Mental health strategy 2017-2027: second progress report

2. Children and Young People’s Mental Health and Wellbeing

We want to realise the vision of the Mental Health Strategy as it relates to children and young people. That is of a Scotland where children, young people and families can get the right help at the right time, expect recovery, and fully enjoy their rights, free from discrimination and stigma. Our actions under the Mental Health Strategy, together with our other ongoing work, bring a focus on improving the individual and collective support from services. Wherever and whenever a young person asks for help, they should receive the support they need.

We will do this by:

• ensuring that the mental health of children, young people and families is prioritised, and improvement is driven through local and national leadership; 
• bringing coherence, evidence (including the views of children, young people and families) and strategic thinking to all relevant Scottish Government policy to ensure a ‘whole-system’ approach to mental health at local and national level;
• ensuring that our whole system approach to supporting children and young people is reflected in the support and services that are available across Scotland;
• promoting children, young people and families’ understanding of mental health and reducing stigma; and
• ensuring the voices of children young people and families shape policy and services, and that they are involved in designing the right support for them.

The progress summarised in this section shows how we are achieving these aims, both through specific actions in the Strategy, and through other centrepiece work which builds on and further develops those actions. 

Building on the recommendations of the Children and Young People’s Mental Health Taskforce and other key reports, our approach to reform is governed by a set of key priorities:

• embedding a more strategic and coordinated commitment to mental health improvement locally and nationally;
• ensuring GIRFEC principles inform how services work together for mental health (recognising that it was not simply a ‘health service’ issue); 
• understanding the complex spectrum of issues with which children, young people and their families need support, including emotional distress;
• ensuring the workforce has the skills and capacity it needs to address these issues; and
• providing the full range of support for those issues, including primary care, community support and alternative services to CAMHS in many communities. 

These elements of reform can be seen across the different blocks of activity for different age groups and for children, young people and their families overall, as set out below.

We have also set out our response to key sets of recommendations that have informed the progress of our work beyond the Mental Health Strategy, particularly the audit of rejected referrals (published in 2018) and the report by the Youth Commission on Mental Health Services (published earlier this year). These are set out in detail in the appendices of this report.

School-age children (Actions 1, 2, 5, 8, 17, 18, 19 and 20)

In June 2018 we established the Children and Young People’s Mental Health Taskforce to support and build on the aspirations of the Strategy. The Taskforce, chaired by Dr Dame Denise Coia, was commissioned jointly with the Convention of Scottish Local Authorities (COSLA) to provide recommendations for improvements in provision for children and young people’s mental health in Scotland. Its remit was to work in partnership to develop a programme of sustainable reforms. In particular, the Taskforce was directed to act on the recommendations of the audit of rejected referrals to CAMHS (Action 18). 

As one of its early actions, in December 2018, the Taskforce published a Delivery Plan which called for an immediate investment in CAMHS teams to reduce pressure on the system and to support capacity building in early intervention. The Taskforce published its final recommendations on 4 July 2019. The recommendations included: a call for a Scotland-wide commitment to change; more community-based services to ensure that there was a wide and effective range of supports available for children, young people and their families; improvements in support for the workforce; improvements in digital information sharing and the use of technology; and reforms to CAMHS. 

In response to the publication of the final recommendations, the Scottish Government and COSLA announced that the work of the Taskforce would be taken forward by a new programme board – the Children and Young People’s Mental Health and Wellbeing Programme Board – which they jointly chair. The work of the Programme Board builds on the work of the Taskforce, the Mental Health Strategy, and other key reports such as rejected referrals. It focuses on: 

• strengthening local partnership planning for improved mental health and wellbeing outcomes (Action 8);
• enhancing existing community based supports and developing innovative approaches for emotional/mental distress (Action 17);
• delivering the 2019 Programme for Government commitment on a 24/7 mental health crisis support and prevention telephone and text service for children, young people, their families and carers;
• developing a Service Specification, and a support and improvement programme for CAMHS and neurodevelopmental services across Scotland (Action 18);
• improving the performance of CAMHS and Psychological Therapies;
• developing more targeted pathways and support for particularly vulnerable groups of the population, especially those in care, and those at the edge of, or in secure care (Action 5);
• investing in the development of the workforce across Scotland to support mental health and wellbeing; and
• strengthening the role of public services scrutiny in driving improvement in mental health and wellbeing.

The work of the Programme Board rests on the foundation of activity started by the Mental Health Strategy, and extended through the Taskforce and successive Programmes for Government.

Emotional wellbeing of young people

Understanding the experiences and stories of young people growing up in a modern Scotland is fundamentally important to the Scottish Government. By listening to young people’s views on things that can affect their mental health, and acting accordingly, we can help build positive emotional wellbeing at an early stage.

In April 2019, we published research exploring the reported worsening of mental wellbeing among adolescent girls in Scotland. We took direct action based on the conclusions of that review, and have:

• committed £90,000 of funding to co-produce advice on the healthy use of social media and screen time. This advice is being created in partnership with children and young people by the Children’s Parliament and the Scottish Youth Parliament;
• established a Body Image Advisory Group, independently co-chaired by the Mental Health Foundation and a young person with lived experience. The Group will provide the Scottish Government with policy recommendations in early 2020; and
• commissioned an intensive review of evidence on the effects of screen use on sleep and the implications of this for mental health (this review will be published in early 2020).

We will continue to engage with young people, and to take bold and world-leading steps based on what we hear.

