Spotlight falls on forgotten age group

Mental health experts agree that a shake-up of the mental health
system is desperately needed to provide more and improved services
to children and adolescents. But while there is hope for children’s
mental health needs being better served by a mental health section
in the forthcoming national service framework (NSF), there is no
immediate prospect for adolescents, who often fall through the gap
between children’s and adult services.

This week, mental health charity YoungMinds, and Youth Access,
which is the association for young people’s information, advice,
counselling and support services (Yiacs), each launched a strategy
focusing on this “forgotten” client group.

YoungMinds identifies several problems affecting adolescents’
access to services. It claims that services for adolescents have
rarely been specified and actively commissioned, with the result
that staff in children and adults’ mental health services often
feel ill-equipped and under-resourced to work with the age group.

The charity explains that the age cut-off point for children and
adolescent mental health services (CAMHS) varies in different
services across the country. It can be at 14,16 or 19 years, with
few services dealing adequately with the 16-21 age group. Some
young people referred after their 14th birthday may need services
that continue until they are beyond the age range and, because of
this, specialist CAMHS may not take them on.

In response to these difficulties, YoungMinds has devised a
strategy aimed at creating a “seamless” service that carries young
people through into adult mental health services. It suggests the
creation, locally, of a “virtual team” for adolescents made up of
professionals from both the specialist CAMHS and the adult mental
health services. The team’s work should be accountable to the
commissioning authority, which in turn should be required to
demonstrate it is meeting the needs of adolescents to the
government.

As the professionals would be part of the CAMHS and adult mental
health service, the young person could move across the service
boundaries while continuing to receive appropriate care.

Peter Wilson, director of YoungMinds, says that one of the problems
with the current framework is that boundaries between children and
adult services are too rigid.

“It’s been almost a part of history that services for adolescents,
particularly late adolescents, have been under-funded,
under-resourced and under thought out. We are concerned that
vulnerable young people get to an age where child services are not
available, particularly in CAMHS, and adult-trained mental health
specialists are not tuned in,” he explains.

However, he says it is not realistic to set up a brand new service
for adolescents. The benefit of the proposed virtual team would be
that it uses existing resources within mental health and
counselling services.

YoungMinds is hoping to interest primary care trusts (PCTs) in the
strategy. Wilson explains: “We are going to have to convince PCTs,
which are now in charge of commissioning services, to recognise
this problem. There needs to be a clinical lead within any PCT to
ensure that the needs of children and adolescents are thought
about.”

The strategy raises the problem of young people’s access to
specialist mental health services, and suggests that access needs
to be possible from several places and professionals, including
self-referral.

David Joannides, Dorset’s social services director, believes that
widening the referral process is the correct way forward, provided
some restrictions remain in place.

“We have to move away from some of the traditional obstacles to
referring. We need to develop more open door services where it is
possible for others to refer but where there are still some
safeguards,” he explains.

Another part of the strategy considers the setting of this
specialist service. It states that it should not be constrained by
existing outpatient arrangements, but could be more appropriate if
it was delivered in the community at a youth club or at home.

Joannides, also the lead on mental health issues for the
Association of Directors of Social Services, believes that
delivering services in more acceptable settings is the right
approach, adding that it can be necessary to take services to
people rather than the other way around.

‘Breaking Down the Barriers’, the strategy compiled by Youth
Access, identifies eight immediate priorities. These include an
insistence that the NSF for mental health and for children should
address the specific mental health needs of young people and adults
aged 16 to 25, and also that a funding stream must be identified to
“support and nurture” young adults’ mental health.

Catherine Wilson, the strategy’s author and Youth Access’s national
development manager for mental health, says that some Yiacs have
been complaining that they are struggling to get funding. There are
also problems with child/adolescent and adult mental health
services, which only accept referrals from GPs.

“When people tried to refer to child and adolescent services or
adult mental health services there either wasn’t the service in the
area or they wouldn’t recognise the assessment process,” she
explains.

The requirement for the young person to go to the GP in order to be
referred has resulted in many falling through the net. Most Yiacs
feel they are bridging the gap in services, often having to work
with clients despite not necessarily being the best service for
their needs.

“We hope this strategy will raise awareness of 16-25 year olds’
mental health needs, and provide evidence to build and expand
existing counselling services,” she says.

Youth Access hopes to gain cross-departmental government support
for young people’s counselling services, and copies of the strategy
are being sent to ministers and the mental health tsar, Louis
Appleby.

One part of the strategy proposes improving access to services for
young people in rural areas through improvement in transport
schemes and mobile counselling services. Andrew McCulloch, director
of policy at the Sainsbury Centre for Mental Health, says that the
postcode lottery is a fundamental issue that hampers fair
distribution of services.

“If you live in some parts of London or Birmingham you can access a
range of child and adolescent mental health services. If you live
in rural areas outside the catchment areas then you’ll find it
extremely difficult to access services,” he says.

There can be little doubt that mental health services for
adolescents have been neglected for too long. The publication of
these two strategies offers a launch pad for further debate on how
best to improve services for this age group. But soon the talk
needs to be converted into action.

Proposals from YoungMinds

– A directive for health agencies to develop a service that meets
the particular mental health needs of adolescents, building on
CAMHS and adult mental health resources.

– An adolescent specialist service commissioned from more agencies
including social services, education and youth services.

– A “virtual” team of child and adult psychiatrists and other
professionals to treat 16-25 year olds.

– Access to and delivery of the specialist service in an acceptable
setting, and not constrained by existing outpatient
arrangements.

– Access from several places and professionals, including
self-referral.

Youth access’s immediate priorities:

– DfES must champion across government the development of youth
counselling services.

– Funding stream to support young people and young adults’ mental
health should be identified.

– National service frameworks for mental health and for children
need to address the specific mental health needs of young people
and young adults.

– National evaluation should take the place of effectiveness of
current provision for 16-25 year olds.

– A nationally recognised evaluation tool for measuring young
people’s counselling outcomes should be adopted.

– Funding periods should be extended to five years with allocated
funds for infrastructure costs.

– Targets and incentives should be attached to mental health
initiatives and policy to stimulate joint working.

– A secure national programme of development is needed to enable
YIACS to meet Youth Access Quality standards.