2Cross-departmental working
Arrangements for cross-departmental working
12.Future in Mind, the government’s vision for children and young people’s mental health services, contains 49 proposals, made by a commissioned taskforce and accepted by the government. The strategy identifies a range of bodies across government as having an important role in delivering these proposals. The government has initiated a number of work programmes intended to help take forward Future in Mind although these do not deliver it in full. It has not defined what actions and budget it would need to implement each proposal in full, nor has it set quantified targets for the delivery of each proposal. There is no single governance structure for the delivery of Future in Mind, or for supporting children and young people’s mental health more generally. With the exception of the Green Paper (a joint initiative led by the Department and the Department for Education) the main work programmes taking forward Future in Mind are all led by the NHS.25
13.The Department told us it does not intend to use Future in Mind as the basis of its future plans to improve services and support for children and young people’s mental health. NHS England is developing its ten-year plan which is likely to prioritise mental health services for children and young people within the NHS, but the Department is not preparing a corresponding cross-departmental plan. Instead, the Department told us it would take a similar approach to its joint working on the Green Paper with the Department for Education; working on a one-to-one basis with at least five departments. However, it is not clear how some cross-departmental issues affecting children and young people’s mental health services will be addressed, for example affordable housing for staff.26
Prevention and early intervention
14.Preventing mental health conditions, or addressing them earlier, is thought to be better for young people and their families and more cost effective since it can reduce the need for more intensive services later on. Many areas of government that provide preventative or early intervention services sit outside the health sector, for example schools and local government. However, these face significant funding challenges and many bodies have reduced non-statutory support in recent years. One example of this, given by the Royal College of Nursing, is the significant decline in the number of school nurses (which are local authority-funded). The Royal College of Nursing told us that school nurses are ideally placed to support children and young people’s mental health in schools because of their training in child development. The number of school nurses has declined (falling by 16% between April 2015 and January 2018) despite the fact that NHS England sees them as an important part of the mental health system.27
15.There is limited information about what mental health support is available for children and young people outside the health sector, and limited understanding about the impact of reductions to such support on the demand for NHS services. NHS England told us it is working with the Children’s Commissioner and others to improve its understanding. A further challenge to implementing prevention and early intervention initiatives is the limited knowledge about which approaches are effective. Under its Green Paper proposals, the government aims to improve prevention and early intervention and the Department told us it will test what school-based approaches work best, and whether they reduce the demand for more specialist NHS services. But since it will only start to roll out services from 2019, this will come too late to make a significant difference to the current programme to improve NHS services.28
25 Q232; C&AG’s Report, para 1.10–1.11, 1.13, 3.18–3.19, figures 4, 5, 18
26 Qq85, 88, 121–122, 154–155, 222–238; C&AG’s Report, para 1.13, figure 1; Letter from the Department of Health & Social Care, para 2, 19 November 2018
27 Qq 2, 7, 11, 28–29, 33, 36, 43–46, 86, 89, 100–111, 124, 126–133, 149; C&AG’s Report, para 1.15, 2.27–2.28, 3.22–3.24, figures 3, 18; Children and Young People’s Mental Health Coalition (MHS0001) para 2.3, 2.4
28 Qq89, 149–151; C&AG’s Report, para 1.15–1.16, 2.27–2.28, 3.22–3.24; Letter from the Department of Health & Social Care, para 5, 19 November 2018
Published: 11 January 2019