Summary of key findings

Key findings:

1. There was strong testimony from front-line professionals that a needs-based model is the best way to support and respond to young people. A needsbased model allows the child to be placed at the centre of decision-making and where appropriate to exercise choice as to what support they need.
2. Both young people and front-line professionals expressed a frustration at the conventional linear approach to describing care pathways, which overemphasises reliance on a statutory relationship that may not be the most trusted relationship. A linear pathway also frequently fails to utilise the relationships that may be central to the child or young person. Young people’s journeys are not linear and neither are their needs, so effective solutions cannot be solely linear either.
3. Initial and continuing assessment of mental health status is essential for monitoring and meeting needs. There are a range of tools in use that could support the assessment depending on the need of the child or young person. Strengths and Difficulties Questionnaires by themselves are not sufficient. Examples of different methods of assessment can be found in our Call for Evidence.
4. When we asked our young person’s reference group who should complete the assessment, they consistently reported that how it was completed was more important than by whom. The group were eager to recommend that there is an initial meeting between the chosen professional and the young person before any assessment is done as ‘trust and getting to know each other first before you share deep stuff’ is crucial for young people. The Expert Working Group supports this recommendation.
5. Statutory services must ensure they allow those who have key relationships with the young person to contribute to decision-making. There was evidence offered during the course of the project that people with central current relationships with the child or young person, most commonly the main caregiver, were excluded from decision-making.
6. Caregivers need to be fully aware and informed of what statutory and nonstatutory services are available. Additionally, in order to properly support the young people they care for, caregivers need support for their own mental health and wellbeing.
7. Children and young people want choices outside of child and adolescent mental health services. The most commonly cited examples by children and young people when asked what helps on a bad day were having time out and space to breathe, followed by recreational activity. Self-help (including peer mentoring) and resources within the community should be seen as viable choices for supporting the young person.
8. . The Expert Working Group strongly advocates the reframing of accountability for looked after children and young people’s mental health and emotional wellbeing. We believe that there need to be stronger mechanisms of accountability within existing systems which we highlight in our recommendations.
9. Building on the success of the virtual school head, the Expert Working Group believes that a similar oversight role of a virtual mental health lead is needed.
10. Statutory services are becoming much better at consulting children and young people. While this is a welcome step forward, it is only by collaborating with young people that we can move beyond services ‘done to’ to services ‘done with’. If young people are not involved effectively from the start, they will disengage with professionals and services and the commissioning of services will not be informed by those using the service
11. In relation to mental health assessment, the Expert Working Group made key process recommendations that shift control back to the child and young person, including, where possible, a strengths-based approach focusing on enhancing resilience. This is detailed in our pathways and decision trees.

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Read more on improving mental health support for our children and young people:

• Expert Working Group final report
• Recommendations, key risks and quality statements