View the updated communications toolkit for 2022-23 here.
In Summer 2020, senior mental health leads in London agreed that children and young people’s mental health (CYPMH) should be a priority focus of the mental health COVID-19 recovery. As a result, the Healthy London Partnership CYPMH Programme have established a CYPMH COVID-19 Recovery Steering Group, chaired by our two Senior Responsible Officers representing the Cavendish Square Group, Paul Jenkins, Chief Executive Officer at The Tavistock and Portman NHS Foundation Trust, and Charlotte Harrison, Medical Director at South West London and St George’s Mental Health NHS Trust. The Steering Group has prioritised the development of consistent communication messages about CYPMH. to link into existing communication channels and community targeted messaging to ensure there is joined up messaging across the system in London.
During wave 1 of Covid19 referrals to CYP Mental Health Services dropped to 47% of the expected rate.
There has been a rise in CYP MH presentations to A&E across London despite the availability of all age 24/7 crisis lines that have been established to provide appropriate urgent support.
There is outdated crisis information online including (signposting to NHS111 over the NHS urgent mental health crisis helplines that should be used.) It is also not always clear that these helplines are available for children and young people, parents and their families.
Whilst specific arrangements and support offers vary across boroughs, this document sets out key messages with supporting assets that will:
Address barriers to accessing services by building on the ‘your NHS is here for you’ messaging. This will provide assurance to CYP and their families that CAMHS services are open and safe from Covid.
Promote all age 24/7 crisis lines and provide clear and consistent messaging on how to seek help in a crisis.
What is included in the toolkit: to cascade key messages during wave 2 of Covid19.
Children and Young People Mental Health and Crisis messaging
A selection of social media images for specific posts
How to change supporting images according to the organisation/ industry: logo, CYP crisis number, hashtag
Downloadable PowerPoint document for all images and content: images targeted CYP and images targeted for the parents/carers looking after the young people.
In 2017, London’s Crisis Care Programme developed multiagency training sessions to support the preparation of local systems for section 136 (s136) Mental Health Act (MHA) legislation changes in November 2017. These were initially held in each of London’s mental health trusts and at London Ambulance Service (LAS). The training focused on MHA and aligning local policies to London’s s136 pathway and Health Based Place of Safety specification. It covered the roles and responsibilities for staff along the s136 pathway, particularly in light of the legislative changes.
Recognising challenges for the care of s136 patients in emergency departments (EDs), Healthy London Partnership (HLP) also developed and carried out a series of bespoke training sessions in 2018-19 to specifically focus on the role of EDs.
An evaluation was carried out to assess the effectiveness and impact of the training through attendee feedback, collected via tailored evaluation forms, and identify areas for improvement in future training opportunities.
Since its launch in June 2017, there have been 935 attendees from Mental health trusts, emergency departments, LAS, local authorities (AMHPs) and police. The training has received excellent feedback with 94-95% satisfaction across the sessions and 86-89% of attendees reporting that the training would make a difference to the way they did their job.
In order to keep staff up to date, reach those unable to attend and train new staff, organisations along the s136 pathway will need to continue to provide training on the topics covered within the multiagency training.
With over 200 events taking place across London, the aim of the week was to highlight the positive impact that participating in arts, cultural and creative activity can have on mental health and wellbeing.
The week kicked off with a Creative Health Conference at the Southbank Centre that included keynotes from both the Rt Hon Matt Hancock MP, Secretary of State for Health and Social Care, and Simon Stevens, NHS England chief executive. The event was attended by over 700 people from across the arts, health and academic sectors.
Here, Gillian Moore, director of music at the Southbank Centre, introduces the conference:
Thrive LDN’s main activity for the week involved attending creative events based around the issue of mental health, speaking to artists and participants about their mental health journey and the ways in which being creative has helped them. Here, composer and musician Douglas MacGregor discusses his project, Songs of Loss and Healing:
The Thrive LDN team also visited the BRIT School’s Year 12 Visual Art & Design end of year show, Temporary, to explore how the topic of mental health had influenced some of the students’ work.
Students Paige and James discussed their projects with Thrive LDN:
The week concluded with a conference at the Wellcome Collection. Making it Mainstream – Creativity and Wellbeing in the Media which focused on how the impact that creative or cultural activity can have on health and wellbeing is being portrayed in the mainstream media. The speakers included television producers and presenters involved in making shows such as the BBC’s Our Dementia Choir with Vicky McClure and Darcey Bussell: Dancing to Happiness.
