Child mental health services in England: a continuing crisis

Mental Health Care Reforms in Latin America: Child and Adolescent Mental Health Services in Mexico

Addressing Social Determinants of Mental Health in Pediatrics During the Coronavirus Disease 2019 Pandemic.

This study examined the efforts of states' mental health authorities to promote the use of evidence-based practices through policy. Data were drawn from three components of a national study, including a survey of state children's mental health directors (N=53), which was developed using a three-step process that involved stakeholders. Data from the directors' survey revealed that over 90% of states are implementing strategies to support the use of evidence-based practices. The scope of these efforts varies, with 36% reporting statewide reach. Further, states' strategies for implementing evidence-based practices are often not accompanied by comparable efforts to enhance information systems, even though enhancing such systems can bolster opportunities for successful implementation. Variability in the adoption of evidence-based practices, poor attention to information systems, and inconsistent fiscal policies threaten states' efforts to improve the quality of children's mental health services.

Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth.

National Health Service Child and Adolescent Mental Health Services are specialist teams that assess and treat children and young people with mental health problems. Overall, 497,502 children were referred to National Health Service Child and Adolescent Mental Health Services between 2020 and 2021, and almost one-quarter of these referrals were not successful. Unsuccessful referrals are often distressing for children and families who are turned away usually after a long waiting period and without necessarily being redirected to alternative services. The process is also costly to services because time is wasted reviewing documents about children who should have been referred for alternative help and may prevent young people who need specialist help receiving it in a timely way. The overarching aim of this study was to understand what the problems are with Child and Adolescent Mental Health Services referrals and identify solutions that could improve referral success. A key objective was to talk widely with young people and families, people working in Child and Adolescent Mental Health Services and mental health professionals so that we could understand fully what the problems were and how we might develop their solutions. We gathered individual pseudonymised patient data from nine Child and Adolescent Mental Health Services, and referral data from four National Health Service Trusts to look at what data are available and how complete it is. We report wide variation in the numbers of referrals between and within Trusts and in the proportions not being successful for treatment. Data on factors such as age and gender of children and young people referred into Child and Adolescent Mental Health Services and who made the referral are routinely collected, but ethnicity of the children and young people's reason for referral are not as well collected across all Trusts. We also conducted focus groups with over 100 individuals with differing perspectives on the Child and Adolescent Mental Health Services referral process (children and young people, parents and carers, key referrers, and Child and Adolescent Mental Health Services professionals) and asked about current difficulties within the referral process, as well as potential solutions to these. Problems identified included: confusion about what Child and Adolescent Mental Health Services is for, that is what it does and does not provide; and lack of support provided during the referral process. Possible solutions included: streamlining the referral pathways through digital technologies with accompanying standardisation of referral forms for National Health Service Child and Adolescent Mental Health Services; and early ongoing communication throughout the referral 'journey' for the referrer/family. Should consider the standardisation of and improvement to the Child and Adolescent Mental Health Services referral process following the recommendations outlined in this project. This study is registered on ClinicalTrials.gov with the identifier: NCT05412368. https://clinicaltrials.gov/study/NCT05412368. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR131379) and is published in full in Health and Social Care Delivery Research; Vol. 13, No. 21. See the NIHR Funding and Awards website for further award information.

Background: There is general consensus that child and adolescent mental health services in low- and middle-income countries have an urgent need to be strengthened. However, this require not only a universal understanding of services and service needs, but also in-depth local knowledge to inform relevant service strengthening. This study sought to explore the perspectives of senior child and adolescent mental health service providers and policy-makers in one South African province to identify strengths, weaknesses, opportunities, and threats to child and adolescent mental health services.Methods: A qualitative study was conducted with 13 purposively sampled senior child and adolescent mental health service providers, senior managers, and policy-makers from the Western Cape Province, using a half-day multi-stakeholder workshop format. Verbal and written data were recorded and coded for analysis. Two independent raters performed thematic analysis.Results: The comprehensive bio-psycho-social approach and strong specialist child and adolescent mental health service units were identified as strengths. Limited capacity, workload demands, inadequate and inequitable resource allocation, poor implementation of early detection and preventative policies, and overall neglect of child and adolescent mental health services, were identified as weaknesses. Collaborative working between child and adolescent mental health and pediatric services, and increased provincial government (Department of Health) involvement, were identified as potential opportunities to develop and strengthen child and adolescent mental health services. Silo working of agencies, societal stressors, inadequate infrastructure and other resources, and lack of dedicated funding for child and adolescent mental health, were identified as threats to the development of services.Conclusions: This analysis of strengths, weaknesses, opportunities, and threats reinforced the widespread neglect of child and adolescent mental health services in South Africa and highlighted areas for further research and advocacy. There is a clear need to explore the perspectives and experiences of service users and providers to generate comprehensive multi-stakeholder evidence that may identify positive "tipping points" for improvements and strengthening of child and adolescent mental health service delivery, training, and research.

