Service provision

Service provision

National picture

There has been a significant rise in demand for mental health services for children and young people, which has not been matched by increases in service provision (House of Commons Committee, 2021).

  • Pre-pandemic, around 60% of children and young people who had a mental health condition were not accessing mental health support (Health and Social Care Committee, 2021).
  • There are substantial delays between when people first display the symptoms of poor mental health and starting treatment: this ranges from 6-8 years in mood disorders, 6 years in bipolar disorder and between 9 to 23 years for anxiety disorders (Fusar-Poli, 2019).
  • High access thresholds and long waiting times for services mean that many young people’s mental health problems escalate to the point of crisis (Care Quality Commission, 2018a).
    • In 2021-22, the average time spent waiting after being referred to specialist mental health services and receiving treatment in England increased to 40 days, from 32 days in 2020-21 (Children’s Commissioner, 2023a).
    • Around 1 in 4 children who were referred to services in 2020/21 did not get accepted at all (their referrals were closed before treatment) (Children’s Commissioner, 2023b).
  • There are ‘unsustainable’ staff shortfalls in many mental health services (Health and Social Care Committee, 2021), and staff shortages are a major barrier to improving and expanding mental health services. During 2021-22, 17,000 staff (12%) left the NHS mental health workforce, up from 13,000 (9%) a year earlier (Department of Health & Social Care, 2023).
  • There are too many children and young people in inpatient units subject to inappropriate care; including care that is far from home and involves restrictive interventions, the experiences of which are often traumatic (Health and Social Care Committee, 2021).

Local picture

Local service provision can be understood through the THRIVE framework, which was introduced in Cambridgeshire and Peterborough in 2015, to replace the tiered model of mental health services (i-THRIVE, 2023). This person-centred and needs-led approach was developed by the Anna Freud National Centre for Children and Families and the Tavistock and Portman NHS Foundation Trust.

Figure 33: Services available for children and young people in Cambridgeshire and Peterborough. Image source: Mapping spend across children and young people’s mental health services Cambridgeshire and Peterborough 

The Mental Health and Wellbeing Pre-birth to Age 25 years Needs Assessment (2019) included a mapping of services in Cambridgeshire and Peterborough supporting children and young people’s mental health. The Cambridgeshire and Peterborough’s children and young people’s mental health strategy 2022 – 2025 (2022-2025) built on this analysing service data from:

  • Health services: YOUnited, Child and Adolescent Mental Health Services, the First Response Service, Emotional Health and Wellbeing Service, Adult Mental Health Services and adult inpatient data.
  • Local authority services: Early Help.
  • Voluntary and Community sector services: Blue Smile, Centre 33, Choices Counselling, CPSL Mind, Kooth.com, Ormiston Families, Romsey Mill, Talk to Stars, Turtle Dove Cambridge, YMCA Trinity Group and Young People’s Counselling Service.

How are local services performing?

A review carried out by the Children’s Commissioner, published in 2023, explored how each Clinical Commissioning Group (CCG) in England compared in terms of children’s access to mental health services (Children’s Commissioner, 2023b). Cambridgeshire and Peterborough CCG was ranked as the 21st worst performing by overall score, out of 106 CCGs. The per child spend on mental health support was particularly low compared to other areas.

Table 16: Scoring of NHS Cambridgeshire and Peterborough CCG children’s mental health services in the 2021/22 financial year. Adapted from: Children’s mental health services 2021-2022

Scores were based on (Children’s Commissioner, 2023b):

  1. ‘Mental health spend per child – calculated using NHS Five Year Forward View for Mental Health spending figures and Office for National Statistics population estimates for Clinical Commissioning Group areas (where higher spend per child corresponds with a higher score)
  2. CCG spending on children’s mental health as a percentage of a CCG’s total allocation (where higher spending corresponds with a higher score)
  3. Average waiting time for children who receive a second contact with services (where lower average waiting times corresponds with a higher score)
  4. Total number of children referred to children’s mental health services as a proportion of the under-18 population (where higher shares of children referred corresponds with a higher score)
  5. The percentage of referrals that are closed before treatment (where a lower percentage of referrals closed corresponds with a higher score)

For each indicator, CCGs were ranked from best to worst and assigned to 5 quintiles. Scores are then given to each CCG based on their quintile group, with the best performing 20% of CCGs being given a score of 5 while the worst performers are given a score of 1. We then add these quintile scores together to form an overall score ranging from a minimum of 5 (worst) to a maximum of 25 (best) for each CCG. An overall score of 5 would indicate being in the bottom quintile across all 5 measures while a score of 25 would indicate being in the top quintile across all measures. Greater weight was given to spending in the overall measure by using two spending indicators to compensate for the fact that some CCGs will have invested in lower-level MH services that will not necessarily be reflected in the number of children referred, average waiting times or percentage of referrals closed.’ – Taken from Children’s mental health services 2021-2022

Additional resources

References

Full list of references is included at the end of this chapter.

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