The number of young people experiencing mental health problems is increasing and figures indicate that this is not a recent development. In 2012 the Chief Medical Officer had observed rising rates of self-harm[1] and recent NHS data shows an increase in mental disorders since 2017.
‘Rates of probable mental disorders have increased since 2017. In 2020, one in six (16.0%) children aged 5 to 16 years were identified as having a probable mental disorder, increasing from one in nine (10.8%) in 2017. The increase was evident in both boys and girls.’[2]
Local areas have long been involved in implementing interventions, services and whole system approaches to an often increasing prevalence of local mental health need. This is reinforced at a national level, via Department for Education and NHS England’s focus on school responses; and through plans for local transformation of children and young people’s emotional wellbeing and mental health, from Future in Mind, and through Transforming children and young people’s mental health provision: a green paper and the NHS Long Term Plan.
There is a wealth of evidence to show that earlier intervention can effectively reduce the risk of problems resulting in crisis. But often when faced with a strain on resources, it can be challenging for local areas to test out new approaches to building resilience and better emotional wellbeing. Knowledge about evidence-based early intervention approaches may be available, but having real-time examples of system change within the context of local challenges can be highly beneficial to local practitioners and decision makers.
Over the past six years, The National Lottery Community Fund has invested £67.4m in HeadStart, a strategic programme to test out innovative approaches around emotional wellbeing and mental health for young people age 10-16. Six areas nationwide were awarded funding in 2016 to develop and deliver a HeadStart programme locally and these were Blackpool, Cornwall, Hull, Kent, Newham and Wolverhampton.
Here at the National Children’s Bureau we have worked closely with the HeadStart partnerships in the latter stage of the programme as they moved from ‘test and learn’ to ‘learn and embed’, and considered sustainability of the programme. As ‘Support and Development Provider’, NCB have supported HeadStart areas to plan for the sustainability of the programme, as well as consider how developing and implementing HeadStart can benefit the wider children and young people’s mental health professional networks and workforce.
The need for better integration and early intervention approaches was further magnified as the Covid-19 pandemic began. With ‘stay at home’ guidance issued in March 2020, local systems of support for children and young people had to respond and change rapidly. As physical and mental health concerns accelerated and inequalities were further exposed, the HeadStart partnerships were well placed to respond to local needs across health, education, children’s services, and the voluntary/community sector, and through working with young people and parents as part of a place based approach.
With good quality relationships and approaches embedded across the local system, the partnerships were able to quickly mobilise responses and adapt service offers. NCB recognised the importance of making this learning available to a wider national audience and in October 2020, held the ‘Emotional wellbeing and return to school’ virtual national conference attended by over 200 delegates from across the children and young people’s mental health workforce. This was an opportunity to hear national updates from DfE and Public Health in response to the Covid-19 pandemic, and for the HeadStart partnerships to showcase their approaches on working with schools with ‘access to good practice tools and information’[3]. A second conference ‘Responding to emotional wellbeing and mental health needs of children and young people: learning from HeadStart partnerships’ was held in October 2021 focusing on strategic responses to emotional wellbeing and mental health needs of young people, with learning from HeadStart highlighted that would be useful for stakeholders looking to devise local responses and minimise the impact of the ongoing pandemic.
NCB has continued to gather key learning and practice examples from the partnerships on the range of services and approaches that have been developed to build resilience and support emotional wellbeing and mental health. From partnership working between health and education, supporting young people with mild to moderate mental health concerns to prevent the need for more specialist services, and empowering the workforce (and in some cases the whole town!) to ensure that young people can receive support when and where they most need it. We have now created a library of resources on key themes of the HeadStart programme most useful for local areas who want to consider or implement similar approaches, such as working with schools, community approaches, cross systems working, participation and co-production, workforce development and digital approaches. There are over 20 articles showcasing this work and a series of themed outputs on national developments such as social prescribing, wellbeing in schools, working with vulnerable young people, Mental Health Support Teams and partnership (or integrated) working.
As the partnerships planned for sustainability of the HeadStart programme locally, we convened a HeadStart Community of Practice, developing a Key Lines of Enquiry tool, considering national developments such as Integrated Care Systems, and supporting a culture of learning between the partnerships and exploring key topics such as cost-benefit analysis of services. We undertook cost-benefit analysis for four partnerships to further support local commissioning discussions. Feedback from one area highlighted how this work had really strengthened their HeadStart sustainability business case.
Overall, HeadStart has demonstrated the importance of enabling young people to develop good quality relationships with a trusted adult who can support them or know how they can access support in a range of ways, reiterating that mental health is everybody’s business. The partnerships have also demonstrated real innovation in supporting young people, for example through multi-agency approaches which have enabled young people to access suitable alternative support to CAMHS and helping schools to embed whole school resilience and trauma informed approaches. These types of developments are now more relevant than ever as local areas seek how best to support young people beyond the Covid-19 pandemic. Increasing focus on early intervention, place based and more personalised responses and increasing links between health, education and community services will continue to be a key focus in children’s mental health policy and practice development for some time.
Delivering lasting change can take time, and test and learn approaches offer a key opportunity to understand change, in this case due to Covid-19 in the context of significant local structural and cultural upheaval. In harnessing and disseminating the practical learning about ‘what works’ in improving outcomes for children and young people’s mental health, we have been able to demonstrate a legacy for funding programmes like HeadStart.
[3] Quotation from conference delegate