Children and young people’s (CYP) mental health discovery brief

After prioritising work it has been agreed to work on the following;

What are the opportunities to support children and young people in preparation for their first or subsequent contact from a children and young person’s mental health service?

We will explore this opportunity by conducting a discovery phase. We have a multidisciplinary team which includes CYP mental health subject matter expertise and clinical expertise.

Below is a list of assumptions and justifications about who we currently believe our users are and why we think this work is important. We are conducting further research, this will evolve.

Who do we think this will affect?

Before beginning the discovery, with collaboration from our clinical expert, we broke down some of the key users we believe we’ll be speaking to and designing with:

• Children and young people waiting for mental health support or have a recent experience of waiting.
• Parents/guardians/carers with dependents who are seeking/have recently sought mental health support
• Health Professionals

Why is this important?

There were a number of factors that played into why we believe this is important, here is a selection of recent reports or articles that highlight that this area is worth investigating;

• CYP mental health identified as important in the NHS Long Term Plan
• Active waiting is the idea that there are practical, actionable tasks or care that could be done in the gap between referral and care. There is evidence that “active waiting” helps increase appointment attendance and reduce dropout
• It has been reported that services are in high demand.
• One in eight (12.8%) 5 to 19 year olds had at least one mental disorder when assessed in 2017
• Referrals to child mental health units have been on the rise for the past 3 years.
• CQC reported that the “system as a whole is complex and fragmented. Mental health care is funded, commissioned and provided by many different organisations that do not always work together in a joined-up way. As a result, too many children and young people have a poor experience of care and some are unable to access timely and appropriate support.”
• Waiting times appear to be variable but in some cases can be multiple months long
• It has been reported that a child’s mental health may deteriorate while waiting for support from CYPMHS
• High waiting times are associated with high Do Not Attend rates/Was not brought rates which are costly to the NHS and don’t help people be seen quicker.

In one report a patient awaiting care said;

while I was waiting [for care] my anxiety increased as I felt I was being ignored and sidelined. While we are waiting report

You can also hear about a selection of young people’s experiences in these two videos:

• The therapy experience: what’s it really like? Youth ambassadors talk about their experiences of therapy at the Brandon Centre.
• Channel 4 documentary (2019)

Measures of success

We want to make things better. At the beginning of the discovery we think we could improve;

• A better user experience of applying for and awaiting care
• Supporting children and young people to be ‘treatment ready’, ensuring that children, young people and families are clear about what to expect from services
• People feel cared for and not forgotten about
• Reduction in did not attend rates/was not brought rates

As this is a brand new collaboration between NHSX and NHS England we acknowledge that success should also be seen in the light of:

• Exposing new ways of working
• Building capability

What will the team be doing?

We intend to;

• Learn about users and their context
• Map a users whole problem
• Understand what services are currently available
• Assess some of the current artefacts that are currently in use (for example appointment letters sent to patients)
• Consider accessibility needs and users who are in need of alternative paths through a service
• Know the existing research in this space
• Quantify the scale of the problem
• Understand constraints that could affect delivery
• Identify improvements we might be able to make
• Run a workshop to explore the consequences of any future interventions
• Recommendations on what we should do next
• Write a short report of work done and share with interested parties

We endeavour to know enough, to make recommendations that we have confidence in.