A long-term plan to thrive

7 January 2019

For years we’ve sought parity of access to quality care for physical and mental health conditions. But a goal without a plan is just a wish, and as such today’s (Monday, January 7) release of the long-term plan for the NHS is something to be greeted with cautious enthusiasm. 

Young people sitting on a bench

The plan makes a commitment to a major increase in investment in mental health services rising to at least £2.3 billion a year by 2023/24. The plan also pledges to give mental health help to 345,000 more children and young people through the expansion of community-based services, including in schools.

This news follows the recent ‘Trailblazer’ announcement, where, amongst other successful sites, NHS England awarded Camden Clinical Commissioning Group funding for a collaboration between Camden Council, Camden CCG, and our Trust. This scheme is the pilot phase of the implementation of the Government’s CAMHS Green Paper which the Trust, alongside our Camden partners, was able to input into based on the evidence of the longstanding work we have delivered in Camden schools.

Building on our established CAMHS school service, new Mental Health Support Teams (MHST) will support young people with mild to moderate mental health difficulties as well as vulnerable groups at increased risk of developing mental health problems. There will be two MHSTs, each covering 15 primary and secondary schools across Camden.

The long-term plan will also see around two million more people who suffer anxiety, depression or other problems receive help over the next decade. We know that 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, but funding constraints and disjointed mental health services for children and young people have led to damning criticism.

It’s hoped the extra funding attached to the long-term plan will go some way to making much needed 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?

One answer is THRIVE, a conceptual framework for Child and Adolescent Mental Health developed by a collaboration of authors from the Anna Freud National Centre for Children and Families and the Tavistock and Portman NHS Foundation Trust and highlighted in the Long-Term Plan. The THRIVE framework is an integrated, person centred, and needs led approach to delivering mental health services for children, young people and their families. It conceptualises need in five categories; Thriving, Getting Advice and Signposting, Getting Help, Getting More Help and Getting Risk Support.

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. The programme has been part of our delivery of CAMHS services in Camden and has had a clear positive impact on outcomes and the use of resources.

There are other important challenges in implementing the plan not least about workforce with some estimates that we will require an additional 8,000 staff working in CAMHS services to meet the new ambitions. There is a real opportunity, however, to harness the lifting of stigma and the change in public attitudes towards mental health problems to help attract young people to careers in mental health.

A plan is just that until there is action to implement it but, nonetheless, today’s announcement feels like an important milestone in the efforts to improve the mental health of young people in England.

– Paul Jenkins, Chief Executive, Tavistock and Portman NHS Foundation Trust

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