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Young people’s mental health admissions require “multiple suicide attempts”

New research finds that the threshold to receive in-patient mental health care is too high, saying alternative community crisis services could be the answer.

27/01/23

Young people’s mental health admissions require “multiple suicide attempts”

Families are increasingly relying on ambulance and police services to deliver mental health support, particularly for those young people aged 16-17, a new report has found.

The report for Look Ahead also argues Accident and Emergency departments have become an ‘accidental hub’ for children and young people experiencing crisis but are ill-equipped to offer the treatment required.

It finds increasing demand for children and young people’s crisis mental health services amidst challenges with existing services. Researchers heard from professionals, service users and their families and carers found that this meant young people “had to have attempted suicide multiple times to be offered inpatient support.”

Based on in-depth interviews with service users, parents and carers, and NHS and social care staff from across England, the findings draw on experience of treating depression, anxiety, self-harm, suicidal thoughts and suicide attempts, eating disorders, addiction and psychosis.

The number of children and young people contacting mental health services rose by nearly a third from 2020 to 2021. Data also shows families are increasingly relying on ambulance and police services to deliver mental health support, particularly for those young people aged 16-17.

Accounts from patients and experts indicate that young people suffering the effects of mental health crisis are then frequently placed in unsuitable general paediatric wards alongside younger children, for ongoing medical monitoring.

Private sector providers now deliver the majority of support for hospitalised young people with mental health difficulties at “exceptionally high” cost. Where children and young people are referred away from general wards, the report highlights that 55% are looked after in the private sector, where costs for crisis CYPMH services, “are exceptionally high, and “do not always support young people in the most effective way”.

Chris Hampson, Chief Executive of Look Ahead, said the deep challenges in mental health care crisis provision for young people is setting up a ticking timebomb for mental health services in the future – as young people become vulnerable adults.

The NHS is doing all it can in impossible circumstances, but the result is a service that both costs more than it should and helps too few of those in crisis.

This research shows how much more needs to be done to redirect funds towards early intervention and prevention, in particular through intensive supported housing as an alternative to hospital. These are the community services that can help people before they reach crisis point.”

The report recommends alternative community crisis services, including supported housing away from hospital settings to reduce pressure on A&E and reduce costs by more than 50%.

It identifies alternative commissioning routes for a new residential, community-based crisis service which sits outside hospital and could cost 52% less than existing services. Such services would be an alternative for those in mental health crisis, or for those who did not meet the current – very high – threshold for admission.

The report examines examples including The Hope Service, run by Surrey and Borders Partnership NHS Foundation Trust.

The service provides intensive community support to young people aged 11-18, preventing, or shortening, their admission to inpatient units. The Extended Hope Service also provides out of hours support for young people in crisis, offering mental health assessments and a unit to provide residential care for young people in crisis for up to 7 days.

The Hope Service is CQC and Ofsted registered, and is staffed by social workers, nurses, teachers, psychologists, art and drama therapists, psychiatrists, family therapists and activity workers. The team works with young people, their families and carers to co-produce a plan of care aimed at preventing the escalation of mental ill health or intensive social care support.

According to the report, an expansion of these housing and care facilities for young people in mental health crisis would make the best use of the government’s commitment to increase overall NHS mental healthcare funding by £2.3bn a year.

Financial modelling undertaken as part of the research demonstrates that specialised health and housing services for young people in mental health crisis could cost some 52% less than an equivalent stay in hospital, at £2,000 per week instead of £4,200.

“The findings of this research are devastating and should serve as a wake-up call for the Government on young people’s mental health,” Liberal Democrat Health Spokesperson, Daisy Cooper MP, said at the report launch.

“The harrowing interviews in this report lay bare just how desperate young people and their families are for treatment, and that there is nowhere to turn unless they have reached crisis point – sometimes many times.

“Expanding community support should be a no-brainer: it’s better for young people in mental health crisis and would save money in the public purses. Adopting this approach would be nothing short of a revolution in mental health care, saving thousands of people from ongoing ill-health in adulthood.”

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