• CYP services need to be provided on the same scale as the adult IAPT programme
  • The new support teams in schools are welcome but will not reach enough children fast enough
  • The breadth of access has to increase to reach more children sooner

The NHS should dramatically expand its mental health services for children and young people, as well as how the service as a whole interacts with under 18s, the Children’s Commissioner for England has told the HSJ.

Anne Longfield believes the NHS must have services across schools and communities that can detect problems and intervene early to prevent children reaching a crisis point.

She said the Department of Health and Social Care has not gone far enough with the new provisions outlined in this summer’s green paper on child mental health, though it is a welcome step in the right direction.

The government said it will spend £209m training 8,000 new mental health practitioners to work in support teams to improve links between schools and the NHS.

This will more than double the CYP mental health workforce. Longfield welcomed the greater impetus and funding but believes the support teams won’t reach enough children fast enough.

She said the scale of the challenge facing CYP mental health services demands a much larger response, equivalent to the adult Improving Access to Psychological Therapies programme.

This would need a considerable increase in funding and workforce but Ms Longfield says “that is what we have deemed as necessary for adults. I think that absolutely needs to be the same for children.”

This month HSJ revealed more than 500 children waited more than a year to access mental health treatment after referral from their GP. “Clearly it’s something everyone knows is absolutely unacceptable. That’s why I’m talking about the scale, and that’s why I’m talking about the scale of changes need of the scale of IAPT.”

The IAPT programme has been in place since 2008 with the aim of transforming adult mental health services. The NHS says nearly a million people access IAPT services each year.

She also highlighted IAPT’s national standards – for waiting times, access to services, and outcomes – as something she would want to see emulated for children.

Ultimately she said coverage has to expand: “The whole thrust in my view must be around helping as many children with low level health needs as possible, to be able to avert them from not only escalation of their difficulties but also the feeling that there is no one there unless it’s really, really serious. But that’s the scale of what’s got to change.”

Longfield is the third Children’s Commissioner, an independent role created in 2005 in the wake of the Victoria Climbié scandal. She has been in office for four years and children’s mental health is a priority of her tenure.

The office is independent of government and was founded to advocate for the rights of children and young people, especially the most vulnerable.

The commissioner gathers evidence and can request access to data from government agencies. While the office cannot force organisations to comply with its recommendations, it can be a vocal critic of government performance.

Longfield has had formal and informal conversations with health officials compiling the long term plan. She believes the work done by her office “that puts us in a place where we think we can see what needs to change.”

“There are certain things that we believe are really important to have at the heart of the 10 year plan,” she said.

It is an opportunity to transform how the NHS interacts with children and how it offers services to children and young people, she explained.

She wants to see “early help, informal, as and when it’s needed to help them get over the difficulties early on rather than leave it to escalate. 

“When you look at mental health often children say they won’t willingly go to a GP surgery, they won’t go to a specialist, because they feel that maybe they aren’t at that level of need, but also they often feel this stigma around that.”

Children tell her they want to see health professionals around schools and youth clubs, she said. Then they can “get to know those individuals and get more informal advice, rather than wait until it gets [so] serious that they then have to go and see the specialist.”

The health specialists promised in last year’s green paper are welcome, Longfield said. “The potential for them I see is enormous, my real problem with that is [that help] won’t get to enough children fast enough.

”So by the end of the five year period, it will only have got to a quarter of the areas and that really means that three quarters of children are unlikely to get that help.”

Longfield also wants to see greater integration between health and social care to better identify the most vulnerable children and families.

“We have an army of people working with children throughout their life but they’re all working on a particular aspect, in their particular professional zone, and with a particular aspect of the child’s problem. That needs to change,” she said.