Focus on children and young people’s mental health

Victoria Watkins, Deputy Chief Inspector lead for children and young people, and Jemima Burnage, Deputy Chief Inspector of mental health, discuss our latest provider collaboration review, which focused on mental health care of children and young people during the COVID-19 pandemic.

We’re stating the obvious, but children and young people matter. And we’re not alone in worrying for our generation of children and young people and their future. Why? Well, amongst other things, they’ve been disproportionately affected by coronavirus. None of us know the full extent of this impact, and we may not fully understand for years to come.

A recent blog talked about our joint report with Ofsted in which we explored the experiences of children and young people with special education needs and disabilities (SEND) and their families during the pandemic. Although we saw some good examples of effective system collaboration and local areas adapting their ways of working, what came through loud and clear was that children and young people with SEND were even more vulnerable than they were before.

At the Care Quality Commission (CQC), we’ve been continuing our focus on children and young people with our latest provider collaboration review.

These reviews were set up to look at how health and social care providers worked together in response to the pandemic. The aim was to understand people’s experiences of health and care, share learning between providers, and highlight common challenges.

Issues around mental health care and support for children and young people are not new. And we’ve previously raised our concerns about the quality of care and support children and young people receive.

So to keep the spotlight on these issues, for our final provider collaboration review we looked at the mental health care and support for children and young people up to 18-years-old during the pandemic. This included children and young people seeking help from mental health services for the first time, as well as those receiving continued mental health and care support.

What we did

In June and July 2021, we carried out reviews in seven areas of England. It was really important that we got to the heart of children and young people’s experiences, so we undertook some specific activities to do that. This included commissioning Participation People to engage with children and young people using services and undertaking case tracking activity. Thanks to this, we heard from just over 1,700 children and young people and their voices feature throughout our report.

What we found

The pandemic has had a huge impact on the mental health of children and young people and led to an increased demand on services, particularly eating disorder services. We also heard of an increase in the number of children and young people presenting to emergency departments with mental health needs.

We recognise that our report is reflective of what we found during a specific period of time in the areas we looked at. However, many of the themes, issues and challenges that came out of the reviews aren’t new. They may resonate with other people, providers and systems across the country. And we think there is value in talking about some of the common challenges and sharing the good practice we saw.

Our report highlights some of the current challenges that systems need to address:

• Early intervention: Systems need to take action to ensure children and young people are receiving the right mental health support early on, before they reach crisis point. This includes making sure they have the right staff, with the right skills to meet the needs of children and young people.
• Collaboration: Providers and systems must continue to reduce silo working and improve how they work together.
• Communication: As well as better joint working, systems should improve communication: both between providers and families, and between system partners.
• Health inequalities: There needs to be a continued focus on addressing health inequalities. This includes tacking health inequalities for children and young people with mental health needs experiencing deprivation, those from Black and minority ethnic backgrounds, and those who identify as lesbian, gay, bisexual and transgender (LGBT+), and/or have physical, sensory and learning disabilities.
• Digital technology: Digital technology has given some children and young people access to services they may not previously have had, however it is not the right approach for everyone. Children and young people must have a choice in how they access care and support, whether that’s online, face-to-face, or a combination of both.

Across our reviews, we saw some great examples of systems working collaboratively to ensure continued access to mental health support. This ranged from joint awareness campaigns to new helplines for children and young people. A few systems spoke positively about Mental Health Support Teams, which are being rolled-out across England.

We heard of children and young people being cared for in unsuitable environments. Providers we spoke to recognised how challenging and potentially unsafe this could be. In all areas, we heard how providers worked together to address this. Positive examples included clinical commissioning groups securing additional funding for eating disorder charities to provide early intervention and coping strategies for children and young people waiting for beds and the creation of bespoke safe rooms and quiet areas where children and young people could be monitored while waiting for care.

We want to pay tribute to the dedicated leaders and frontline workers. We saw some excellent, rapid developments to help children and young people when they were most in need, particularly to enhance access. We heard of a reduction in bureaucracy, breaking down of boundaries, and closer working. It’s important this is recognised and celebrated.

But there is more to do.

As we said at the start of this blog, we all need to be worried about the impact of the pandemic on the mental health of children and young people. We would encourage you to read the report, look at the positive examples we found, and consider how you might apply that in your own system.

But above everything, please listen to the voices and experiences of children and young people. Hear their words, acknowledge the challenges, and build on the excellent work we’ve seen to come together and effect change.