Recommendations, key risks and quality statements
Professional? These recommendations, key risks and quality statements are extracted from the Expert Working Group final report on improving mental health support for our children and young people
Young person? See our dedicated website for young people.
Commissioning and accountability
Young people’s needs are met because there are systems and procedures in place to hold commissioners and providers to account. All those jointly responsible for commissioning have the knowledge and information to work together to make informed decisions that are responsive to children and young people’s needs.
There is insufficient accountability in the current system.
- Clinical Commissioning Groups should ensure commissioning is informed by a Joint Strategic Needs Assessment (JSNA) which addresses the mental health and wellbeing needs of looked after children and care leavers. This should be reflected in Local Transformation Plans.
- The Local Safeguarding Children Board, Corporate Parent Board and Health and Wellbeing Board should give appropriate priority to ensuring that the mental health needs of children and young people in care and leaving care are met.
- Ofsted, the Care Quality Commission and Her Majesty’s Inspectorate of Prisons should review their regulatory frameworks linked to registration to ensure that equal weight and attention is being given to mental and physical health needs.
- The statutory review of the child’s care plan by the independent reviewing officers must include at each meeting a review of whether mental health needs have been met.
Each locality has an accountable, independent virtual mental health lead whose primary responsibility is the mental health and emotional wellbeing of looked after children and young people.
This person provides leadership and oversight of the local system and ensures a holistic approach to care is in place, including ensuring that appropriate information is shared with everyone who is involved in the child or young person’s care.
There is no consistent leadership for supporting, monitoring and championing young people’s mental health.
- Building on the success of the virtual school head (VSH), a similar oversight role of a virtual mental health lead (VMHL) is established. This is to ensure that every child and young person in the system is getting the support they needed for their emotional wellbeing and health.
- Every school should have a designated teacher with the training and competence in identifying and understanding the mental health needs of all their pupils who are looked-after.
- Ministers at the Department for Education and Department of Health should work together to ensure children in care and leaving care have access to services provided for their mental health and wellbeing.
Everyone working directly with the children and young people, including those who are transitioning into adulthood, will have the knowledge, skills and competencies to recognise and respond to their mental health needs. This includes knowing when and how to access support from more specialist services if needed.
Caregivers are not sufficiently supported by the current system, either to access services for the young person they care for or to support their own mental health and wellbeing.
- Caregivers need to be informed of which statutory and non-statutory services are available when support is needed for the child or young person. This should be included in each area’s local offer. It is crucial that services are funded to support caregivers’ training and development.
Foster carers, special guardians, kinship carers, adoptive parents and those providing first-line support in children’s homes are recognised and valued as members of the workforce. They are provided with opportunities for training and development and are included in decision-making. They have access to support and advice from specialist mental health services for their own mental health and that of the child for whom they are caring.
Those working directly with young people do not always receive sufficient training to support complex mental health needs.
- Caregivers should receive support for their own mental health and wellbeing.
- Everyone working directly with looked after children should receive training on children and young people’s mental health so they are equipped with the appropriate skills.
Children and young people’s right to be involved in decision-making that affects their lives is recognised and supported. They are listened to as experts in their own experience by being given opportunities to work with professionals in planning and reviewing their support, including involvement in their care plan and pathway plan. This should be consistent with their individual development, preferences and needs.
The current model of delivering care relies too much on diagnosis and not enough on need.
Children and young people are not consistently being offered the platform to contribute to decision-making that affects their lives.
Children and young people want choices outside of child and adolescent mental health services. Their views must be listened to and responded to appropriately. Our consultations with children and young people highlighted that children often feel they are not given choices as to how to manage their own mental health and wellbeing.
- A needs-based model is the best way to support and respond to young people. This model places the young person at the centre of decision-making and where appropriate lets them exercise choice as to how and what support they access. This allows appropriate support to be generated by need, rather than diagnosis.
- Existing mechanisms for capturing direct views of young people should be integral to planning and commissioning arrangements. Local Health Watch services should monitor the effectiveness of mental health care arrangements for children and young people who are looked after, and report their findings to Health and Wellbeing Boards at least annually.
- Self-help, peer mentoring and community initiatives should be considered (if a young person expresses this is their preference) before a referral to more formal child and adolescent mental health services.
Children and young people know what services and support they are entitled to, and what those services provide. An informed and accountable workforce ensures that children and young people can access support that meets their individual needs and preferences, whatever their first point of contact.
A linear pathway can prevent a child or young person from sharing information essential for decision-making, as it places accountability on a statutory relationship that may not be their trusted relationship.
- Formal services should be more flexible in who they will allow to support the young person, acknowledging that support can come from a range of services and places. Health, education and social services need to work collaboratively to achieve this recommendation.
Universal health and wellbeing screening of all looked after children and young people are of a quality to act as an early warning system to identify support needs and prevent problems escalating. Young people and those supporting them meet to assess what the young person wants to achieve, and the help they need to achieve it. Assessments are not a ‘one-off’ exercise, but are ongoing, with flexibility in format and delivery, according to the individual needs and preferences of the young person.
Strengths and Difficulties Questionnaires (SDQ) by themselves do not capture the full range of emotional and wellbeing needs of a child or young person. Initial and continuing assessment of mental health status is essential for monitoring and meeting needs.
- The Strengths and Difficulties Questionnaire should be supported by a broader set of measures which can trigger a comprehensive mental health assessment. There are a range of tools in use that could support the assessment depending on the need of the young person.
- Assessments should focus on understanding the individual’s mental health and emotional wellbeing in the context of their current situation and past experiences, rather than solely focusing on the presenting symptoms. The young person, their caregivers, family (where appropriate) and professionals’ viewpoints should be included. Young people should be able to share who they would like to accompany them to assessments, and where possible those wishes should be accommodated.