Children and Young People's Mental Health and Wellbeing Joint Delivery Board: final report

Progress

As outlined above, over the course of the JDB, the Task and Finish Groups have taken a wide range of action to support the delivery of better mental health support for children, young people and families in Scotland. This includes:

• developing and disseminating learning
• producing training and development resources for the workforce
• supporting improvements in services
• identifying areas for further work.

As part of their review of the work of the JDB, PHS considered progress made towards the Board's outcomes at Appendix C (uploaded as supporting document). It was noted that due to the varied phases the deliverables began, only deliverables One and Four were at a stage when it would be feasible for them to demonstrate the impact of the work on the mental health and wellbeing of children and young people. While elements of this data suggested work undertaken is having a positive impact on children and young people's mental health, in relation to children and young people accessing community-based support for example, it was highlighted that improvements can still be made in the collection and interpretation of data, with further work required to consider how to capture outcomes in the longer-term.

PHS also noted that where it is not possible at this stage to demonstrate direct impacts of the JDB's work on the mental health and wellbeing of children and young people, it is possible to see how the activities of the JDB can contribute to change both through supporting the development of existing work and by influencing future work.

Overarching Themes and Priorities

In reviewing the reports from Task and Finish Groups, the JDB identified key themes including:

Connectivity - A 'golden thread' that emerged through discussions was the importance of connections between services across the spectrum of mental health provision and the need for this to continue to be developed. The majority of deliverables identified an opportunity to support this through Children's Services Planning. This has a national and local role in driving a whole systems approach to the planning and delivery of services and support. It safeguards, supports and promotes wellbeing, and leads to improved outcomes.

Culture - The Board also agreed that the issues it sought to address are cultural and structural, involving multiple policy areas, sectors, and professions; for individuals and families, they are often lifelong and inter-generational. Given this, it reflected that two years was too short a time frame to begin to see the impact of the work it had undertaken and that:

• the work it has undertaken to date requires time and support to develop and embed locally, and
• any governance structure replacing the JDB should be considered over a longer time period.

The Board also identified a number of priorities that should be considered as children and young people's mental health work moves forward:

Retaining a focus on prevention - A degree of progress has been made in implementing early intervention approaches, for instance through the Community Mental Health and Wellbeing Supports and Services Framework. Whilst there remains work to be done, indications are that these services are making a difference to children, young people, their families, and carers. It is recognised that there are currently significant financial pressures across the system, but it is the Board's view

that prevention and non-clinical approaches to mental health support should not be lost as a result.

Care experienced/children and young people in vulnerable situations - There remains significant work to be done to meet the mental health needs of care experienced children and young people, and those most at risk within the system, with work undertaken over the life of the Board to be developed further and wider work related to the delivery of the Promise to be undertaken.

Crisis - As evidenced by Task and Finish Group Two - Ensure crisis support is available 24/7 to children and young people, there remain gaps in service provision for children and young people in crisis. Whilst the group was able to make recommendations, gaps remain and bridging them must be a priority for the JDB's successor. This must take account of the specific needs of children and young people in vulnerable situations.

Policy Coherence - The JDB recognised the significant complexity of the mental health policy and delivery landscape. Currently, interrelated policy decisions are made by separate forums on perinatal work, suicide prevention and student mental health, all of which are interrelated. The next steps should bring greater clarity on how mental health policy work connects, where key decisions are made and how this sits within the wider children and young people policy and delivery context.

These themes and priorities were considered in the formulation of the Board's recommendations but should also be considered more broadly in relation to next steps.

Reflections and Learning

In addition to considering progress made towards outcome its outcomes, the PHS review of the JDB provided insight into the process undertaken and provided a number of learning points for consideration in our next steps including:

• The JDB process was seen by participants as helpful in supporting a greater understanding of national policy processes and local delivery challenges, enhancing participants understanding and learning on effective ways to connect national delivery and local implementation
• Whilst an outcomes framework was created during the life of the JDB, a clearer outcomes framework earlier in the process may have helped work progress as well as providing a coherent framework to monitor and evaluate implementation. It would have also helped to locate the work of the JDB within the wider system
• There are currently a range of opportunities for aligning and embedding the work of the JDB with existing and emerging Scottish Government and local strategies which provide a focus on collective, whole system action. This includes connecting work within and across other frameworks (e.g. the Children, Young People and Families Wellbeing Framework) and new Scottish Government and COSLA strategies that focus on a preventative approach to children and young people's mental health and wellbeing (Mental Health and Wellbeing Strategy; Suicide Prevention; Self Harm), as well as strategies aimed at tackling inequalities and poverty and other social determinants impacting on children and young people and families
• A longer-term plan for evaluation would allow time to consider additional issues raised in this review, such as the need to develop monitoring and evaluation that captures the full journey of a child or young person through support and services and over the longer-term.