Autistic children and young people are at increased risk of mental health difficulties, but often face barriers when seeking help from Child and Adolescent Mental Health Services. This study aimed to (1) explore the experiences of parents/carers seeking help from Child and Adolescent Mental Health Services for their autistic child’s mental health difficulties, and (2) gain parents’ perceptions of the accessibility of Child and Adolescent Mental Health Services for their child. A mixed-methods survey design was used. In total, 300 parents/carers took part from across the United Kingdom. Quantitative data were analysed using descriptive statistics, and qualitative data using qualitative content analysis. Findings demonstrated ongoing struggles that parents/carers faced when seeking help from Child and Adolescent Mental Health Services. Those who were referred reported a lack of reasonable adjustments and offers of ineffective or inappropriate therapies. Ultimately, parents felt their child’s mental health difficulties either did not improve or declined to the point of crisis. However, there was a recognition that some professionals were kind and compassionate. There is a need for a more neuro-inclusive and personalised approach in Child and Adolescent Mental Health Services. Further research, funding and training are urgently needed to ensure support is accessible, timely and effective for autistic young people.Lay abstractAutistic children and young people are more likely to experience mental health difficulties than neurotypical peers, but also face more barriers when seeking help from Child and Adolescent Mental Health Services. Findings highlight the need for a more neuroaffirmative approach from the professionals themselves, in the adjustments offered, and in the therapies provided. Barriers to Child and Adolescent Mental Health Services for autistic children and young people include diagnostic overshadowing (i.e. assuming mental health difficulties are part of autism), high thresholds for assessment and a lack of professional knowledge about autism and care pathways. Healthcare policies should ensure that all Child and Adolescent Mental Health Services professionals receive neuroaffirmative training and that resources/funding are provided for appropriate adjustments and early support. There is also a need for further research and funding to develop and evaluate effective neuroaffirmative therapeutic interventions.

Politics on the mind: assessing the state of mental health after the election

This study examined the relationship of age and gender with risk of arrest among adolescents and young adults who were intensive adolescent users of public mental health services. Data were obtained from the Massachusetts Department of Mental Health (DMH) and juvenile and criminal courts. Participants were youths receiving DMH adolescent case management services sometime in 1994-1996 who were born between 1976 and 1979 (781 males and 738 females). They were cross-matched to document arrests between age seven and 25. The study examined age at first arrest, age-specific risk, and the relationship between arrest history and arrest risk by gender and age. Most males (69%) and almost half the females (46%) were arrested by age 25. First arrest was most common before age 18. As in the general population, males' arrest patterns were more concerning than those of females, although patterns were of concern in both groups. Most female arrestees had multiple arrests, many as adults. No gender differences were observed for several factors, including risk of first arrest over age 18. Risk was far greater for those arrested in the previous year than for those never arrested. Findings justify concerns of public mental health systems regarding justice system involvement of adolescent clients. Risk of first arrest was significant from early adolescence through age 24, indicating a need for arrest prevention into young adulthood. The heightened arrest risk at all ages among those who were recently arrested demarcates a population in need of immediate intervention.

Treatment Intensity in Child and Adolescent Mental Health Services and Health Care Reform in Norway, 1998–2006

Mental health problems are one of the most pressing public health concerns of our time. Sweden has seen a sharp increase in mental disorders among children and youth during the last decade. The evidence base for treatment of psychiatric conditions has developed strongly. Clinical practice guidelines aim to compile such evidence and support healthcare professionals in evidence-based clinical decision-making. In Sweden, the national guidelines for the treatment of depression and anxiety disorders in children and adolescents were launched in 2010. The aim of this study was two folded, (i) to explore to what extent these guidelines were known and adhered to by health professionals in Child and Adolescent Mental Health Services and (ii) to investigate factors influencing implementation of the guidelines informed by the Consolidated Framework for Implementation Research. A qualitative approach was used, and data were collected through interviews with 18 health professionals in Child Mental Health Services in Sweden and a combination of conventional and directed content analyses was used. The Consolidated Framework for Implementation Research guided and structured data collection and analysis. The guidelines were largely unknown by health professionals in Child Mental Health Services in all the clinics investigated. Adherence to guideline recommendations was reported as very low. Barriers to implementation were found in relation to the characteristics of the intervention, outer setting, inner setting and characteristics of the individuals involved. The government initiative to develop and disseminate the guidelines seems to have made very little impact on health professionals' clinical practice. The guidelines were poorly aligned with the health professionals' knowledge and beliefs about effective mental health services for children and youth with depression and anxiety disorders. Suggestions for future efforts to improve the development and implementation of guidelines in Child Mental Health Services settings are given.

