Commissioning for wellbeing

It has been heartening to see the renewed focus from policymakers on children and young peoples’ mental health. The NHS Long-Term Plan, Ofsted school inspections that place a priority on pupils’ mental health and wellbeing, and the recent children’s commissioner for England report highlighting additional investment in school counsellors all demonstrate this strategic priority.

There is no doubt that since Future in Mind was published in 2015 there has been a step-change in our response and awareness of children and young people’s mental health and wellbeing. The strategic priority could not be clearer and is long overdue – ongoing narratives regarding long waiting times, increasing demand, and the system in general not working are a testament to that. It is going to take time to get right. However, an ongoing question for me is whether we are focusing on the right population groups?

I have recently been working with Cardiff City Council on its commissioning strategy for looked-after children and their social workers highlighted the mental health and wellbeing needs of this important group. It was very high on their list of priorities which rightly has now been reflected in the commissioning strategy.

Adults who have an experience of the care system are over-represented in mental health, substance misuse and homelessness services and live, on average, a shorter life than their peers. Evidence of the impact of adverse childhood experiences or childhood trauma are well known. This gives not just evidence but also the cost-benefit analysis for why adult and health services need to see the importance of investing in support for looked-after children. Is this not a strong example of the importance of the need for prevention and early intervention?

There is increasing evidence of psychological interventions which are seen to help. Research shows the value of mental health support including access to counselling and psychotherapy, focus on forming secure attachments, interventions such as multi-systemic therapy and foster care and residential provision working within therapeutic models. There is increasing evidence of what is needed as well as what works.

What can commissioners do to increase recognition of the needs of this group? Here are 10 questions for commissioners to consider:

1. Have you got a detailed analysis of the needs of this key group?
2. Is there a shared narrative across partners in the NHS and local government?
3. For children placed in your area, and those placed in other authorities, do you know what interventions they are receiving?
4. Is there a business case across partners showing why such investment makes sense?
5. How does the system prioritise their needs in terms of waiting times and access to interventions?
6. Do you know the funding invested in mental health support for looked-after children and how it is used?
7. Are you contract managing fostering and residential child care providers in terms of their response to mental health and wellbeing needs?
8. How are you working with schools to respond to children in care and their mental health and wellbeing needs?
9. How are the mental health and wellbeing needs of those in care reflected in NHS commissioning intentions or Children’s Strategic Plans?
10. What is in place to support the mental health and wellbeing of social work staff and foster carers?

There are examples where more joint approaches have been successful. There is a jointly funded service in Derby that has been developing a joint approach across clinical psychology, and social care staff. Most importantly, young people were actively involved in the production of the service specification and even gave the new service its name “the Keep”; a strong and safe place for them.

In this changing and improving response to mental health and wellbeing it is important we make sure that the most vulnerable, whose voice is not always heard, do not get missed. For our children and young people who are looked after we need to make sure they are heard and that we improve our response to their needs. It is time they were put at the top of the list of priorities.

• Frank McGhee is director at Commissioning4Outcomes and the former national transformation adviser for NHS England children’s mental health team, and former director of integrated commissioning, Derby City Council and Southern Derbyshire Clinical Commissioning Group