In order that these issues are considered by any future governance and the opportunities are taken to align with other strategies and frameworks, consideration has been given to how the recommendations can be taken forward, outlined on page 21. Ensuring consideration of outcomes by any incoming governance structure is also addressed within the JDB's recommendations.

Recommendations

The JDB considered recommendations from each Task and Finish Group, taking these into account in the formulation of a set of final recommendations to support taking this work forward. The final high-level recommendations of the JDB are provided below. Full recommendations can be found at Appendix A.

Strategic Recommendation One: Appropriate good practice sharing events and networks should be continued/established to ensure learning from the Joint Delivery Board is disseminated, and platforms provided that continue to support good practice development across the mental health continuum in line with relevant frameworks, specifications and/or standards. Support for practice platforms must be coordinated to allow for information sharing and strong connections between groups to address shared issues.

Strategic Recommendation Two: Scottish Government, Local Government, the third sector, Health Boards and relevant partners should seek to further understand, develop and deliver a whole systems approach to mental health provision at a national and local level, ensuring connections between services are established, optimised and well understood by those that deliver and use them.

Strategic Recommendation Three: Actions progressed by the governance structure that follows the Joint Delivery Board should be underpinned from the outset by a clear set of short, medium and long-term outcomes and a shared understanding of how progression towards mental health goals will be monitored and evaluated.

Strategic Recommendation Four: In alignment with the UNCRC and the ethos of previous mental health work, Scottish Government, Local Government and relevant strategic partners, should ensure children and young people from all backgrounds are a core partner in improving mental health matters that affect them, at personal, community and wider society level and have their views taken seriously.

Strategic Recommendation Five: A shared and accessible language should be used to describe mental health and associated services, to ensure services are designed with a common goal and children, young people and their families feel able to access them.

Strategic Recommendation Six: Quality learning resources and training opportunities considered by the JDB are developed, disseminated, supported, evaluated and accessible for the children and young people's mental health and mental wellbeing workforce. These must align to the strategic planning processes that relate to children and young people's mental health and continue to evolve to ensure the needs of our communities are met.

Strategic Recommendation Seven: Scottish Government should continue to provide funding for mental health and wellbeing services across the mental health continuum, including prevention and early intervention, in line with agreed commitments that result from the work of the JDB.

Strategic Recommendation Eight: Beyond the life of the JDB, Scottish Government, Local Government, Health Boards, and the third sector should produce targeted communication on mental health and wellbeing to ensure that all stakeholders including children and young people, parents and carers, mental health and mental wellbeing professionals can access the information that they need to support themselves and/or others.

Strategic Recommendation Nine: Scottish Government and COSLA should seek to influence policy development across the wider social determinants of children and young people's mental health, including education and family support, to further embed approaches that support mental health and mental wellbeing.

Taking the recommendations forward

Learning from the PHS review of the JDB indicated that progressing the recommendations would benefit from clear demarcation between policy and programme and making links to relevant frameworks and strategic developments.

Across the recommendations the key drivers identified include:

• Mental Health and Wellbeing Strategy and associated delivery plans
• Mental Health and Wellbeing Strategy Workforce Plan
• Children's Services Plans
• Community Mental Health and Wellbeing Supports and Services Framework
• CAMHS Service Specification
• Neurodevelopmental Service Specification
• Further Mental Health Quality Standards being considered by Scottish Government
• Principles of Participation and Engagement developed by the JDB
• Redesign of Urgent Care Mental Health Workstream Group.

Consideration will be given to how recommendations can be progressed via these mechanisms.

Children and young people's mental health remains of upmost importance. Whilst we recognise what has been achieved, we also recognise the considerable challenge ahead of us in continuing to support our children and young people. It is hoped actions and learning from the JDB will support children and young people and inform next steps in further developing across the system.