A guest briefing from NHS Clinical Commissioners in mental health awareness week
Today’s top interview: Sean Harriss: ‘Coming back has given me a really big buzz’
Today’s resolution: Public health staff pay rise row resolved
Today’s top comment: Participative democracy is a long-term task: Anthony Zacharzewski
The NHS Long Term Plan has made it clear that the NHS needs to do things differently if we are to help our children stay mentally healthy. But we cannot do it alone. The factors contributing to mental health problems are myriad, which means that improving children and young people’s (CYP) mental health requires a system wide approach encompassing education, social services, public health and youth justice as well as the NHS.
The policy environment for children and young people’s mental health has, for many years, highlighted the need for an integrated approach. There are good reasons for this. It reduces the chances of duplication in terms of commissioning and provision of services. It creates the potential for sharing budgets and risk and it means we can plan around the needs of each child rather than being constrained by services.
Implementing an integrated model is not without challenge, however, as clinical commissioning groups and local authorities attempt to work together whilst balancing their own duties and priorities. It can take a big leap of faith for many commissioners to invest in a service whose benefits may not become apparent for many years, or that may benefit another agency. But having a joined-up approach with a shared vision and a joint or aligned budget can help everyone.
The CYP mental health system is very complex and involves a number of different agencies who may have competing priorities and no existing relationship. Until recently, CYP mental health hasn’t always been a priority in the way it is now, so it has been overlooked in some areas. Health and wellbeing boards are a vehicle for integration, and whilst they work well in some areas, it isn’t universal. Crucially, children and young people can’t vote and until more recently have had little say in the services that are commissioned and provided for them.
Thankfully, things are changing. In Manchester, for example, great progress has been made towards integration in adult mental health services. But due to the cross-system working necessary to tackle poor mental health in young people, integrated commissioning for CYP on their patch is much less developed. So even in the more developed systems, integrated commissioning is still work in progress.
A shared vision and commitment from leaders in CCGs, local authorities and other partners is a good place to start. This sets the tone and the higher-level outcomes and objectives that the county or borough want to see. Hertfordshire County Council has a vision for children and young people. It covers good mental health and wellbeing, but it is part of a broader focus on a child’s needs which covers being safe, healthy, being able to prosper, take part, and thrive. The vision and its overarching plan have a strong focus on primary prevention and early intervention. It also links in with Hertfordshire’s Health and Wellbeing Strategy, which shape the commissioning of services across the health and care system.
We are already seeing many areas moving away from the current tiered model for CYP mental health services and implementing the i-THRIVE model, which focuses on need rather than on structures or interventions. The framework includes a focus on maintaining wellbeing through community-based promotion and prevention strategies, as well as on addressing specific mental health concerns. The NHS Long Term Plan advocates extending i-Thrive to cover 0-25s. If that approach is fully implemented, it would be a seismic shift for CYP mental health.
The children’s and young person’s mental health sector has talked about the importance of integration for a long time, but despite some levers that help, such as being able to pool budgets, it has largely remained an ambition rather than a reality. The NHS Long Term Plan brought children and young people’s mental health services into sharp focus and put forward some promising proposals for integrating health and care systems. But this new effort from the NHS will only take us so far. For a truly sustainable and integrated system, we need everyone to work with their local partners to collectively take responsibility for the next generation.
Dr Phil Moore, co-chair of NHS Clinical Commissioners’ Mental Health Commissioners Network and deputy chair (clinical) at NHS Kingston CCG
Paula Lavis, member network and policy manager for NHS Clinical Commissioners and author of the recently published Defragmenting CAMHS - commissioning the children and young people’s mental health system: Strategic Briefing