Sir Sam Everington, GP at Bromley-By-Bow, Chair of NHS Tower Hamlets Clinical Commissioning Group and Chair of the London Clinical Commissioning Council, gave a presentation on social prescribing:
A full round up of all the events which took place during Creativity and Wellbeing Week, London-wide and nationally, is available online here.
Sharon Long, a school governor in Lewisham, talks about the importance of London-wide approach to delivering early intervention to support staff in schools and colleges.
We all know the impact of mental health on children, young people and families, in London, 9% of 5-19-year olds have a mental health disorder. In schools, this manifests in many ways, and it is critical that we look at the ways in which we can support children, young people and their families. As a school we also know that this must be a whole school approach, one that cuts across everything …. safeguarding, inclusion, the curriculum, staff training, teaching and learning, behaviour and something that as governors we need to consciously review and challenge ourselves to improve.
As a school, we want to look at our practice, learn from other places and are keen to see what the trailblazer areas develop. We have been looking at a new approach around behaviour and inclusion, we have a great inclusion team, which includes a family support worker and a therapist for two days a week and we have seen the impact of these interventions. Like other schools, we have regular staff training, we review our policies and practice, we do deep dives on behaviour and inclusion with a focus on the needs of key children.We are working in a challenging environment like all schools, our budgets are facing an 8% real time decrease. 25% of our children have Special Educational Needs and we are looking at how we support those children effectively.We are looking at innovative ways of supporting all CYP, 80% of whom get no additional funding, yet need specialist support and staff who have been trained around key areas such as autism and mental health.
Mental health and young people in London
The trailblazer areas will be establishing mental health support teams in schools, focusing on early intervention around mild to moderate mental health issues. Having these teams in place help address a very clear challenge in schools, the vast majority of school staff are teaching, very few have the capacity to build those relationships and improve develop our links with CAMHS, and other services. We need both a whole school approach and whole family, we are lucky to have a children’s centre attached to the school, but this doesn’t meet the needs of all parents and carers. Trailblazer areas should hopefully help resource this and make sure that there are systems in place to work with the families as well as children.
Some of the resources on offer via Healthy London Partnership Children and Young People’s Programme already offer us some guidance and support on what we can do.We should maximise the support on offer to make sure whatever services we put in place are effective, designed with children and young people. Healthy London Partnership has developed a fantastic school’s mental health toolkit which provides a wide range of information and guidance on how to promote emotional wellbeing and mental health within schools.
As we know, supporting children and young people with their mental health is critical if we want them to achieve their potential; we need to listen to what they want and what better start than the feedback from the Healthy London Partnership and Young Minds (Amplified) review which provides an overview of 10 ways young people in London want schools to support their mental health. As a school, we must ensure that we get children to feedback on existing provision, what else they need and constantly come back to the values and ethos of the school and inclusivity.
Within all of this we need to also focus on staff and what they need to help their emotional health and well-being. Research by the National Education Union found that 26% of teachers with less than five years’ experience planned to quit within five years, quoting workloads and accountability regimes as key factors.
In March, the Secretary of State for Education announced the creation of a new expert advisory group on wellbeing to support teacher recruitment and retention, alongside the significant reforms introduced via the new Early Career Framework. The group will include Paul Farmer, the Chief Executive of Mind; Peter Fonagy, the Chief Executive of the Anna Freud National Centre for Children and Families; and Nancy Hey, Director of the What Works Wellbeing Centre. Serving teachers and leaders and other representatives of the schools and colleges sector will also be involved, including the Association of Schools and College Leaders.
This is also well documented within the NHS around the recruitment and retention of staff, where young peoples mental health care is impacted by staffing challenges and workloads. As well as the challenges in securing CAMHS where only 6% of the NHS mental health budget is spent on children and young people.
Finally, having just been inspected recently, we know that looking at the new Ofsted Inspection Framework there will be a welcome emphasis on how our curriculum extends beyond the academic/technical or vocational and how we support children to discover their talents, build their resilience and help keep them physically and mentally healthy.
