By Emma Burns, Elisha Jadav, Jenny Taylor
Part three of the Darzi Diagnosis, a new blog series by TPHC’s Consultancy team. Every month our experts explore an issue highlighted by Lord Ara Darzi’s independent investigation into the state of the NHS, and share how our knowledge and experience can support your efforts to improve patient care.
Lord Darzi’s review of the NHS in England provides a stark reminder of the surge in mental health needs for children and young people. Referrals to mental health services almost trebled between 2016 and 2024 from around 40,000 to almost 120,000 a year. By April 2024, there were 343,000 referrals for children and young people under 18 waiting for mental health services, including 109,000 referrals waiting for more than a year.
Waits can occur at any point in a child’s treatment, including ‘hidden waits’, which happen between a first and second, or subsequent, contacts with a service.
Supporting children and young people’s mental health
“For any person, a year wait is far too long,” Lord Darzi’s review says. “But for young people who are going through profound life changes, this is particularly concerning.”
Supporting the health of children and young people improves their chances of leading healthy, fulfilling lives. Long waits for mental health support can affect their education, relationships, and social experiences. For those already impacted by health inequalities, long waits for support increase the risk of these unfair and avoidable impacts continuing into the next generation.
Insights from young people in the Young Minds 2022 survey highlighted that over 40% waited over a month for mental health support after seeking it. It also showed that more than a quarter of young people tried to end their lives while waiting.
A two-fold approach
We have helped integrated care boards (ICBs) to take strategic steps to improve mental health services for children and young people by:
- using detailed data analysis to enable them to target community mental health services. For some this might include identifying areas of highest need and devising interventions to respond in the most effective way
- facilitating close working on prevention and community care between agencies supporting children and young people.
This work, which supports the shifts expected under national health policy, can unlock services’ ability to respond sooner and provide timely, targeted support with shorter waits, and the best care. Evidence suggests that getting early support can build emotional resilience and the capacity to cope with stress, challenges and adversity, which could help children and young people’s mental health – now and later in life.
Using data to identify levels of need and target response
Analysing data can enable ICBs to better understand existing demand and the factors that are driving long waits. It can also identify high areas of need across their services, including where unaddressed inequalities may be contributing to their backlogs.
Case study
TPHC’s Mental Health Transformation team, part of our Partnerships portfolio, led work to understand waiting times in London for children and young people, the factors driving long waits, and to explore inequalities in access for those on waiting lists.
As part of this, analysts from TPHC’s Consulting team undertook a two-phase data diagnostic, of waiting times data in London between 2019-2023. They analysed:
- waits by ICB
- the length of both initial and hidden waits across London ICBs and providers
- waits by demographic groups including ethnicity and gender
They also gathered qualitative and quantitative intelligence through an evidence review, and stakeholder interviews with 4 Week Wait Pilot sites.
Findings highlighted that factors contributing to extended waiting times included pathways, demand and capacity, workforce challenges, and inequalities.
Both phases of the data diagnostic identified longer waits for children and young people from global majority communities, males, and those waiting for neurodevelopmental services.
It identified patterns of variation among patient groups at local/borough level, informing ICBs of where targeting of services could be beneficial.
Feedback captured through the data diagnostic also included better understanding how and why we are seeing overrepresentation of some groups in the waiting times data, which should be explored further locally. Since this work, areas have submitted plans to tackle the 104 week waits, which we assume will be for neurodevelopmental services.
It also showed variation in data capture, quality and consistency. Regular data stocktakes and review will help services to record data consistently, reduce the risk of anomalies or duplication, and will support readiness to comply with the new NHS England metric for mental health waiting times.
Prevention in the community
The Darzi review calls for increased investment in the community, stating that: “Too many people end up in hospital, because too little is spent in the community.” And: “There is a fundamental problem in the distribution of resources between mental health and physical health. Mental health accounts for more than 20 per cent of the disease burden but less than 10 per cent of NHS expenditure. This is not new.’’
Investment has been signalled by the Government through the Autumn Budget, ahead of the new 10-Year Health Plan.
We have real insight into the mental health experiences of young Londoners who identify as Asian, Black or Latin American, and what they want from community mental health support thanks to the Listening Project, which our Children and Young People’s Mental Health team co-led with a number of partner organisations.
In 2022/23 the project worked with numerous partners to connect with young Londoners aged 12 to 25 to understand the impacts on their mental health of many aspects of their daily lives, including their experiences of school, their families and the police. It also asked what they would like to support their mental wellbeing.
This showed a clear need for:
- culturally sensitive services with a sufficiently ethnically diverse workforce who acknowledge and understand their racialised experiences
- long-term therapeutic relationships with practitioners who they meet in informal spaces (such as community settings)
- choice for young people over the type of professional they work with and their treatment options or interventions.
This is a quote from a young person who contributed their insights to the Listening Project:
“Services need to care and understand young people, not judge or just take the school’s point of view. To make things better, it would be good to help children more around life, not just talking but doing activities and helping them.”
Enhanced community provision for children and young people with mental health needs could include:
- the rollout of early intervention strategies, such as localised awareness campaigns, building emotional resilience by educating children and young people earlier about mental health, and about where to find support
- the expansion of early support hubs and school mental health support teams. The Children’s Society notes that: “More than two thirds of young people would prefer to be able to access mental health support without going through their GP,’’ due to concerns around the perceived stigma of asking for help, which is stronger in some communities and demographics. These services could help support those who do not reach the threshold for child and adolescent mental health services (CAMHS).
Early support and other preventative initiatives can be implemented for children and young people through multi-agency collaboration, bringing together health, housing, education, and social services. TPHC provides Thrive LDN and Good Thinking – two city-wide initiatives in London which specifically focus on good mental wellbeing.
As part of its remit, Thrive LDN produces support offers and resources for specific populations, including support for young people. This includes awareness campaigns and tailored resources such as conversation starters on mental health and wellbeing, and funding suicide prevention training in schools.
Good Thinking, which is commissioned by pan London agencies including ICBs, provides practical advice and tools to support young people to look after their mental wellbeing, as well as resources for their parents and carers.
Conclusion
We know that integrated care boards and mental health providers are committed to bringing down waiting times for children and young people and providing the best care to those who need it as quickly as possible.
With commitment and investment, the approaches explored in this blog are practical and actionable, and the enhancement of children and young people’s mental health and community services, which Darzi calls for, can be realised.
About TPHC
The TPHC team offers an in-depth understanding of the mental health landscape, and the blend of skills ICBs and providers need to address complex challenges and to deliver change.
Our team works shoulder to shoulder with organisations to plan and implement vital transformation and improvement programmes and solutions. We also provide specialised support in digital and analytics, communications and engagement. Learn more about working with us here.
Contact us to learn more about how we can draw on our extensive mental health portfolio to meet your organisation’s strategic goals and priorities.
About the authors
Emma Burns is a Senior Consultant specialising in communications. Emma supports clients with communications strategy, tactics and delivery, drawing on skills developed during her 14 years as a journalist for national papers and magazines, and 16+ years in the NHS.
Elisha Jadav is a Communications and Marketing Manager. Elisha is experienced in strategic communications, b2b content marketing, and is passionate about co-producing content with experts by experience.
Jenny Taylor is a Programme Manager in TPHC’s Mental Health Transformation team. Before joining TPHC, Jenny worked in a number of third-sector organisations supporting children and young people.