Learning from the Pandemic to Improve Children and Young People’s Mental Health Support
Policy Manager and Mental Health First Aider for the NHS Confederation reflects on how the pandemic has put intense strain on mental health support services.
The rate of mental disorder in children and young people (CYP) has been climbing over the past decade, but the number of young people needing mental health support has been turbocharged during the pandemic, putting pressure on the whole system, including on the NHS and social care. The Covid Inquiry has recently commenced, and our members tell us that for mental health a key learning point must be that we cannot carry on providing services in the way we have in the past, as the system simply doesn’t have the workforce or the beds to provide services to meet this level of demand.
The rate of mental disorder in people aged 6–16 years rose from one in nine in 2017 to one in six in 2021 alongside a huge rise in the number of CYP being referred to, and in contact with specialist mental health services during the pandemic. Numbers are still much higher than pre-pandemic.
In particular, there was a significant increase in the number of young people accessing eating disorder services during the earlier stages of the pandemic and the figure is still higher than before COVID-19. As a result of the pressure this puts on the system, too many children and young people are waiting too long for help.
Our members, providers of mental health services, are telling us that they are now seeing young people with very severe and complex needs, and if they are admitted to hospital, they are staying longer. This puts more pressure on beds both in the mental health sector and in paediatric units.
There is rightly focus on the elective care backlog. What isn’t talked about so much is the estimated 1.6 million people awaiting mental health support. How we tackle this is important, and given we are also going through a cost-of-living crisis, there are likely to be repercussions if we don’t provide appropriate mental health support for people when they need it.
What needs to change
We know that mental health problems often have their roots in childhood. Half of adult mental health problems are present by age 15, and three quarters by 24. There is good evidence for early intervention, but it takes a leap of faith for commissioners, as the rewards on investment are often not seen until years later.
Unfortunately, mental healthcare has been underserved in financial allocations, leading to budgets being stretched to help services cope with the high number of people needing expensive specialist services and a dilemma for also providing dedicated funding for early intervention services.
The challenge is that if we don’t invest in early intervention, it will be difficult to reduce the number of CYP needing specialist services. While there is an economic case for funding early intervention, there is also a clear moral one, to alleviate suffering, ensuring children and young people can get off to a good start in life, get a good education and thrive, and grow up to be healthy adults, who are part of the workforce and can reach their full potential.
Health leaders have told us the Government needs to encourage and enable ICSs to invest in early intervention to bring about this change, but we also need more funding for mental health across the board to ensure that people with serious mental health issues are also being supported. This is a huge challenge as public sector funding is under significant pressure, but ultimately, we need to invest to save.
Another barrier is having the workforce to deliver the transformation we want to see in CYP mental health services. We are behind the national targets for number of psychiatrists and nurses and vacancy rates are high in many areas. This needs to be factored into the forthcoming NHS workforce plan.
There are already good examples of early intervention services. The Mental Health Support Teams (MHSTs) in schools, have increased workforce capacity and provide much needed support for pupils and school staff. While there is still work to do, progress has been made on rolling out MHSTs, and it is expected that 500 will be up and running by 2024.
Schools already provide a wide range of support, even if they do not have a mental health support team. For instance, schools commission voluntary sector services such as Place2Be,which provides counselling and mental health support in schools and work with pupils, families, and school staff. Additional capacity can also be provided by digital services such as Kooth, which already works in many schools to provide safe, online mental health support for pupils.
Early support hubs – such as 42nd Street in Manchester and Young Person’s Advisory Service (YPAS) in Liverpool – provide a community based one-stop shop approach for young people up to the age of 25, largely provided by the voluntary sector and commissioned by the NHS or local authorities.
Social prescribers also work with both adults and young people. People working in these roles often have lived experience of mental ill health and can bring a different skill set to traditional mental health roles such as psychiatrists or nurses.
It is essential that we learn from what we know helps improve children and young people’s mental health and intervene before they reach crisis point. If we do not, we will be stuck in a vicious circle, where people with serious mental health problems in childhood needing specialist mental health support, will become adults with serious and enduring mental health issues.
The government is talking about the importance of growth in the economy, but we know that people with serious mental health issues often have poorer outcomes such as not having good educational qualifications, not being in employment, and potentially lost to our workforce.
We must invest in prevention and early intervention to help support our children and protect them for unnecessary suffering, but also to reduce pressures on our precious mental health services.
On November 17th, IPPO is holding an online event to discuss the findings of its systematic review, which has looked at ‘What are the most effective, scalable interventions to address anxiety and depression, shown to have surfaced during the COVID-19 pandemic?’. Sign up here to attend.