In mental health services, many 16 to 17-year olds are not being treated, 18-year-olds are falling through a gap, and the needs specific to 18 to 25-year-olds aren’t being addressed. The NHS Long Term Plan is addressing this by committing to providing a comprehensive service for 0 to 25-year-olds, explains Paula Lavis, member network and policy manager at NHS Clinical Commissioners.
Imagine you are 17, you have serious mental health problems and have been on a waiting list for children and young people’s mental health services (CYPMHS) for the last year. When you finally access services, you are told they can’t help you because you are too old for children’s services and must be re-referred to adult mental health services (AMHS). You are put on another waiting list and find that despite being very ill, you can’t access specialist support because you aren’t ill enough to meet the threshold for acceptance into AMHS.
When you turn 18
Unfortunately, this isn’t a new or unusual story, but it is the reality for many 16 to 17-year olds who need specialist mental health services. Often they aren’t accepted as they wouldn’t be able to complete treatment before their 18th birthday.
The reason we have this cliff edge is because the age cut off for referral into CYPMHS is when you turn 18. Society may think of 18-year-olds as adults, but developmentally they may not be. Moving into adult services can be a big shock for some young people, especially if they aren’t ready or haven’t been prepared to make this transition.
Transferring from children and young people services to adult services
This difference between children and adult services gets played out on several different levels. For patients and their loved ones, the culture is very different: CYPMHS is very family orientated whereas AMHS focuses on the individual and can exclude families, even if the families still provide support to the young person. There is often a different commissioner for children and young people’s services, which can include mental health, and adult mental health services. The children and young people’s commissioner will commission services for young people up to their 18th birthday, and the mental health commissioner will commission services for adults, but often no-one is planning or contracting a provider to deliver mental health services to meet the specific needs of young people aged 18-25.
There is often little transitional planning and while the patients’ records will be forwarded, you often hear from young people that they have been reassessed, given a different diagnosis and treatment plan. There can also be the issue for 18-25s that staff working in AMHS may have less experience in children and young people’s mental health and working with this age group in a developmentally appropriate way. Conversely, very serious mental illnesses, such as psychosis, are rare in younger children and often first emerge in the late teens, and as a result, staff working in CYPMHS may have less experience of working with under-18s who have these mental illnesses.
Providing a more comprehensive offer
A key driver in transforming mental health services for young people is the commitment in the NHS Long Term Plan to provide a comprehensive offer for 0-25-year olds that reaches across mental health services for children and young people and adults by 2023/24. This approach should ensure that there are seamless CYPMHS so children have easier access to mental health support and young people do not fall off the ‘cliff edge’ at what can be a very vulnerable time. Of course, some people will still need to make the transition to adult mental health services at age 25, but with support most will be in a much better position to make this move than they were at 18.
Developing mental health services for 0-25s will be a challenge for many areas – this represents a radical change in the way the NHS delivers care - but we won’t be starting from scratch. There are existing NHS service models for 0-25-year olds that prove that the system can change provided it has the right support and dedication, although it’s worth remembering that one size won’t fit all, so services will need to be tailored to the local context. In addition, many voluntary sector services have been providing age-appropriate services for years. Youth, Information, Advice and Counselling (YIACS) services provide a one-stop shop approach which brings together mental health support along with sexual health, drug and alcohol support, housing advice, debt advice and other services under one roof. You may have heard of the Headspace model, which is from Australia. Well, it is based on YIACS.
What we are doing
The gap between CYPMHS and AMHS is a serious weakness in the current system. The commitment in the Long Term Plan for every area to develop comprehensive mental health services for 0-25s is a radical shift in policy and should help avoid the cliff edge in service provision. The challenge to the system is to seize this opportunity and make sure that developmentally appropriate mental health services that meet the needs of young adults as well as children and young people are fully implemented across the country.
In response to this challenge, NHS Clinical Commissioners’ Mental Health Commissioners Network is working with the Royal College of Psychiatrists and other partners, including the voluntary sector and young people, to help the system transform mental health services for 0-25s.
Paula Lavis is member network and policy manager at NHS Clinical Commissioners. Follow the network on Twitter @NHSCCPress