Through wide-ranging commitments in the 2018 Programme for Government, we set out a £250 million package of measures to support positive mental health and prevent ill-health. A centrepiece commitment was to invest over £60 million in additional school counselling services across all of Scotland. We are working closely with our local government partners to deliver this commitment, which is in support of Actions 1 and 2 in the Strategy. This will ensure that every secondary school has access to counselling services, whilst also improving the ability of local primary and special schools to access counselling. We anticipate that the first cohort of counsellors will be in schools during this academic year, with the full cohort in place by September 2020.

In addition, we have committed to put in place an extra 250 school nurses by 2022, to provide more comprehensive support for children with mild to moderate emotional and mental health challenges. The first intake of 50 nurses has started in the 2019/20 academic year.

Community wellbeing services (Action 17)

One of the main actions of the Programme Board will be to take forward the Taskforce recommendation to develop community mental health services across much of Scotland. Over the next three years we will establish a community wellbeing service to enable children and young people aged 5 to 24 years access to a range of mental health support in the community. 

This service aims to address the gap between the support offered by universal services, such as schools and primary care, and more specialist health services such as CAMHS. It will be delivered in partnership by Local Authorities, Integration Authorities and third sector organisations This will be an open-access model so children and young people can self-refer, and referrals can be made by people working with and supporting children and young people. Our ambition for this service is that it be expanded to include all adults, and this will be explored as the service is rolled out.

We will also provide a crisis support service for children and young people and their families, ensuring that there is comprehensive, analogous support to physical health crisis support. We will be reviewing existing services and options available, and will then develop services so that support is available 24/7 for children, young people and their families who need urgent support.

Adverse childhood experiences (Actions 5, 6 and 7)

We remain focused on reducing and mitigating the impact of ACEs through taking forward specific work in respect of at-risk groups of young people. This was a significant focus of the Taskforce’s work, through its dedicated “at-risk” work stream. As part of the work of the Children and Young People’s Mental Health and Wellbeing Programme Board, we will focus on developing pathways into the right mental health support for at-risk populations. Over the next year, this includes developing targeted pathways for young people in, or at the edge of secure care, young people who offend, and young people in care. This will include pathways into specialist services, but will mainly focus on the earliest possible point of intervention in each vulnerable young person’s journey.

Specialist inpatient care (Actions 19 and 20)

We have also developed a protocol for admissions to non-specialist wards for young people with mental health problems, where such an admission is clinically and socially appropriate for the young person. This is to ensure that safe and appropriate care can be provided in non-specialist settings, and has been taken forward in response to a Mental Welfare Commission recommendation (Action 19). The protocol will be published in early 2020.

More specific needs have required more targeted actions. NHS Lothian and NHS Greater Glasgow and Clyde (GGC) have been selected to develop a Learning Disability Psychiatric Inpatient Service for all up to the age of 18 (Action 20). The business case for national designation of the service is currently being taken forward by NHS National Services Scotland. NHS Lothian and NHS GGC are currently preparing the capital investment Outline Business Case, and are reviewing options including new build and adaptation of existing facilities. We are further supporting work on developing pathways in and out of specialist services.

In addition, a Secure Adolescent Inpatient Service for Scotland is being built by NHS Ayrshire and Arran (Action 20). The new service is expected to start in 2021. 

Young adults (Actions 21, 22 and 26)

In support of Action 21, we have worked with NHS Boards to support the national roll-out of Transition Care Plans (TCPs). Transitioning between CAMHS and adult services is an issue that young people have frequently raised as a concern. We listened to that feedback and developed the TCPs directly with young people to ensure they were useful and intuitive. We now expect that TCPs will be used as standard in every transition between CAMHS and adult services, and will continue to work with Boards to further refine and enhance the transitions process.

During Eating Disorders Awareness Week in 2019, we relaunched NHS Lothian and Beat’s Digital Peer Support Service for those with an eating disorder, continuing our support for Action 22. The relaunch included the addition of a telephone coaching service for parents and carers, reflecting feedback from users of the service. The positive experiences of participants since the resource was first launched in 2018 is why we have relaunched the project for a further three years. We continue to work towards our ambition that those suffering with an eating disorder are supported and given hope of recovery, whatever their circumstances.

Additionally, we announced that there will be Scottish-specific Guidelines on the management and treatment of eating disorders, which will be produced by the Scottish Intercollegiate Guidelines Network (SIGN). When the SIGN guidelines are published, we will have a Scotland-specific blueprint, and we will expect it to be carefully followed across the country.

In support of Action 26, we published the first ever national Vision to Improve Early Intervention in Psychosis on 30 June 2019. The Vision lays out the steps we are going to take to ensure that the right support for psychosis is available across the country, no matter where people live. To ensure the delivery of our Vision, and as set out in the 2019 Programme Government, we will establish a National Early Intervention in Psychosis Improvement Network, overseen by Healthcare Improvement Scotland. We are backing this work with an investment of an additional £390,000.

Further and higher education (Action 9)

In support of Action 9, we continue to support the National Union of Students (NUS) to develop its “Think Positive” campaign to ensure consistent support for students across Scotland. More institutions now have a Student Mental Health Agreement (SMHA) in place than ever before – there has been a 31% increase compared with summer 2018. The SMHAs help colleges, universities and Student Associations to work together, and to improve student mental ill health on campus whilst improving staff knowledge and tackling stigma and discrimination. NUS Scotland has continued to work with institutions to finalise and promote their SMHAs over the course of 2018/19.

In addition, the 2018 Programme for Government has strengthened counselling provision in higher and further education institutions, with over 80 additional counsellors over the next four years. In November this year, the Scottish Government announced the first tranche of funding to support the roll out of this expansion.