YoungMinds Manifesto:A New Strategy for Young People’s Mental Health

Young people’s mental health is one of the most pressing social issues facing the UKOne in eight children and young people have a

diagnosable mental health conditioni, and half of

all lifetime mental health problems emerge by the

age of 14, with 75% being present by the age of 24.ii

In addition, many young people experience mental

distress, but do not reach the threshold for a clinical

diagnosis. England regularly comes in the bottom half

of international league tables for child wellbeing.

In recent years, there has been a rise in the prevalence

of mental health problems amongst children and

young people, which has led to a significant increase

in demand for already overstretched mental health

services. Referrals to Child and Adolescent Mental

Health Services (CAMHS) have reportedly increased

by 45% in the last two years,iii and A&E attendances

by young people with mental health problems have

almost tripled in the last decade.iv Shockingly, this has

meant that one in four 11-16 year olds with a mental

health condition have self-harmed or been suicidal,v

and suicide remains the leading cause of death for both

males and females aged 5-19.vi

Research shows that experiencing mental ill health in childhood or adolescence can have a significant impact across the life course.

It has been shown to substantially affect young people’s

educational outcomes, earnings, employment, ability

to maintain relationships, likelihood of engaging in

risk-taking behaviour, and risk of an early death.vii The

human and financial costs of failing to support young

people are high, and undermine our health as a society.

Despite this, NHS data shows that currently only one in three children and young people with a diagnosable mental health condition receives NHS care or treatment.viii

This means that thousands of young people are being turned away without the vital support they need. This too often leads to an unnecessary escalation of their needs, and leaves them and their families in a state of crisis.

In the last few years there has been increased investment and welcome commitments to increase access to and improve children and young people’s mental health services through the NHS Long-Term Plan and the Green Paper on Children and Young People’s Mental Health. They were an important step forwards, but they do not go far enough.

The NHS will never be able to meet the scale of need on its own. In addition to investing in NHS mental health services, it is clear that we need a radical new holistic approach to prevent the development and escalation of mental health problems in children and young people.

If we do not act now, we will be failing another generation of young people, leaving them in escalating crisis, and withholding the vital support they and their families need to manage their mental health and thrive.

This is why YoungMinds is calling on the Government to introduce a bold cross-Government strategy for children and young people’s mental health to:

The factors that cause and exacerbate young people’s mental health problems are complex and multiple.

We know that those children who have had the most difficult starts in life are more likely to develop mental health problems, more likely to become suicidal, and more likely to die younger than their peers, and some groups of young people are more at risk than others. Furthermore, at least one in three adult mental health conditions relate directly to childhood adversity and trauma.ix

Given the rising prevalence of mental health problems in childhood, and the increasing demand for services, it is clear that we need to do substantially more to address the factors that make children and young people’s mental health worse. To do this successfully, we need to see consistent action across government to prevent the development of mental and emotional distress, and to ensure there is early help for young people when problems first emerge and for those most at risk.

We need to see a joined-up approach across government so that policy development leads to a positive impact on young people’s mental health and wellbeing, and reduces the need for more specialist

NHS treatment.

We call on the Government to:

• Establish a Cabinet Committee on Children and Young People’s Mental Health to oversee the cross-Government strategy, and ensure that policy across government has a positive impact on young people’s mental health.

• Take action across government to tackle the major factors and determinants in mental ill health amongst children and young people.

• Give young people a strong voice to ensure that policy decisions are informed by their experiences, creativity, insight and the pressures they face.

1. Address the factors that make young people’s mental health worse

1. Address the factors that make young people’s mental health worse

2. Support young people and families to better understand and manage their mental health

3. Provide early intervention in every community

4. Reform and modernise our mental health services

2in3 young people with mental health problems could not find support when they first needed it x

? ?

Young people and their families consistently tell us that they want more support to help them to develop the skills, confidence and knowledge to be able to better look after their mental health.

Whether it’s to self-manage an emerging mental health problem, or to better understand an ongoing need, they are calling out for greater insight and support. However, too often children, young people and families are unable to find or access the tools, resources or information to be able to do this.

In a recent YoungMinds survey, 51% of young people said that they didn’t ask for help for their mental health because they didn’t understand what they were going throughxi and two-thirds of parents said that neither they nor their child were signposted to any support while waiting for a CAMHS appointment.xii

To prevent children’s mental health needs from escalating to crisis point, we need to empower children, young people and families to be partners in looking after their mental health, alongside universal and targeted service provision.

Every day, our Parents Helpline hears from families who have been waiting for months for mental health support, or have been turned away by specialist services. Too often children and young people become suicidal, start to self-harm or drop out of school before they are able to get help.

