Just six per cent of the NHS mental health budget is spent on child and adolescent mental health services (CAMHS). So the commitment in the government's NHS Long Term Plan to "grow" funding for CAMHS faster than any other area has been welcomed by the children and young people's sector.
The plan, launched last month, promises to ringfence £2.3bn each year for wider mental health services in an attempt to deliver on the government's pledge to support an additional 345,000 children and young people through communiy-based services.
The plan states that between the ages of five and 15, "one in every nine children has a mental disorder". Yet, as of 2017/18, fewer than a third of young people in this group were estimated to have accessed help.
It sets a bold goal "to ensure that 100 per cent of children and young people who need specialist care can access it". As of 2017/18, 30 per cent of children accessed help compared to 25 per cent two years earlier, according to the long-term plan.
The scale of the task ahead was emphasised in a recent report by the public accounts committee, which concluded that the government has "no comprehensive, long-term plan" for how it will fulfil its commitment to implement its 2015 Future in Mind strategy.
While the CAMHS section of the plan spans just two pages of the 136-page document, it is packed with ambition for boosting crisis support, community-based services, transition to adulthood, eating disorders and joint working between agencies.
Here is a summary of the key actions NHS England aims to take over the next decade to deliver the plan's ambitions, along with reaction from sector leaders.
Crisis support
Through NHS 111, all children and young people experiencing a mental health crisis will be able to access care 24 hours a day, seven days a week.
Emma Thomas, chief executive of charity YoungMinds, which already runs a crisis helpline, says the moves would make a "huge difference" to young people. However, she wants assurances that pledges on improving community crisis support mentioned elsewhere in the plan will apply to children and young people.
"We often hear from young people who have gone to accident and emergency because they don't know where else to turn - it can be a crowded and stressful environment for young people going through a crisis," says Thomas.
"We welcome the proposals and seek assurances that the community-based crisis service will also support all ages, providing vital crisis services for young people."
Community-based services
The plan states that the government will expand access of mental health support in schools to reach a further 345,000 children and young people by 2023/24. This would be done largely through school- or college-based mental health support teams, which will be trialled in 20 schools in 25 areas later this year. The plan aims to test new approaches outside of education settings and aims to deliver four-week waiting times ahead of new standards.
Charity Place2Be, which provides school-based wellbeing services, aims to work closely with the support teams, which were first unveiled in the 2017 children's mental health government green paper and are backed with £215m of funding from the departments of health and education.
Dr Patrick Johnston, Place2Be director of learning and practice, says he is looking forward to seeing the action plans translate across the 25 trailblazers.
"Currently, each area will be thinking how best to deliver their plans, providing the best impact for their children, young people and families," he says.
"There will be variations in how this is delivered across the country and we hope that a collaborative approach will be used, with sharing of best practice as evidence is built."
James Kenrick, chief executive of counselling charity Youth Access, is calling for a redesign of community-based services that are led by young people.
He says: "We welcome the commitment to scale up the level of community-based support available to young people, but this will need to be accompanied by a radical redesign of services, led by young people, if it is to lead to the young person-centred, early intervention and prevention approach that is required."
According to the plan, the teams would be trained specifically in the support needs of young people at most risk of developing mental health issues - such as lesbian, gay, bisexual, transgender (LGBT+) young people or children in care.
There are also plans to develop services to help 6,000 children and young people with complex trauma, who are not reaching the attention of Sexual Assault Referral Services.
Transition to adulthood
The plan promises a "comprehensive offer for nought to 25-year-olds that reaches across" children and adult services to remove existing barriers between the two.
To address this, the "iThrive" approach - a framework used to integrate health, social care, education and voluntary sector support for children and young people aged under 18 - will be extended to under-25s.
Matthew Reed, chief executive of The Children's Society, which runs the Pause transition service in Birmingham, welcomes the pledge, but cautions: "We want NHS England to look carefully at how this help can be rolled out effectively, including providing evidence about what works and support for local services to put this into practice.
"This should be a key task for the Children and Young People's Transformation Programme which demonstrates NHS England's commitment to driving forward real change for young people. Otherwise, we risk a postcode lottery, meaning it could be years before all vulnerable young people get the support they deserve."
Youth Access' Kenrick adds: "NHS England seems genuinely committed to delivering change for young adults at last, but there's a lot of work ahead to thrash out the details and embed that change across the system.
"Local commissioners will need to embrace a bigger role for youth information, advice and counselling services, and other voluntary sector providers if the laudable ambitions in the plan are to be achieved."
Eating disorders
Over the next five years, the plan promises to boost investment in children and young people's eating disorder services as demand rises.
This would maintain delivery beyond 2020/21, of the 95 per cent standard for children and young people to access treatment within one week of assessment.
It claims that the NHS is "on track" to meet the standard by then, and adds: "Four-fifths of children and young people with an eating disorder now receive treatment within one week in urgent cases and four weeks for non-urgent cases."
Andrew Radford, chief executive of eating disorders charity Beat, welcomed the extra investment.
"The progress that has been made on reducing waiting times for children and young people with these devastating illnesses must be maintained, and the extra investment should address the postcode lottery that still exists," adds Radford. "To achieve this, it is vital the money goes to frontline services where it's most needed."
Joint working
Local government is acknowledged as having an important role in funding and commissioning preventative health services such as sexual health and support for children via school nursing and health visitors.
The plan says the government and the NHS will consider a possible "stronger role" for the NHS in commissioning services, and what best future arrangements might be.
Closer working across all agencies is vital, says The Children's Society's Reed. While he welcomes the detail on how mental health services will work with schools, he warns that "the plan does not include a strong vision" for connecting the NHS and social care.
He says: "If the government truly wants to see improvements for children, it must urgently address the problems facing children's social care because all partners will need to play their part if the plan is to prove a success.
"That includes the voluntary sector and we look forward to working with local clinical commission groups to help make this happen."
The Local Government Association says that the plan "could go further to recognise the wider role that local government and other services play in delivering the Healthy Child Programme, and influencing the health of children and young people more widely".
The statement adds: "It is vital that the NHS and local government develop a system-wide approach to workforce planning and that the impact of changes to the NHS workforce on the social care workforce is considered."
OTHER MEASURES IN THE NHS LONG TERM PLAN
Young families and maternity:
- An expansion of the Saving Babies Lives Care Bundle that focuses on preventing pre-term birth, including encouraging development of specialist birth clinics to care for women with heightened risk, including younger mothers and those from deprived backgrounds.
- Establish 20 community hubs that work closely with councils to bring together perinatal care, mental health, specialist and health visiting services.
Learning disabilities and autism:
- Introduce hearing, sight and dental checks to residential special schools.
- Test and implement the most effective ways to reduce waiting times for specialist mental health services for children with autism.
- Jointly develop packages to support children with autism or other neurodevelopmental disorders and their families throughout the diagnostic process.
- By 2023/24, children with a learning disability, autism or both with the most complex needs will have a designated key worker, initially to support those at risk of being admitted to hospital.
- Reduce the number of children with a learning disability, autism or both, cared for in an inpatient facility.
Other health services:
- Increase funding from £11m up to a combined total of £25m a year by 2023/24 for children's palliative care.
- Create a Children and Young People's Transformation Programme to oversee the delivery of the plan.
- From 2019/20, clinical networks will be rolled out to improve care for children with long-term conditions such as asthma, epilepsy and diabetes.
