Children and young people community mental health crisis services: national implementation guidance for urgent and emergency mental health care for children and young people

Supporting children and young people in mental health crisis

Improving the experience and outcomes of children and young people who present with a mental health crisis is a national priority.

The NHS Long Term Plan set out that all children and young people experiencing a mental health crisis must be able to access timely age-appropriate crisis care 24 hours a day,  7 days a week. This is achieved through a combination of access to urgent mental health helplines via NHS 111 ‘select mental health option’, crisis assessment, brief response, and intensive home treatment functions.

The crisis services developed in line with the NHS Long Term Plan ambition must, as a minimum, offer the functions and hours of operation outlined below, to all children and young people aged 0-18 years (up to 17 years and 364 days):

Function Hours of operation
1. Single point of access through NHS 111 ‘select mental health option’ to crisis support, advice and triage. 24 hours a day, 7 days a week.
2. Crisis biopsychosocial assessment in the emergency department and/or in community settings. 24 hours a day, 7 days a week in both the emergency department and community settings or a combination across both settings.
3a. Brief response in the emergency department and/or in community settings, with 3b. children and young people being offered brief interventions in the home and/or community. a) Brief response: 24 hours a day, 7 days a week in both the emergency department and community settings or a combination across both settings.

b) Brief intervention: 7 days a week across locally determined extended hours in the home and/or community.
4. Intensive home treatment service for children and young people who might otherwise require inpatient care, or intensive support that exceeds the normal capability of a generic children and young people’s mental health community team in the home and/or community. 7 days a week across locally determined extended hours in the home and/or community.

Note: extended hours are hours outside the standard hours of operation (Monday to Friday, 9am to 5pm).

Developing local mental health crisis pathways

The development of local mental health crisis pathways includes a range of alternative services. Depending on local need and service configuration, crisis services in some areas will be provided by community children and young people’s mental health practitioners, but in other areas may be provided through a blended model which includes support from inpatient and/or adult mental health practitioners. Where services include blended models with inpatient care and/or existing adult team practitioners, there must be an integrated approach with children and young people’s mental health services including knowledge of community pathways and systems.

Local areas should be mindful of the necessary workforce and training needs required to ensure all staff are appropriately trained, competent and experienced in working with children and young people with mental health needs, and that services offered provide safe, effective and appropriate crisis care 24/7 for all children and young people. Systems are encouraged to explore local solutions and training packages that are tailored to meet the unique needs of their local communities.

National implementation guidance for urgent and emergency mental health care for children and young people is available to support ongoing local implementation of crisis services by commissioners and providers, working with service users and their families, carers, and other partners.