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Improving children and young people’s mental health services

The government has started to tackle issues of parity of esteem between physical and mental health services for children and young people, but there is a long way to go to ensure equal access to care, says the National Audit Office (NAO).

In a report published today, the NAO has said that even if current initiatives are delivered as intended, there would remain significant unmet need for mental health services amongst young people. Experience in other sectors suggests that programmes to improve access to mental health services may also uncover previously unidentified further demand.

The government started from a very low base when it developed its strategy for children and young people’s mental health services. The most recent (2004) survey of children’s mental health needs found around 10% of 5 to 16 year olds had a mental health condition. It also estimated that only around a quarter of children and young people requiring support from mental health services can access the services they need.

The government’s current work to improve mental health support for children and young people is an important but modest step towards achieving its longer term aspirations. It includes initiatives to increase the proportion of children and young people who need support accessing NHS-funded mental health services from around 25% to 35%, estimated to be equivalent to treating an additional 70,000 children and young people per year, between 2015-16 and 2020-21. This reflects the Department’s assessment of what is possible within current funding and staffing constraints.

However, the NAO has found significant weaknesses and unreliability in the government’s data which undermines its understanding of its progress and whether additional funding has been spent as intended. In particular, the NHS cannot reliably track progress against one of its key targets to treat an additional 70,000 children and young people. It is encouraging that it has met its interim access rate target for 2017-18, but as this was based on a one-off data collection, it still cannot be confident about how fast access is improving. The NHS is working to improve the data it collects including developing the first comprehensive collection of data on NHS-funded children and young people’s services.

An additional £1.4 billion was committed to children and young people’s mental health services between 2016-17 and 2020-21. Since the government launched its strategy, local health spending on these services has increased. However, NHS England cannot be sure all the additional funding has been spent as intended by clinical commissioning groups, although it has tried to strengthen controls in 2018-19. In reality, it has limited powers to ensure that CCGs increase spending in line with their intentions and it has chosen not to introduce any restrictions on how CCGs spend the additional funding received.

Slow progress on increasing the mental health workforce in England by 40% (4,500 staff) is emerging as a major risk to delivering the government’s ambitions and there are currently no data available to monitor any increase. In March 2018, local areas were only planning to recruit 3,410 NHS staff by 2020-21. This means that to meet the original ambitions a quarter of new posts would need to come from outside the NHS, but local areas have not yet estimated how many non-NHS staff they will need.

New government estimates, expected late 2018, of the number of children and young people with a mental health condition are likely to be higher than previously estimated, which will make it even harder for the government to achieve its long-term ambitions. If prevalence is 50% higher than the previous 2004 estimate, this would mean NHS England would have to treat an additional 186,000 children and young people in order to achieve an access rate of 35% by 2020-21.

The report recommends that the Department, working in conjunction with other departments, should set out the scale of the needs of young people requiring mental health services, building on the new prevalence data when available and identify what work and resources are needed to implement its 2015 strategy, Future in Mind, in full.

“Parity of esteem between physical and mental health services for children and young people is a laudable aim. However, to deliver meaningful change, this must be matched by the necessary planning, resourcing and co-ordination. Despite a welcome start this aim remains far off. Current targets to improve care are modest and even if met would still mean two-thirds of those who need help are not seen. Rising estimates of demand may indicate that the government is even further away than it thought.”

Amyas Morse, head of the NAO, 9 October 2018

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