In a recent YoungMinds survey of over 2000 parents, 76% stated that their child’s mental health had deteriorated while waiting for an appointment.xiii

Furthermore, less than one in ten young people told us that they found it easy to get support for their mental health.xiv

We urgently need a step-change in support to ensure that all children and young people are able to receive early help, to prevent an unnecessary escalation of their mental health needs and before they reach crisis point. This requires a dedicated and comprehensive expansion of early intervention support in communities, which goes much further than existing commitments.

We call on the Government to:

• Empower children, young people and families to self-manage their mental health by creating a digital self-management hub, co-designed by young people, which provides tailored information, advice, and evidence-based resources, activities and Apps, focused specifically and based on the needs of the young person.

• Enable families to better support young people who are experiencing mental ill health by expanding provision for a designated online and telephone service to provide advice, information and emotional support for any parents, carers and adults who are concerned about the mental health of a child or young person.

• Make it easier for people to find, and access, the right support by requiring local areas to develop tools (including digital) to promote services that support children and young people’s mental health and wellbeing. This would also improve the capability of professionals to signpost to relevant service.

• Give young people an equal say in decisions about their care and treatment, and the mental health services they receive by fully embedding shared decision-making in the implementation of the NHS Long-Term Plan across England.

We call on the Government to:

• Introduce inclusive, open access mental health hubs for children and young people in every local area. Building on the Headspace model in Australia, the hubs would be co-designed with young people, to reflect the needs of individual communities, and would ensure there was no wrong door for young people when looking for support.

• Make mental health a core component in all training for professionals who work with children, young people and families, in order to ensure all workforces have adequate knowledge and skills to provide practical and appropriate support.

• Ensure that every school, college and university has access to on-site specialist mental health expertise and support to increase the provision of early help for students with emerging mental health needs, or those experiencing a crisis.

• Introduce a national commitment and strategy to address childhood adversity and trauma, with dedicated training for professionals who work with children and young people, an expansion of trauma-informed models of care, and an established common identification framework across services.

2. Support all young people and families to better understand and manage their mental health

3. Provide early intervention in every community

Referencesi NHS Digital (2018) Mental Health of Children and Young

People in England, 2017. Based on 12.8% of 5 to 19 year olds being identified as having a diagnosable mental health condition

ii Kessler RC et al. (2005). Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication

iii Dispatches: Young, British and Depressed, broadcast on Channel 4, 29th July 2019

iv Parliamentary Question

v NHS Digital (2018) Mental Health of Children and Young People in England, 2017

vi Office for National Statistics (2017) Deaths registered in England and Wales

vii Evidence summarised in YoungMinds (2018), Addressing Adversity

viii Exact figure 36% - data taken from NHS Digital Five Year Forward View for Mental Health Dashboard – Q4 2017/18;

ix Kessler, R. (2010). Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys’ British Journal of Psychiatry 197(5): 378–385

x YoungMinds (2019), Act Early survey

xi YoungMinds (2018), #FightingFor Report

xii YoungMinds (2018), A New Era for Young People’s Mental Health

xiii Ibid

xiv YoungMinds (2018), #FightingFor Report

xv YoungMinds (2019), Act Early survey

Good quality inpatient care or mental health treatment can be a lifeline, and can help young people to recover from a crisis, move back home, or manage their needs effectively.

However, accessing inpatient care or CAMHS can be a frightening experience for young people. When the care or treatment is inappropriate, or unhelpful, this can have a harmful and traumatic impact.

There is currently a postcode lottery in the quality and experience of care in CAMHS and mental health hospitals. The Mental Health Act is more than 30 years old, and children and families across the country do not always experience consistent rights and protections.

Pathways into, and through, mental health support need further modernisation. There is an urgent need for increased community-based provision to ensure that young people with the most complex needs receive good quality care in a setting that is right for them, and when young people access inpatient care they should be assured of minimum standard of rights and protections. Worryingly, some young people continue to be detained for too long in hospitals because good quality support in their community isn’t available. This makes them more likely to be subject to increased use of restraint, seclusion and segregation.

The NHS Long-Term plan includes ambitious proposals to reform services and service models across children and

young people’s mental health services. It is essential that these reforms are delivered across the country and that new legislation is introduced to ensure that our mental health system is fit for the 21st century.

We call on the Government to:

• Introduce legislation to reform the Mental Health Act, and enshrine the rights of children and young people accessing mental health services in the NHS constitution.

• Increase access to NHS mental health services for children and young people by delivering on the commitments of the NHS Long-Term Plan and make sure that the promised investment reaches the frontline.

• Improve the quality, experience and flexibility of mental health services for children and young people by developing new models of care, care pathways and person-centred approaches to care that are available close to the home of the young person, or in a way that works best for them.

4. Reform and modernise our mental health services

For more information about young people’s mental health contact:

E ymenquiries@youngminds.org.uk | www.youngminds.org.uk

© 2019 YoungMinds. Registered charity numbers 1016968 & SC039700

Almost half of young people with mental health problems cited traumatic experiences a factor that had a significant impact on their mental healthxv