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Children and Young People's Mental Health: A Framework for Promotion, Prevention and Care

1. INTRODUCTION

1.1 Good mental health is important for a stable, secure and thriving society; it is important for learning and for sound academic and business achievements in the future. But most of all, good mental health is important for children and young people to get the most from their lives.

1.2 In the autumn of 2000, the Scottish Executive commissioned a needs assessment of the mental health of Scotland's children and young people. The resulting Scottish Needs Assessment Programme (SNAP) Report on Child and Adolescent Mental Health² was published in 2003 and was well received. This was in large part due to the meticulous review process, which involved those working in the field of children and young people's mental health and wider children's services in the development of the recommendations. In addition, and importantly, the views of children and young people themselves shaped the final document.

1.3 The report made 10 broad recommendations. Some have implications at a national level; some for local strategic planning; and others for local practice. This Framework is intended to support local practice and should be used in an inter-agency way and within the children's services planning context.

1.4 The SNAP report emphasised that all agencies and organisations have a role in supporting the mental health of children and young people. It highlighted the need to address the whole continuum of mental health - from mental health promotion, through preventing mental illness, to supporting, treating and caring for those children and young people experiencing mental health difficulties of all ranges of complexity and severity. It also suggested that mental health promotion should underpin all work with children and young people, even when they are mentally unwell and accessing specialist mental health services. This is a complex matrix which needs to take account of:

• The life stages of children and young people
• The settings/places where young people live their lives
• The range of people and organisations who come into contact with children and young people
• The continuum of mental health to mental ill-health
• Underlying principles such as inequalities, accessibility and participation

About the Framework

1.5 The Child Health Support Group (CHSG) and the Scottish Executive have been working together to promote children and young people's mental health in Scotland, and ensure better delivery of mental health services for those who need them. A Child and Adolescent Mental Health (CAMH) Development Group was established in 2002, to draw on the expertise of colleagues from NHS services, education, social work and the voluntary sector in taking this work forward. The major focus of the CAMH Development Group's work has been implementation of the recommendations made in the SNAP report, culminating in development of this Framework.

1.6 Following discussion with the Child Health Commissioners³ in August 2003, the CAMH Development Group agreed to develop a framework to assist local health, education and social work services in planning and delivering integrated approaches to children and young people's mental health across the continuum of promotion, prevention and care.

1.7 As part of the development process, over 200 delegates from a range of disciplines attended the Child Health Support Group SNAP Into Action conference in March 2004. Working in small groups, participants considered roles and interventions in a range of scenarios, all of which had a mental health element. Around 30 young people were involved in the event following a SNAP follow-up event which had been arranged specifically for young people earlier in the month.

1.8 This Framework is the result, and expands on the Child Health Support Group's original Template for Child Health Services⁴ and A Framework for Mental Health Services in Scotland.⁵ It also contributes to delivery of the National Programme for Improving Mental Health and Wellbeing⁶ Action Plan⁷. The Framework is intended to be used by local agencies as a planning and audit tool, to identify goals and milestones for continuous improvement in the delivery of services and approaches to support and improve the mental health of children and young people in Scotland.

1.9 During the development of the Framework, a separate working group has been giving detailed consideration to the size, configuration and commissioning arrangements for psychiatric inpatient services for children and young people in Scotland. The Inpatient Working Group's recommendations complement and inform this Framework, and will be presented in detail in a separate report.

1.10 In the context of the SNAP report, and recognising the significant workforce issues relating to child and adolescent mental health, the Scottish Executive has also established a Child and Adolescent Mental Health (CAMH) Workforce Group to identify ways in which to build capacity for promotion, prevention, care and treatment within the children's services workforce across a range of agencies. That Group is currently considering:

• Inpatient and intensive mental health services for children and young people
• Community based specialist mental health services for children and young people
• How to build "mental health capacity" across the network of children's services

1.11 The process involves a study of current workforce, projecting the workforce needed in the future, and modelling how that workforce can be built, offering a number of options. The CAMH Workforce Group expects to report in spring 2005. In the meantime, the Scottish Executive has already made £1m available over two years to support workforce development in children and young people's mental health. Training and development offers a positive use of short term investment to improve capacity and ensure longer term benefit. The funds are therefore being used to support:

• Children and young people's inpatient nurse training and development
• Training for those working with vulnerable children and young people
• An increase in specialist skill capacity
• Service redesign

Who is the Framework for?

1.12 Because the Framework needs to be an easily used and accessible tool, the CAMH Development Group decided to adopt a phased approach, rather than try to produce a comprehensive multi-agency document all at once. This first phase is written from an NHS perspective, defining and developing the potential contribution of the NHS to link with partners right across the spectrum of mental health promotion, prevention, treatment and care.

1.13 The document takes a broad view of the contribution of the NHS. It is about a shared vision for children and young people's mental health, and it is about joint leadership, planning and delivery. It is envisaged that the Framework will be owned and implemented through multi-agency children's service planning processes, and in the context of integrated children's services planning guidance soon to be published by the Scottish Executive. It is also anticipated that the Framework activity will have a place within the Community Planning process, within Joint Health Improvement Plans. There are proposals to work with colleagues in other agencies to develop similar frameworks to elaborate from other perspectives, such as education or social work.

How to use the Framework

1.14 This document does not set out a prescriptive formula for addressing the mental health needs of children and young people. One size does not fit all. What the Framework does is to outline the basis of a "good enough" service. Much that is described within this Framework is already happening somewhere in Scotland, and in the final document, we hope to include examples of activity drawn from contributions provided by those who respond to the consultation.

1.15 All of the elements outlined in the Framework are expected to exist within local services within 5 years.

1.16 In order to help start the implementation process, Young Minds and the Scottish Development Centre for Mental Health (SDC) have been commissioned to support local areas in using the Framework to identify what already exists, where there are gaps and what action is required.

1.17 Although this document is written from an NHS perspective, it is anticipated that it will be taken forward by the Children's Services Planning groups. Accordingly, identified action should be agreed and included within the Children's Services Plans for 2005-08.

1.18 None of the service elements, activities or partners included in the tables of this Framework are listed in any particular order of importance or priority. Lead partners are indicative only and are denoted in bold.

Achieving change

1.19 During the consultation period, the Young Minds and SDC implementation support team will work with NHS Boards and their partners to identify the steps needed to implement the Framework in their areas. Agencies should consider the resource implications of realising the Framework and funding options, including the extent to which existing funding sources - both mainstream and specific - can be used. The implementation support team will report these discussions as part of the consultation process and resource implications will be discussed further in the final document.

Monitoring

1.20 The Framework is intended as a self-assessment tool to support service planning and continuous improvement. It is not intended to be used as a monitoring tool. Planning for the delivery of effective services and approaches to meet the mental health needs of children and young people across promotion, prevention and care will be monitored through children's services plans, Joint Local Implementation Plans relating to the Mental Health (Care & Treatment) (Scotland) Act 2003, and through Joint Health Improvement Plans. The involvement of children, young people and their families should feed into the relevant planning processes. The Child Health Commissioners are expected to take the lead in ensuring this happens.

1.21 The Scottish Executive will be monitoring integrated children's services plans for each area, and these, together with annual updates, will also form part of the accountability review process for NHS Boards. The Scottish Executive will also be looking to rationalise existing quality assurance and accountability arrangements across services for children and young people. This will include new arrangements for the joint inspection of children's services.

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