This is HSJ’s fortnightly briefing covering quality, performance and finances in the mental health sector.

Feedback and comments are welcome, so please feel free to email me in confidence.

Green paper unveiled

The much anticipated green paper of children and young people’s mental health services – first promised by prime minister Theresa May back in Janaury – is to be published on Monday, 4 December.

The main announcements will not be new to people in the sector, having been leaked to the The Guardian a week ago, but the headline figure is that the government is pledging an extra £300m for children’s mental health.

This breaks down to:

  • £95m to train senior designated health leads in every school and college in England; and
  • £209m to create new mental health support teams to improve links between schools and the NHS.

The government has not yet said whether the funding is recurrent or one-off.

The announcement also pledges the piloting of a new four week waiting time for children and young people to access NHS mental health services.

On the face of it this is good news.

Having a designated lead in every school and college should help provide young people with the information necessary to access the support services they need. Likewise, mental health support teams will offer early interventions such as cognitive behavioural therapy to pupils before their conditions get serious enough to need more expensive NHS treatment.

More questions than answers

But the initial announcement raises more questions than it answers for mental health leaders both in the NHS and in the wider sector.

The first is where the cash for these schemes is going to come from? There was no mention of an extra £300m for CAMHS in the budget so it is reasonable to suspect that it is not new money.

Some cash might rightly come from the Department for Education, but with potentially thousands of mental health support team members expected to be recruited and trained in evidence-based interventions such as CBT, it is likely a lot of this cash will come from within the NHS.

But more importantly the briefing from the government does not address how a new child and adolescent mental health services waiting time target will be funded. More access to services usually equals more cost. How will it be met? We don’t know.

The leak to the The Guardian suggested the “key proposal” of the green paper would be this new four-week access target for children and young people with depression and anxiety.

Clearly, it seemed important to whoever was briefing the Guardian.

So it is interesting that it barely figures in the government’s press release except for a throwaway bullet point about piloting this target. No mention of where, when, how? 

Another battle line 

As colleagues have already pointed out, battle lines are being drawn between the government and the NHS on funding. This applies to CAMHS as much as emergency and elective waiting times.

While no mental health leader has denied the need for a new CAMHS access target, they have privately raised serious concerns about trying to implement one without new resources – be they cash or workforce.

On the other hand, Jeremy Hunt is said to be very keen to introduce a new target for CAMHS.

The fact that the green paper is pledging pilots shows that a compromise has been reached. HSJ has been told that this argument went right down to the wire. The lack of details means we don’t yet know who has compromised the most.

Show me the money!

In their negotiations with the government, NHS leaders have been emphatic about the CAMHS target – there can be no new target without new money.

As well as funding, there is also a recruitment question - the sector already has very ambitious plans to expand the workforce but a new CAMHS target could add additional pressure to an already stretched service.

What remains a mystery is whether there will be any new investment for the CAMHS pilots, and if so, who is picking up the bill – there is nothing about it in the briefings so far.

The green paper will be published on 4 December, before 12 weeks of consultation – so there will be plenty of opportunity to scrutinise these plans further.