About the author
Chair of Governors Beecroft Garden School London Borough of Lewisham
Strategic Director, Partnership for Young London
Mental Health in Schools Advisor to Healthy London Partnership
April is #StressAwarenessMonth in the UK and Dr Richard Graham, Good Thinking’s Consultant Psychiatrist and Clinical Lead, has been discovering: do people always know when they’re stressed?
“At Good Thinking we wanted to dig a little deeper into stress. Do people always know when they’re stressed? The answer was quite surprising. And when we look further into the issue of burn out, it gets really interesting.
Mental health problems don’t announce themselves with a fanfare. Often, they creep up on you, slowly changing how you see the world and affecting how well you feel and function. It’s no easier for those around you to spot them, and the most conscientious people can struggle on silently. So, when feeling ‘not right’ many people look online, through search and social media, and the first word they tend to turn to is ‘stress’. Type stress into Google search and you will get well over a billion pages – almost three to five times the number of pages for anxiety or depression. People also search for what they feel, and at Good Thinking we’ve found a common feeling was ‘racing thoughts’ in addition to ‘constant worrying’ and ‘feeling overwhelmed’. So many people don’t actually feel stressed, but notice something different in themselves, and want to understand what it means. But often there is just a focus on work, on how much there is to do, and feeling bad about never getting to a point of feeling on top of things. The most stressed among us can just feel bad about their struggle to work.
Mental health problems don’t announce themselves with a fanfare. Often, they creep up on you, slowly changing how you see the world and affecting how well you feel and function. It’s no easier for those around you to spot them, and the most conscientious people can struggle on silently.
Unchecked, stress can impact on your physical health and mental health, and in time lead to burn out. This is not a new mental health problem, but it is remarkable that burn out is occurring in surprising situations; professional video gamers and You Tubers seem to be struggling as much as public sector workers. So why would those working in the digital economy be at risk in the same way that our team members might?
The term ‘burn out’ was coined by the psychologist Herbert Freudenberger in1974; he described it as particularly relevant to caring professionals. Yet three years before in 1971, in the US, it was air traffic controllers who were commonly reporting vocational ‘burn out,’ a form of exhaustion that is noticed by a decline in quantity and quality of work. This was very similar to what doctors were later reporting, yet in a very different area of work. But why?
During the 1960s and 1970s, air traffic controllers reported poor training experiences, inadequate equipment, rapidly changing shift patterns, long shifts without breaks, fatigue, monotony due to automation, and challenges arising from human-machine interfaces. Sound familiar? A huge increase in air traffic, with a small rise in the number of controllers, pushed working conditions beyond what controllers considered to be safe. After human errors were linked to fatal mid-air collisions, things started to change.
Research showed though that those who ‘burnt out’ started off in a better state than their colleagues who didn’t get so stressed, and on the whole were more conscientious and competent. It seemed that workers who strive hardest to meet professional ideals may increase their risk of burnout, which then contributes to them falling to reach those ideals. Having the best ideals or goals could get in the way, causing unintentional harm to themselves or to those they are intending to help. It is sad that back then there was now way to track how you are feeling, and take steps to care for yourself better, when stress was building, and burn out a few steps away.
Those who ‘burnt out’ started off in a better state than their colleagues who didn’t get so stressed, and on the whole were more conscientious and competent. It seemed that workers who strive hardest to meet professional ideals may increase their risk of burnout.
In a world now where we are surrounded by machines and intelligent devices, we can often experience a subtle pressure to be the same, and never properly switch off. Some people will never let their phone battery go flat, and they treat themselves the same. And the most regrettable aspect is that they then (because of our biology and psychology, our need to sleep, rest and take breaks, eat and feel the sunshine) just can’t offer the level of commitment to their work as they would like to. Yet if they could look after themselves better, everyone would benefit.
This is no judgement on anyone. I applaud you if you are one of those fine hardworking individuals who wants to make a difference and go the extra distance. This is just a plea that you use services like Good Thinking to track yourself and use the advice and tools to look after yourself better – before you begin feeling burnt out. Our self-assessment can be a safe place to start, or you might just want to read about stress some more to help explore how you are feeling.
So, don’t settle for second best; put yourself first, and your best will follow. Doctor’s orders.”
