17th August 2016

Progress and challenges in the transformation of young people’s mental health care

This is the second report of the Education Policy Institute’s Commission on children and young people’s mental health.

In our first report Children and Young People’s Mental Health: the State of the Nation, we identified a ‘treatment gap’ where specialist services were, on average, turning away nearly a quarter (23%) of the young people referred to them for treatment. We also found a postcode lottery of waiting times, with many children waiting months to get support.

In this, our second report, we have explored progress made since the publication of Future in Mind, the government’s strategy to transform mental health care for children and young people in England. We identify key barriers to the delivery of the transformation programme. Our research included a freedom of information request to child and adolescent mental health service providers.

You can read the full report here

Key Findings

  • 83 per cent of trusts who responded said they had experienced recruitment difficulties, with 51 instances of a post being advertised a trust only receiving two or fewer applicants. The research found 51 instances of a post being advertised a trust only receiving two or fewer applicants. 80% of trusts had had to advertise posts on multiple occasions to fill roles, with mental health nurses being the most difficult profession to recruit, followed by consultant psychiatrists.
  • Of the 122 published Local Transformation Plans, only 18 areas (15 per cent) have ‘good’ plans. 85% required improvement. 58 (48 per cent) plans ‘require improvement’ and 45 (37 per cent) ‘require substantial improvement’. On average, localities in the Eastern and West Midlands regions performed best. The mean score for the Eastern region was 34.9, while the mean score for the West Midlands was 34.4. Plans from the rest of the South East and the East Midlands received the lowest mean scores: 30 and 29.3 respectively.
  • Recruitment challenges had led to an 82 per cent increase in expenditure on temporary staffing in the last two years. In 15/16 nearly £50m was spent on agency staff by 32 trusts. However, there were significant regional variations in recruitment difficulties, with six areas (15 per cent) not experiencing any problems, in particular trusts in the Midlands and some Northern trusts.
  • For 2016/17 £119m has been allocated to local areas, but this has not been ring-fenced, instead, it has been included in their total baseline allocation– specialist services also sit within a wider network of support from youth services to local authority funded charities and social care, meaning there is a risk that the overall budget for children and young people’s mental health may not increase or may even be reduced due to wider austerity measures.

Policy Recommendations

This autumn, the Education Policy Institute Commission will make detailed policy recommendations for national and local health and care leaders to address the barriers that we have identified above.  It is clear, however, from our research so far, that the following actions are urgently needed:

  1. Health Education England should work with provider trusts and local health and care commissioners to ensure that the workforce strategy to support transformation, covers recruitment and retention of key staff, improving the skill-mix between the different professions and covering training needs for specialist and universal staff such as GPs, health visitors and teachers.
  2. There must continue to be a rigorous process of assurance of how local areas are planning to spend the additional investment and the development of local plans as part of the business planning process for the second year of implementation, particularly given the risk that the transition to baselined funding and ‘mainstreaming’ the plans will shift the focus away from children and young people’s mental health.
  3. At a national level, there should a stronger focus on where action is needed across departments such as with schools and children’s social care.
  4. Unless improving services remain a top priority for the Government, with annual clear implementation plans and access standards at a national level for which the Department for Health as well as NHS England can be held to account, there is a risk that levels of access will remain the same, or even deteriorate. Our aim is to ensure the implementation of Future in Mind is as effective as possible in order to tackle the treatment gap outlined in our first report.

Education Policy Institute Commission

Our Commission is Chaired by former Mental Health Minister Norman Lamb MP. Our Commissioners are:

  • Roy Blatchford, Director, National Education Trust
  • Sarah Brennan, Chief Executive, Young Minds
  • Professor Tanya Byron, clinical psychologist, writer, broadcaster and government advisor
  • Kat Cormack, mental health consultant
  • Jacqui Dyer, adviser to Department and Health and NHS England, service user and carer
  • Professor Peter Fonagy, Chief Executive, Anna Freud Centre, London
  • Dr Lise Hertel, GP, Clinical Lead for Mental Health, NICE, Newham CCG
  • Tim Horton, Health Foundation, former advisor to Ed Miliband MP
  • Dr Charlie Howard, Founder, MAC-UK
  • Dan Mobbs, Chief Executive, MAP, advice and counselling service, Norfolk and Norwich