Off of the top of my head, I can think of five young people I know personally who have needed access to both mental and physical health services due to the effects of their mental health condition over the last 24 months, with not all finding it as easy as others to access those services. If I gave it more thought, or asked my teenage daughter, I estimate that I could double that number relatively quickly.
The good news about this statement is that I know of these young people, because mental health in young people is talked about more than it used to be. However, according to a survey with parents led by the charity YoungMinds, up to three-quarters of young people looking for support from child and adolescent mental health services (CAMHS) become more unwell before they can access treatment. And a recent survey by NHS Providers shows mental health services for children and young people are under growing pressure and increasingly overstretched, despite significant support and investment.
Couple these findings with the rise reported last Autumn in the number of children and young people now experiencing a probable mental disorder, and anecdotal reports of increased numbers and acuity of children and young people in A&E and paediatric settings with both mental and physical healthcare needs, and it is clear treating mental and physical health with the same level of importance is more crucial now than ever.
One of the most remarkable findings of both reports was that a mental health history was rarely taken.
Chief Executive
An absence of equivalent mental and physical healthcare was one of the key messages from the National Confidential Enquiry into Patient Outcome and Death's (NCEPOD)'s 2019 review into the care of young people with mental health conditions admitted to general hospitals. This was a message we had also highlighted in a similar review looking at adults two years previously. One of the most remarkable findings of both reports was that a mental health history was rarely taken; a simple task that would promote the fact that the mind and body are not separate entities, and help to ensure that appropriate healthcare needs are met at an earlier stage.
The analyses from those studies highlighted a range of further areas that could be improved – none of them expensive, and all of them within the gift of local teams, for example:
- mental health professionals supporting staff in general hospital settings, particularly with regard to risk management and familiarising them with specific terminology/language;
- communicating the clinical information of patients with known mental health conditions at the interface between healthcare providers or multi-disciplinary teams; and
- planning the transition of care for young people from child to adult mental health services far enough in advance to make sure they do not fall out of the system.
In addition, analyses undertaken by Swansea University on routine national datasets, as part of the 2019 study of young people, showed that:
- young people in more deprived areas had higher rates of mental health conditions, but lower rates of referral and access to secondary care mental health services; and
- the presentation of young people with mental health conditions to emergency departments was higher relative to other physical health conditions, and their length of stay was longer too, particularly so for males, which may have been due to the severity of their self-harm.
What can you as an individual or executive board member do to promote improved care for young people with mental health conditions who will access your services?
One of the hardest things about trying to make local improvements is knowing where to start. It might seem daunting to measure the 'size of the issue', but only by doing so can you move forward. To help with this we have provided a recommendation checklist to aid local assessment of current status against the report recommendations and identify areas for quality improvement. Even if planned changes are worked through in very small steps, it will help drive change locally, and ultimately, nationally. I would suggest trying to collaborate with other hospitals and healthcare providers to share learning as well as processes and templates.
Key actions for executive boards include nominating or appointing a clinical lead for children and young people's mental health in general hospitals; and developing local clinical network arrangements between acute general health and mental health services.
The use of electronic patient records will improve record sharing between mental health hospitals and acute general hospitals within and outside the NHS.
Chief Executive
Key actions for executive boards with help from commissioners and healthcare professionals include ensuring children and young people admitted to acute general hospitals have prompt access to age-appropriate mental health liaison services when needed. The use of electronic patient records will improve record sharing between mental health hospitals and acute general hospitals within and outside the NHS. However, if electronic records are not available, then patients should not be transferred without relevant paper notes and could be encouraged to carry a patient passport that outlines their agreed care plan.
Key actions for commissioners and healthcare professionals with help from executive boards include ensuring continuation of mental healthcare within and across service providers, particularly at the point of transition to adult services, as well as ensuring mental health risk management plans are clearly available in all general hospital records for patients admitted with a current mental health condition. A further key action is providing children and young people with mental health conditions an opportunity for a private confidential discussion with physical and/or mental health professionals when they are seen in an emergency department or ward in an acute general hospital or mental health facility.
Ordinarily we would expect it to take around five years before the impact of reports such as ours are fully recognised
Chief Executive
Ordinarily we would expect it to take around five years before the impact of reports such as ours are fully recognised, and the COVID-19 pandemic will undoubtedly impact this further. However, there have been welcome wider national developments which dovetail well with our work and we hope will support more rapid progress on our recommendations. For example, the NHS Long Term plan has committed to expanding access to community based mental health services and providing support during the period of transition from child to adult healthcare. Furthermore, the Academy of Medical Royal Colleges is currently working with stakeholders to develop and promote national guidance outlining the expectation required of general hospital staff in the care of children and young people with mental health conditions. Locally, we have heard of pathways being reviewed to ensure easier access to mental health services during admission to a general hospital.
However, whilst waiting for national directives, every hospital admission can be an opportunity to assess mental health as well as physical health needs, and to review mental health risk and care plans where they are already in place. To do this, healthcare staff need to be available, trained, supported. They need to be able to ask for help from specialist/more senior colleagues when needed. By working together, executive boards, healthcare professionals and commissioners can provide equivalent mental and physical healthcare services to young people and adults cared for in their organisations.
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