207 336 8445 or visit www.youngminds.org.uk