8 January 2019

Changing the shape of children and young people’s mental health services – How can we help our children to thrive?

For many years England’s health and social care services have come up against criticism for not providing the same access to care or quality of care for mental health needs as for physical health. Approximately 1 in 4 people in the UK will experience a mental health problem each year, with 50% of mental health problems established by age 14. The need for high-quality mental health services, starting with those for children and young people, is now higher on the national agenda than ever before.

In recent years, funding constraints and disjointed mental health services for children and young people have led to damning criticism. In 2017 Anne Longfield, the Children’s Commissioner for England, said there was ‘no clear expectation placed on local areas about which services should be provided, or how ill a child needs to be before they should receive care’ and described progress to improve services as ‘unacceptably slow’.

But is the tide beginning to turn? This October the government announced at least £2 billion of extra funding is to be allocated for improvements in mental health services. But what might ideal children and young people’s mental health support look like and how can it be delivered to best suit those most in need?

“It’s important to remember that mental health services for children and their families aren’t just delivered by healthcare professionals” reminds Professor Miranda Wolpert, Professor of Evidence Based Research & Practice at UCL. “For mental health care to be effective, those responsible for delivering care need to work together with children, young people and their families, and speak a common language that everyone understands”.

In response to a growing need to provide better mental health care and support, Professor Wolpert and her colleagues created a new framework – THRIVE. THRIVE is a set of principles for creating consistent and effective communities of mental health help and support for children, young people and families.

“Traditional models of care are based on the idea that children referred to mental health services fit neatly on to a pathway of care – they are assessed, diagnosed, given treatment and then discharged. The reality is very different. It’s not always possible to give a clear diagnosis and the best course of treatment or support can vary widely depending on the individual’s needs”.

THRIVE emphasises that the decision on how best to support a child’s mental health cannot be based purely on their diagnosis or presenting symptoms. It stresses the importance of drawing on the evidence base, alongside being transparent about the limitations of treatment, and explicitly engaging children and their families in shared decision-making about the type of help or support they need. The framework suggests that all those involved in the delivery of care across health, education, social care and the voluntary sector work closely with one another to meet these needs, agree on aims, and review progress.

Although 10% of children and young people have a mental health problem, statistics show that less than 25% of those in need are able to access support. “The THRIVE Framework was born out of a clear need to think differently about how children’s mental health services are delivered” explained THRIVE co-author and Consultant Clinical Psychologist, Dr Rachel James.

To help translate the THRIVE Framework into practice, experts in child mental health from the Anna Freud National Centre for Children and Families, the Tavistock and Portman NHS Foundation Trust, the Dartmouth Institute for Health Policy and Clinical Practice and UCLPartners set up an implementation programme – i-THRIVE, providing coaching and training to cross-sector professionals around the country in the key principles of the THRIVE Framework.

“i-THRIVE is building capacity across the children’s workforce to help identify the mental health needs of vulnerable children and young people and their families” explains Dr Rachel James, who is also the Programme and Clinical Lead for the national i-THRIVE Programme. “Responsibility for our children and young people’s mental health and well-being is everyone’s business. It is crucial that diverse, cross-sector, holistic help and support is offered in meaningful and accessible ways to promote and improve children and young people’s mental health and wellbeing, and helps build resilience within local communities.”

Over the last three years, the NHS Innovation Accelerator has supported i-THRIVE to spread across the country. Adoption of the framework is already having a positive impact. In Yorkshire, an NHS trust has collaborated with young people, their families, the local authority and schools, to set up a social mediation and self-help programme that has resulted in a reported rise in confidence from the young people involved. In Camden, a school’s service delivered in collaboration with child and adolescent mental health service practitioners have helped to develop the skills of staff and parents to promote wellbeing, and has supported teachers to develop intervention plans and strategies. And in Manchester, community projects run by Unity Radio, which provide a platform to support young people, have resulted in a significant reduction in the number of missing from home incidents.

Rachel and the programme team continue to support staff in children’s services up and down the country to adopt the THRIVE Framework. “We’re thrilled that so many services are embracing the principles of the THRIVE Framework, and making it their own to meet local needs” said Rachel. Our aim is for even more services to adopt the framework and we’re continuously improving our offer to sites and our shared learning opportunities.”

To find out how THRIVE could be implemented in your services visit the i-THRIVE website or follow @iTHRIVEinfo on Twitter.

i-THRIVE is delivered through a partnership between the Anna Freud National Centre for Children and Families, the Tavistock and Portman NHS Foundation Trust, the Dartmouth Institute for Health Policy and Clinical Practice and UCLPartners.