Dr Richard Graham is a Consultant Child & Adolescent Psychiatrist, former Clinical Director of the Adolescent Directorate at the Tavistock Clinic and Clinical Lead for Good Thinking. Over the last decade, his work has centred on the impact of technology on development and health. In 2010 launched the UK’s first Technology Addiction Service for young people at Nightingale Hospital in London. In June 2016, he was appointed the Executive Board of the UK Council for Child Internet Safety (UKCCIS is the British Government’s principal advisory body for online safety and security for children and young people) and Co-Chairs the Digital Resilience Working Group. He also works with the BBC, as Digital Well-being Consultant to the Own It App Project.
Healthy London Partnership worked to develop a strategy for the children and young people’s mental health (CYPMH) workforce in early 2019 with significant input from a number of people from across the CYPMH system.
Children and young people’s mental health workforce strategy
The strategy focuses on those whose jobs support the mental health of children and young people (the workforce) and aims to explain why this topic is important, what we did to explore it and our findings. The strategy has been developed in collaboration with Youth Access and Hearts and Minds, and Health Education England who funded and contributed to the final document.
The strategy outlines the background to our work, the challenges that are faced across the system, including real examples of these challenges, followed by clear recommendations on how to address these issues.
The strategy document was launched on Thursday, 30 May 2019 at the Royal Festival Hall to an audience of around 100 individuals representing organisations and groups from across the CYPMH system. The event showcased the truly collaborative process that went into the development of the strategy, and the voice of children and young people that is present throughout. The event also heard from Izzy and Jacob of Here, Queer and Mentally Unclear who gave a brave and thought provoking performance about the relationship between LGBTQ+ identity and mental health.
If you would like to hear more about this piece of work, please contact Jessica Simpson.
1) the 2019/20 service user and staff conference will be about how we achieve health and wellbeing of both our staff and service users
2) we are implementing a new way of working that improves and maintains the health and well being of our staff so they can deliver the best support to our service users
3) we are creating health and wellbeing programmes in our mental health, substance misuse and alcohol services to ensure people can recover and remain well
4) we aim to spread Penrose Roots to Recovery across our services ensuring people we work with have positive experiences working outside and reduce the social isolation they often feel
London’s children and young people mental health trailblazer partners came together for the first time to set out their London-wide approach to delivering early intervention to support staff in schools and colleges.
Half of all cases of diagnosable mental illness begin by age 14 and three-quarters by the age of 24. Supportin children and young people at an earlier stage can help them avoid lifelong struggles with poor mental health.
Establishing new Mental Health Support Teams (MHSTs) to develop models of early intervention and support staff in school and college settings
Trialling a four-week waiting time for access to specialist NHS children and young people’s mental health services.
The first Mental Health Support Teams will be set up in 25 trailblazer areas – of which 12 trailblazers will also trial a four-week waiting time across England. In London, there are seven trailblazer areas, supported by Healthy London Partnership, of which four are also trialling the four-week waiting time pilots.
London’s trailblazers’ introductory workshop
On Tuesday, 12 February 2019, Healthy London Partnership brought together all the different London trailblazer partners for an introductory workshop.
The event saw over 100 attendees from across partnership organisations – including health, education, local authorities and voluntary sectors – come together for the first time, and provided a dedicated space to discuss how we plan to progress and deliver the programme in their areas, and to learn from current practices elsewhere in London.
Tracy Parr, Director of Transformation, Children and Young People and Mental Health at Healthy London Partnership, said:
“The Children and Young People Mental Health Trailblazers is an exciting opportunity to build strong partnerships between mental health services and schools and to expand the delivery of much-needed support for our young people. I hope this will start to turn the tide of the burden of mental health that we have amongst young people in London.
“Schools and colleges play a vital role in building the resilience and wellbeing of young Londoners. The additional resources and potential for enhanced partnerships available through the programme will make a huge difference to existing provision and will provide a unique platform for sharing learning across the country.
“At Healthy London Partnership we are looking forward to sharing our experience of supporting transformational change by convening people and partners across London, enabling them to learn from each other, to share best practice and seeking out excellence in the provision of services for young Londoners.”
Portia Kumalo, Programme Lead, CYP MH Trailblazer and Whole School Approach at SW London Health & Care Partnership, said:
“South West London Health and Care Partnership will be supporting 44 schools with the provision of three Mental Health Support Teams across Merton, Sutton and Wandsworth. These teams will build on the interventions that are already in place as part of our whole school approach pilot. Aligning the new teams with the whole school approach and embedding what they do into the wider system is critical to their success. Children and young people have also been involved from the start; through focus groups, school youth councils, during lessons and helping with procurement to ensure that what we are doing reflects their voice.
