The government’s current work to improve mental health support for children and young people is an important but modest step towards achieving its longer term aspirations. It includes initiatives to increase the proportion of children and young people who need support accessing NHS-funded mental health services from around 25% to 35%, estimated to be equivalent to treating an additional 70,000 children and young people per year, between 2015-16 and 2020-21. This reflects the Department’s assessment of what is possible within current funding and staffing constraints.
However, the NAO has found significant weaknesses and unreliability in the government’s data which undermines its understanding of its progress and whether additional funding has been spent as intended. In particular, the NHS cannot reliably track progress against one of its key targets to treat an additional 70,000 children and young people.
Slow progress on increasing the mental health workforce in England by 40% (4,500 staff) is emerging as a major risk to delivering the government’s ambitions and there are currently no data available to monitor any increase.
New government estimates of the number of children and young people with a mental health condition are likely to be higher than previously estimated, which will make it even harder for the government to achieve its long-term ambitions. If prevalence is 50% higher than the previous 2004 estimate, this would mean NHS England would have to treat an additional 186,000 children and young people in order to achieve an access rate of 35% by 2020-21.
The report recommends that the Department, working in conjunction with other departments, should set out the scale of the needs of young people requiring mental health services, building on the new prevalence data when available and identify what work and resources are needed to implement its 2015 strategy, Future in Mind, in full.
Key Findings:
- The government faces significant challenges in transforming children and young people’s mental health services, as part of its commitment to parity of esteem between physical and mental health services.
- The government has not set out and costed what it must do to achieve Future in Mind in full.
- The government does not have cross-government accountability arrangements in place to ensure Future in Mind is delivered as intended.
- NHS England cannot be certain all the additional £1.4 billion funding to date was spent as intended, and does not have strong levers to ensure that CCGs increase spending in line with their intentions.
- Local transformation plans set out how local areas intend to transform services but national accountability is weak.
- The NHS is working to improve key information on how many children and young people receive mental health services, how much it spends on providing those services, and which treatments are most effective.
- Significant data weaknesses limit the government’s ability to understand progress towards delivering its ambitions around access to children and young people’s NHS-funded services.
- The number of children and young people with a mental health condition who need help is likely to be higher than previously estimated, which will make it even harder to achieve the government’s ambition.
- Slow progress on workforce expansion is emerging as a major risk to delivering the government’s ambitions, and understanding progress is significantly hindered by a lack of data.
- There is still limited visibility of what public sector bodies outside the health sector spend on mental health services, and what services they provide.
Actions for Government:
- Set out the scale of the challenge, and understand the characteristics and trends in the needs of young people requiring mental health services, building on the new prevalence data when available.
- Set out what actions and resources are required to implement Future in Mind in full, and the main long-term and interim objectives and outcomes. The plans should set out what different parts of government are expected to deliver, be clear about the main uncertainties and build in opportunities to review plans.
- Establish clear leadership of the portfolio and responsibility for taking it forward and bringing together the national and local bodies, and individual programmes, intended to deliver Future in Mind.
- Put in place mechanisms to improve understanding of spend and activity on mental health support across the system, particularly in schools and local authorities.
- Undertake work to better understand the impact of preventative services and early intervention for children and young people on the demand for more intensive or specialist mental health services.
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Improving Children And Young People’s Mental Health Services