The journal asks for key practitioner messages, and these I’ve reproduced here:
Due to rising demand and increasing healthcare waiting times, more CYP present at mental health services at crisis point. To improve care, it is important to understand the types of mental health crisis services and how CYP and their families experience support at these facilities.
Findings from this systematic review indicate that CYP and their families are often unaware of available mental health services and how to access them. Children and young people should be involved in the development of public information about mental health services.
Mental health support needs to be provided through different mechanisms such as face-to-face appointments, text, email, or telephone via a direct line with round-the-clock availability.
Emergency departments (EDs) are often accessed at crisis point. EDs work well where care is provided in a calm and private environment by trained staff with experience in children’s and young people’s mental health.
Improving accessible community based early interventions with clear pathways to designated clinical services might prevent CYP reaching mental health crises.
Our new CAMH-Crisis2 study began in November 2022, and a summary of what we’re doing is here:
There has been a sharp and worrying increase in mental health problems experienced by children and young people. Prior to the pandemic, one in eight 5-19 year olds in England had a probable mental disorder. In 2020, amongst 5-16 year olds this figure had risen to one in six. Amongst those with a mental health difficulty, almost half of older teenagers and a quarter of 11-16 year olds report having self-harmed or attempted suicide. Extreme psychosocial distress, with or without self-harm, is often referred to as a ‘crisis’. Services for young people in crisis are a UK priority, and provision is expanding in the NHS, social care and educational settings. However, despite this and the appearance of national standards very little research into crisis services for young people has been undertaken. We therefore do not know what crisis responses currently exist, who uses services, or what works best for children and young people and their families.
Against this background this project will answer the question, ‘How are mental health crisis responses for children and young people up to the age of 25 sustained, experienced and integrated within their local systems of services’? We will work with a group of young people who advise on research, some of whom have used crisis services, to address the following three objectives:
To describe and map NHS, local authority, education and third sector approaches to the implementation and organisation of crisis care for children and young people across England and Wales.
To identify eight contrasting case studies in which to evaluate how crisis services have developed and are currently organised, sustained, experienced and integrated within the context of their local systems of services.
To compare and contrast these services in the context of the available international evidence, drawing out and disseminating clear implications for the design and delivery of future crisis responses for children and young people and their families.
To help us answer our research question and to meet our objectives we will make use of normalisation process theory. This supports studies into what helps, and what hinders, the implementation and sustainability of new approaches to care.
We will meet our first objective using a survey, creating a detailed record of crisis responses across England and Wales and how they are organised, implemented and used. To meet our second objective, from this detailed record we will identify eight contrasting services selected for variety in terms of: geographic and socioeconomic setting (England/Wales, urban/rural, and relative affluence/poverty); populations served (including ethnic diversity); and service configuration (including third sector and/or social care involvement). Treating each as a case study, we will conduct interviews with children and young people and family members who have used the service. We will also interview commissioners, managers and practitioners, including those providing a crisis response and those working in other parts of the local system. We will gather operational policies and related documents, and data on how each service is used and by whom. In our analysis we will focus on understanding how each crisis service is provided, experienced, implemented and sustained. To meet our final objective we will compare and contrast each case study, and use our synthesised findings to advance the available international evidence for best practice in service provision. We will close by drawing clear, actionable, lessons for the future commissioning and provision of high-quality crisis responses which are sensitive to the support and access needs of a diverse range of children and young people receiving care from a range of services.
In recent months I’ve been part of a team, led by Nicola Evans, bringing together the evidence in the area of responses for children and young people in mental health crisis. Our working definition of a ‘crisis response’ has been the provision of a service in response to extreme psychosocial distress, which for children and young people may be provided in any location such as an emergency department, primary care, a specialist or non-specialist community service, a school, a college, a university, a youth group, or via a crisis support line. Our objectives have been:
To critically appraise, synthesise and present the best available evidence on the organisation of crisis services for children and young people aged 5 to 25 years, across education, health, social care and the third sector.
To determine the effectiveness of current models of mental health crisis support for children and young people.
To explore the experiences and perceptions of young people, families and staff with regards to mental health crisis support for children and young people aged 5 to 25 years.
To determine the goals of crisis intervention
As a project team we’ve been informed by a stakeholder advisory group, and have cast a wide net by searching not only for research but also other relevant evidence including guidance, case studies and more. Methodologically, therefore, this review bears comparison with others I’ve previously written about on this site including the RiSC study and MENLOC. More on this crisis care evidence synthesis to follow in due course.
One of the consequences of NHS resources being mobilised so decisively towards meeting the threat of the novel coronavirus has been the cessation of much face-to-face nursing and health services research other than that connected with COVID-19. A response in March 2020 from the NIHR included the instruction to delay the setting-up of new non-COVID projects, and to pause ongoing studies, in order that the infrastructure supporting NHS research be brought to bear almost exclusively on efforts to tackle the pandemic.
Meanwhile, one type of research relatively unaffected by the coronavirus outbreak is the evidence synthesis. In Cardiff we have the Wales Centre for Evidence Based Care and, in the early months of 2020, I joined a team led by Nicola Evans and Wales Centre colleagues to start work on a synthesis of the evidence in the areas of service organisation, effectiveness and experiences for children and young people in mental health crisis. Our plans include database searching plus online searching for grey literature, policies and guidance. More to follow as the project unfolds, which in April saw us deep in title and abstract screening.