Mental health 360: services for children and young people

Overview

Access is insufficient to meet demand 

There remains a considerable gap in access. The NHS’s access metric for children and young people’s mental health services measures how many children and young people (aged from birth to 17 years) receive at least one contact from NHS-funded mental health services (including MHSTs). Of the 1.4 million children estimated to have a mental health disorder potentially requiring assessment and treatment, less than half (48%) received at least one contact. The data is captured from a wide range of services providing support and treatment for children and young people, including MHSTs in schools, so even taking into account those children who receive support and treatment in other settings, such as primary care, there remains a notable gap. A survey of community service providers conducted by the Community Network also highlighted concerns about long waits for care.  

Among children and young people who have been referred to NHS mental health services, there has been an increase in the proportion of cases that have been closed without treatment. In 2021–22, 32% of children who were referred did not receive treatment – a higher proportion than in 2020–21 (24%) and 2019–20 (27%), though lower than in 2018–19 (36%). Cases may be closed before treatment because the child or young person did not require specialist treatment, chose not to take up treatment, or was referred elsewhere. However, it is indicative of a potential gap between the treatment available from NHS mental health services and the needs of children and young people seeking help.  

The NHS Long Term Plan committed to rolling out MHSTs to between one-fifth and one-quarter of England by the end of 2023. In spring 2023, 398 teams were operational, covering 35% of pupils. Further expansion of MHSTs is planned, with approximately 500 expected to be up and running by April 2024. Rates of training for core workforce roles will mean that NHS England expects to reach 47% MHST coverage by 2023/24. However, the government has yet to announce funding beyond this, leaving just over half of pupils unable to access early support via MHSTs. Early evaluation of MHSTs found that the model has been welcomed, with positive early outcomes. However, there remained a group of children and young people whose needs could not be met by the teams and interventions available but were not serious enough to be accepted for specialist help. 

Timeliness of access is highly variable 

One of the consequences of insufficient access is that children and young people seeking care may face longer waiting times. Data shows that the average (median) waiting time in England between referral and first contact with services is 13 days. However, those waiting to be seen have been waiting an average of 170 days, and 10% of referrals have been waiting for more than two years. This indicates a substantial gap between the number of children and young people requiring support and treatment and the capacity to provide timely access. There is also substantial variation in waiting times between trusts, indicating that services in some areas are less able to meet demand. 

Eating disorder services are the only children and young people’s service with a waiting time standard – that 95% of patients are seen within one week for urgent cases, and four weeks for routine cases. Introduced in 2015, the aim was to reach the target level by 2020. However, the national target for either urgent or routine cases has never been achieved. Performance was improving before the pandemic but deteriorated during and after it, as services received increased numbers of referrals. 

Access to inpatient care is mixed 

The number of admissions to wards for children and young people has fallen since 2019/20. The number of children and young people admitted to adult wards – an indicator of lack of bed capacity – has also fallen. Between 2019/20 and 2021/22, the number of occupied bed days for under-18s (NHS providers) has declined, while the proportion of occupied bed days for non-NHS providers increased from 36% to 43%. This suggests that additional capacity is largely coming from non-NHS providers.  

The Children’s Commissioner has warned of an increasing number of young people not admitted to hospital but being deprived of their liberty. The Association of Directors of Children’s Services has reported an increase in applications to local authorities to deprive children in care of their liberty. These orders are often used to manage complex mental health presentations and behaviours. Their increased use has been attributed to a lack of access to inpatient beds and a lack of alternatives routinely being offered. The government is currently reviewing provision of care for this group but evidence suggests there may be some way to go to ensure sufficient capacity to meet needs.