No wrong door: addressing injustices and achieving better mental healthcare provision for under-18s in acute physical healthcare settings.

Virginia Davies

doi:10.1192/bjb.2021.1

Abstract

The distressing reality that mental healthcare for children and young people in acute trust settings in the UK is woefully underprovided is not news. But with acute trust debts being written off, hospital trusts and commissioners of services have a timely opportunity to address this age- and condition-based discrimination.Delivering a just service for under-18s depends on attitude, resources and adequate knowledge of the tasks involved. This article aims to describe the current landscape, summarise the arguments for better integrating mental healthcare into physical healthcare settings, articulate the tasks involved and the challenges for commissioning and providing, and finally share examples of current service models across the country.Ultimately, commissioning and provider choices will be constrained by resource pressures, but this article aims to underscore why commissioning and providing a portmanteau 'no wrong door' hospital service for children, young people and families is worth the headache of thinking outside old commissioning and provider boxes.

Highlights

Commissioning and provider choices will be constrained by resource pressures, but this article aims to underscore why commissioning and providing a portmanteau ‘no wrong door’ hospital service for children, young people and families is worth the headache of thinking outside old commissioning and provider boxes
Commissioners and providers working within integrated care systems have two broad choices when they consider mental health provision for children, young people and families in acute trust settings: (a) an embedded, multidisciplinary children’s psychological medicine team, staffed by practitioners such as paediatric psychologists, child and adolescent psychiatrists, child mental health nurses, child psychotherapists, physical therapists and social workers, all directly employed by the acute trust and working across all settings; (b) two separate mental health teams, one employed by the mental health trust and seeing crisis/emergencies and one employed by the acute trust seeing all other patients
In an ideal world, where team boundaries are minimised, the first model is preferable. Such embedded services allow children, young people and families access to timely mental healthcare, when and where they need it, with staff versed in their physical health needs and without the long waits that currently plague access to child and adolescent mental health services (CAMHS)

Summary

Introduction

Key considerations in commissioning integrated care for children and young people Four main areas need to be considered when negotiating contracts for integrated acute trust care for under-18s: (a) the range and complexity of mental health tasks to be addressed (b) commissioning discontinuities and fragmentation between adult and child, mental and physical, local and regional/national/international services (c) funding sources for non-patient-facing activities, including staff support and professional development (d) ensuring a single ‘front door’ for children and young people and their families.

Objectives

Results

Conclusion