“We know that some children and young people who develop enduring mental health conditions in childhood, if not treated early enough can progress to adulthood. Our ambition is to pick that up much earlier so that we can intervene and help children to achieve their full potential.”
Mental health and young people in London
London trailblazer areas
The London trailblazer areas include Hounslow CCG, South West London Health & Care Partnership and West London CCG for the Trailblazer sites and Bromley, Camden, Haringey and Tower Hamlets CCGs will be Trailblazer and Four-week waiting time Pilots. These areas will be supported academically by King’s College, University College London and the University of Reading who will be supporting Hounslow CCG.
We will be convening and linking system partners, enabling shared learning within and beyond the trailblazer and four-week waiting time sites.
Supporting children with their emotional wellbeing and mental health is a growing priority for health services and for schools.
Healthy London Partnership has launched a Mental Health in Schools Toolkit, which provides a range of information for schools, governors and commissioners on mental health and emotional wellbeing.
The toolkit includes links to relevant guidance, practical tools and resources, and examples from across London of new initiatives and approaches in schools or across local authorities.
Mental health in schools mapping exercise
One in eight children aged 5-15 are estimated to have a diagnosable mental health problem at any one time. It is estimated that 75% of enduring mental health disorders have commenced by the age of 18.
The extent of services available within schools to support children and young people with their emotional wellbeing and mental health was explored as part of the Mental Health in Schools Project, a joint enterprise between Healthy London Partnership and the Greater London Authority over the summer of 2018.
The mapping exercise of services was conducted through Clinical Commissioning Groups (CCGs), local authorities and mental health provider trusts. The findings showed that in the majority of areas that submitted a response, there is evidence of a considerable range of activity to support emotional wellbeing and mental health within schools. However, the report also a noted variation in the level of knowledge and awareness of services provided and commissioned by schools within a CCG and Local Authority.
Providing support to schools and commissioners
To provide support and increase knowledge and awareness of services for schools and commissioners, we developed a Mental Health in Schools Toolkit in partnership with the GLA. The toolkit will be maintained and updated as method of sharing information.
Commenting on the launch of the Mental Health in Schools Toolkit, Tracy Parr, Healthy London Partnerhsip’s Director of Transformation and Children and Young People lead, said:
“We encourage school leaders and staff, health care professionals and commissioners to use the Mental Health in Schools Toolkit for a wide range of information and guidance on how to promote emotional wellbeing and mental health within schools.
“The extent and detail in the Mental Health in Schools Project mapping report means that there is a significant advance in the information available on what activity is taking place within schools. We are extremely grateful for all of the assistance that we had in compiling the information. It is because of this rich information that we have been able to develop a toolkit which now provides a ‘one stop shop’ on relevant guidance, practical tools and resources, and examples from across London of new initiatives and approaches in schools or across local authorities.
“To further enhance this work, we have also been working with Young Minds’ Amplified programme to engage with young Londoners to see what support they would like to see in schools in the future. It is through partnership working that we will tackle London’s most complex health and care issues and improve the health outcomes of children and young people.”
Why we are focusing on children and young people’s mental health
Children and young people’s mental health care should be easily accessibly, consistent and provide effective care for all mental health conditions across London.
Children and young people say they want mental health care that:
has an integrated child, youth and family-friendly approach
recognises their needs as they see them
makes them feel supported
emphasises the positives
helps them to cope.
1 in 10 children and young people aged between 5 and 15 years old have a diagnosable mental health disorder – that’s three in every school class, and more than 100,000 across the London.
Between 1 in 12 and 1 in 15 children and young people deliberately self-harm – admissions have increased by 68% in 10 years.
Half of all adult mental illness starts before a child reaches the age of 14.
75% of lifetime mental health disorders have their first onset before 18 years of age.
Helping children and young people improve their mental health is an effective means of preventing or reducing the impact of mental health problems in later life.
Our programme of work
A range of national strategies and policies mandate action to transform the mental health system for children and young people including Future in Mind. London’s clinical commissioning groups have been required to develop local transformation plans that respond to the challenges. We are supporting local transformation plans through hands on advice, publishing guidance, running events and workshops to facilitate the sharing and development of best practice. Please get in touch if you would like to know about the work we are doing and how to get involved.