The recent pandemic has brought children and young people’s (CYP) mental wellbeing into sharp focus, with CYP mental health services receiving their highest ever level of referrals, as well as rising complexity and severity.

This webpage has been created to outline the NHS response to the challenge, as well as signposting to existing guidance and principles that may be of use to staff and systems. We will continue to update it as the programme of work progresses, including adding case studies highlighting best practice in this space.

While most CYP will receive care in community settings, there are occasions where attendance or admission to a paediatric or adult acute setting may indeed be the best clinically appropriate option. A few examples of such instances include:

• When a CYP needs an urgent assessment during a mental health crisis, they may need to be seen in A&E where some mental health providers provide a 24/7 service
• CYP who have taken overdoses and/or self-harmed having their physical health assessed and managed at their local A&E/paediatric department
• A short admission to a paediatric ward while waiting for a specialist assessment and treatment
• CYP with low weight eating disorders who may require hospital admission for physical monitoring and treatment (see Junior MARSIPAN guidance for further detail)
• CYP who present in a confused, severely agitated or psychotic state may require physical assessment and investigations

The commitments outlined in the NHS Long Term Plan (LTP) make clear that achieving parity of esteem – valuing mental health equally with physical health – is a key priority, though we acknowledge there is still some way to go in meeting this challenge. For services to be delivered effectively and for patients to feel supported and staff to feel confident, we need to facilitate better integration of physical and mental health for CYP.

How NHS England is responding

With all this in mind, we have strengthened connections across national NHS England teams involved in taking forward CYP priorities and have established a shared programme of work. We aim to:

• Better understand the scale of the issue and how best we can provide support to the system to provide safe, compassionate and appropriate care for patients.
• Ensure the paediatric workforce is trained and supported when caring for CYP presenting to hospital with acute mental health needs, such as eating disorders, and that the workforce understands where to get additional help, should they need it. This may include improving the training offer to the current and future workforce
• Understand how systems and clinicians can work together better by reviewing pathways; identifying areas of innovation and best practice. This may also include building upon current guidance and establishing principles.

We will work in collaboration with national, regional, and local system colleagues, as well as CYP and their parents/carers to achieve this.

We are committed to continuing to deliver on our LTP ambition and have continued to expand and transform services during the pandemic. We are supporting more CYP than ever before and are aiming for an additional 345,000 CYP aged 0-25 to be supported by 2023/24, as well as 100% coverage of crisis and intensive home treatment services over the same period.

All-age 24/7 crisis helplines are available across the country so anyone, including children and young people, can get urgent help whenever they need it. We have also continued roll out of mental health support teams in schools and colleges and recently appointed two CYP nurse advisors specifically to support the wider programme.

In the meantime, we would encourage colleagues to consider our framework for systems (see below for further detail) and make use of the educational resources available here to support professionals managing CYP with mental health needs. It is also crucial to try and build professional relationships with local CYP mental health services and in many cases, this is much easier through platforms like Microsoft Teams.

A framework for systems

Our framework for systems and its associated resources will facilitate systems to come together to collectively support CYP with mental health needs who present in acute and paediatric settings, as well as supporting the clinical teams who care for them.

It has been co-developed with Royal Colleges, professional bodies, national, regional, local system colleagues, CYP and their parents/carers, with a view to continue to support transforming pathways of care, whilst ensuring services work together to provide a holistic approach for CYP with physical health needs, mental health needs, or both.