Ringeisen, Henderson, and Hoagwood 2003) have provided an important discussion of the significance of school context to children's mental health, particularly in relation to empirically supported interventions. They have outlined the influence of context on treatment integrity, and have emphasized appropriately the significant gap between research-supported interventions and practice. Finally, they have proposed a useful heuristic for conceptualizing context and practice from the individual to the organizational to the policy level. Their conclusion is that school context is a critical mediator in both research and practice, one that must be addressed to ensure successful children's mental health services. Although Ringeisen et al. (2003) deal with children's mental health and the school context thoroughly, they address the relationship between children's mental health and school psychology practice in somewhat less detail. In this commentary, I will examine some implications for school psychology practice of moving to a contextual perspective in children's mental health services, as outlined by Ringesein et al. School psychology is the specialty in American professional psychology that is most closely aligned with current, population-based thinking about children's mental health. However, to respond effectively to recent children's mental health policy, school psychology may need to expand the way services are conceptualized, planned, and delivered. Children's mental health is important to schools. As Ringeisen et al. (2003) note, relatively little systematic attention has been given to the effect of children's social and emotional problems on immediate educational outcomes, such as academic achievement. However, broader and longer term implications of children's mental health problems seem clear: Children with social and emotional problems are at much greater risk for dropping out of school and of subsequent problems in adulthood. Children with such problems often have difficulties with peer relationships, may present discipline problems, and often are disengaged from schooling and academic pursuits. They exhibit a higher incidence of family difficulties, which has a further impact on school functioning, and often have fewer resources available to them in the community. Even in the absence of data on the effects of social and emotional problems on short term educational outcomes, the cost to schools and society of failing to deal with these children is obviously--and distressingly--high (Short & Shapiro, 1993). Historically, American schools, as a context for addressing children's mental health problems, have maintained a reactive, often negative stance. Students in the United States are expected to conform to school roles and expectations; failing that, they typically either have been excluded from school or referred for clinical educational or mental health services. Exclusion from school merely relocates the child while depriving him or her of educational supports and services. On the other hand, clinical services are expensive, require substantial additional expertise and resources, and typically define problems as residing within the child, and therefore may fail to address critical contextual contributors to child problems. And, as Ringeisen et al. (2003) accurately point out, add-on program and resource requirements may have caused schools to be less willing to deal with children with social and emotional problems. The recent report of the Surgeon General's Conference on Children's Mental Health (U.S. Public Health Service, 2000) has provided an important framework that schools and school psychologists may use to build context-sensitive mental health services. Important components of this framework include: (a) All children develop socially and emotionally, as well as cognitively, and therefore have social and emotional needs that are as important as educational needs; (b) beyond the social and emotional developmental needs of all children, a smaller group of children have serious social and emotional problems; (c) addressing the social and emotional development and needs of all children likely lowers the incidence of children with expensive and difficult-to-treat social and emotional problems; and (d) schools are crucial both in addressing the social and emotional needs of all children and in providing services to that smaller group of children with social and emotional problems. …

Supporting youth mental health during the COVID-19 pandemic.

PurposeThis paper provides an overview of transitions across forensic child and adolescent mental health services in England and Wales. The purpose of this paper is to delineate the national secure services system for young people in contact with the youth justice system.Design/methodology/approachThis paper reviews findings from the existing literature of transitions across forensic child and adolescent mental health services, drawing attention to present facilitators and barriers to optimal transition. The authors examine the infrastructure of current services and highlight gaps between child and adult service continuity and evaluate the impact of poor transitions on young offenders’ mental health and wellbeing.FindingsYoung offenders experience a broad range of difficulties, from the multiple interfaces with the legal system, untreated mental health problems, and poor transition to adult services. Barriers such as long waiting lists, lack of coordination between services and lack of transition preparation impede significantly smooth transitions.Research limitations/implicationsThe authors need to develop, test and evaluate models of transitional care that improve mental health and wellbeing of this group.Practical implicationsMapping young offenders’ care pathway will help to understand their needs and also to impact current policy and practice. Key workers in forensic services should facilitate the transition process by developing sustainable relationships with the young person and creating a safe clinical environment.Originality/valueTransition of care from forensic child and adolescent mental health services is a neglected area. This paper attempts to highlight the nature and magnitude of the problems at the transition interface in a forensic context.

AimTo provide an understanding of the factors that discouraged staff members from using a new web‐based platform (CAMHSweb) with young people in a child and adolescent mental health service (CAMHS). Although evidence‐based service improvement technology like CAMHSweb is becoming more common in child mental health, the staff‐level barriers to the use of web‐based platforms have not been explored in depth in the literature.MethodSemi‐structured interviews with six employees were carried out in a London‐based child mental health service that a preliminary audit had identified as having a poor utilisation of the platform. All participants had previously been invited to use the platform as part of their clinical work. Results were analysed using thematic analysis (Braun and Clarke, 2006).FindingsThree overarching themes covered staff's practical, personal and philosophical barriers to implementation. Interviewees believed that CAMHSweb was too challenging to implement, that it was not an asset to therapists, and that it interfered with the therapeutic process.Discussion and ImplicationsThese findings provide a nuanced understanding of the multiple factors that may discourage clinicians from using web‐based platforms. This may have implications for researchers or practitioners who aim to design or implement technology in child mental health services.