Towards a Cohesive Whole Report
We are witnessing a mental health crisis among children and young people in England
Over the last decade, there has been a concerning rise in the number of young people suffering with mental health disorders in England.
Data from NHS England reveals that one in five children and young people (CYP) aged eight to 25 had a probable mental health disorder in 2023.
The Children’s Commissioner reports that there are around 1.4 million CYP in England today living with a mental health disorder. The number rose during and after the pandemic. Whereas it has stabilised over the past few years and access to services has increased, the health system continues to struggle to keep pace with demand, leaving many young people without support.
Overwhelmed systems have led to a treatment gap in children’s mental health services with almost half of children and young people’s mental health needs remaining unmet. This has severe consequences for young people, their families, and communities, now and in the future.
We are calling for a bold strategy to transform services by 2030 so no child or young person ends up receiving treatment in a hospital when they could be receiving treatment in the community.
Why we need a whole-system approach to care for children and young people
The government’s existing pledges around children and young people’s mental health show that it recognises the seriousness of the youth mental health crisis.
This report sets out how the government can build on these commitments and the progress made in recent years to close the treatment gap and keep more children and young people out of hospital.
By fully implementing a whole-system approach to community care for children and young people, the government can:
- reduce the immediate pressure on the NHS by providing the right support at the right time
- support better life outcomes
- prevent the escalation of mental health issues, which in turn will reduce the long-term burden on the healthcare system.
This report breaks down the treatment gap by focusing on three cohorts
- Young people stuck on waiting lists: Children and young people who wait for long periods to get support from Child and Adolescent Mental Health Services (CAMHS).
- The missing middle: Children and young people who do not meet the eligibility threshold for CAMHS but whose needs are too complex for school-based support or early access hubs.
- Young people who disengage during the transition to adult’s services: Young people who discontinue their care against clinical advice during or soon after their transition to adult mental health services.
Seven key principles for whole-system approach
Preventative
Developmentally appropriate and needs-based support focused on prevention and
earlier intervention is essential for addressing the development and escalation of
mental health needs before these persist into adulthood.
Integrated and partnership-led
Strong collaboration across sectors, such as education, health, and the voluntary,
community and social enterprise (VCSE) organisations, ensuring a holistic approach
is taken to supporting children and young people’s mental health.
Co-produced
Engaging children, young people, and their families in service design can ensure
that mental health support is responsive, culturally sensitive, and shaped by lived
experience.
Accountable
Clear policy goals and accountability mechanisms guide service delivery, ensuring
that local services meet the government’s mental health ambitions for children and
young people.
Non-stigmatising
Accessible, non-stigmatising routes into support ensure that children, young people,
and their families feel comfortable and are not discouraged from engaging with
mental health services.
Comprehensive and sustainably resourced
Sustainable funding and targeted support are essential for bridging gaps between
services, providing continuity of care and preventing disengagement, particularly
during transitions.
Evidence-based and data-driven
An effective whole-system approach relies on shared data, integrated information
systems, and robust research to improve service planning and treatment outcomes
for children and young people.
What needs to happen in the future?
The government’s plans to expand mental health support in schools and open early access hubs are positive steps towards closing the treatment gap. These programmes will be essential pieces of an integrated mental health system where all providers work together effectively, and no young person misses out on support.
A long-term strategy
A long-term strategy for children and young people’s mental health which takes a whole system approach, prioritising service integration and effective collaboration between NHS and the VCSE sector. This should begin with piloting trailblazer sites to develop the evidence base.
Resource
Dedicated annual transformation or integration funding for CYP mental health services mirroring what has been provided to support the Community Mental Health Transformation for adults and older adults.
Continuous learning
Continued efforts to monitor and learn from past and current transformation initiatives for both adults and CYP to support a whole-system approach to care for children and young people.
For further information on this report, please contact info@rethink.org.