Written Evidence Submitted by the Department of Health and Social Care (CYP0116)
1. Children and young people’s mental health is a priority for the Government, and we remain committed to implementing the key proposals set out in the Green Paper on transforming children and young people’s mental health provision. This included introducing new mental health support teams (MHSTs) in schools and colleges across the country to cover 20-25 per cent of the school age population by 2022/23, and piloting a four-week access and waiting time for children and young people’s mental health services.
2. The Government continues to make progress in implementing those proposals. In December 2018, 25 areas were selected to deliver 59 teams. Since then, three teams in one site at launch have been restructured into two teams, taking the current number of trailblazer teams to 58. The first cohort of the new workforce have now completed training and all 58 teams are fully operational.
3. Roll out of MHSTs has continued through the pandemic and further teams were commissioned in 2019/20 and 20/21. The 2019/20 cohort are due to become fully operational by the end of March 2021. This reflects a minor delay due to the impacts of Covid-19 as a result of an extension in the time required for trainee education mental health practitioners to qualify. As a result, the Government estimates that 15 per cent of the school age population will be covered by operational MHSTs by March 2021 and we are on track to cover at least 20-25 per cent of the country by 2023. Further cohorts are planned each year up to 2023/24
4. More recently, on March 5, the Government announced plans to accelerate the coverage of mental health support teams in schools and colleges over the next financial year, with £79million funding for NHS funded children’s mental health services, including community services, Children and Young People’s Eating Disorder Services and crisis services. We therefore expect to deliver the Long Term Plan commitment to MHSTs covering 20-25 percent of England by April 2022, a year ahead of schedule, and to continue expanding thereafter. We estimate around 400 mental health support teams will be up and running, offering support to almost three million pupils, by April 2023.
5. Twelve of the first trailblazer sites announced in 2018 are also working with us to test how an access and waiting time standard for children and young people’s mental health services might be defined, and assess the resource implications, feasibility and sustainability of delivering this. Our intention is to publish the proposed definition, proposed measurement approach and the learning from the programme in the forthcoming clinical review of standards report. This will inform a recommendation to Government on the potential development and rollout of access and waiting-time standards for all children and young people who need specialist children and young people’s mental health services.
6. In addition to the core proposals of the Green Paper, the 2018 Government response to the consultation on the Green Paper committed to rolling out the Link Programme, which aims to help local areas improve joint working between local NHS mental health services and schools and colleges.
7. The Link Programme has been adapted for delivery during the pandemic, through an interim offer facilitating local problem solving. The training programme (run by the Anna Freud Centre) was previously delivered by face to face in group workshops, but we are now providing full Link Programme training and workshops online to bring together professionals working in education and health.
8. In its response to the pandemic, the Department for Education has worked with the Department of Health and Social Care, NHSEI, Health Education England (HEE), Public Health England (PHE), and key voluntary sector organisations to deliver the Wellbeing for Education Return.
9. This project, backed by £8 million, has funded local authorities to secure and train local experts to provide training, support and signposting for schools and further education (FE) providers, including academies, special schools, pupil referral units and alternative provision. This is intended to help support the wellbeing and resilience of pupils, students, staff, parents and carers during the ongoing pandemic.
10. Over 85 per cent of local authority areas report they are delivering additional training and support into local schools and FE providers as a result of the Wellbeing for Education Return funding.
11. For those in higher education, the Office for Students have provided up to £3 million to fund the Student Space platform, which provides access to dedicated support services, resources and information to help students manage the challenges of student life.
Community Children and Young People’s Mental Health (CYPMH) Services
12. The Future in Mind report (2015) set in train a multiagency transformation in how children, young people and their families were involved in decisions that matter to them, in service development and in how agencies worked together to maximise opportunities and effectiveness. CYPMH Local Transformation Plans were first developed in 2015 following the publication of Future in Mind. They are whole-system plans that set out how local health, children’s services, education, statutory and VCSE agencies will work together to lead and manage change for children and young people’s mental health. They have allowed for local transparency in how the whole health and care system are transforming care and support for the mental health and emotional wellbeing of children and young people.
13. Prior to the Pandemic these Plans were refreshed and republished annually with assurance and monitoring of NHS elements of these plans at both a national and regional level.
14. This positive joint working has recently been recognised in the Joint Targeted Area Inspection (JTAI) reports - carried out by Ofsted, the Care Quality Commission (CQC), Her Majesty’s Inspectorate of Constabulary, Fire and Rescue Services (HMICFRS) and Her Majesty’s Inspectorate of Probation (HMI Probation) - into how multi-agency partnerships identify and respond to children with mental ill health. Feeling heard’: partner agencies working together to make a difference for children with mental ill health: Findings from JTAIs looked into how local partnerships and services were responding to children and their families when children were living with mental ill health; reviewed the practices of individual agencies, as well as the effectiveness of multiagency working arrangements, including children’s social care, health services, youth offending services, schools and the police. The report stated that they (the bodies who carry out the joint inspections) were:
pleased […] to see many strengths in partnership working and arrangements to develop a more cohesive approach to the provision of children’s mental health services. We have seen that when partners work together effectively, prioritise children’s mental health and build a skilled and knowledgeable workforce, this improves children’s access to support with their mental ill health. [. . .] Local partnerships have an important role to play in supporting professionals across all services that work with children to have a better understanding of children’s mental health. [. . .] There are many good examples of agencies working together in innovative ways to improve services and support for children with mental health needs, such as colocation of services, involving voluntary and community sector organisations, and services being flexible in adapting to meet children’s needs.
15. Through the NHS Long Term Plan we remain committed to investing at least an additional £2.3 billion a year into all-age mental health services by 2023/24. This increased investment will see an additional 345,000 children and young people, and a further 370,000 adults and older adults, accessing mental health support every year by 2023/24.
16. The Five Year Forward View for Mental Health (FYFVMH) made a commitment that by 2020/21 an additional 70,000 children and young people with a diagnosable mental health disorder would receive treatment from NHS-funded services. This represents an increased access (based on two contacts as a proxy for treatment) from approximately 25 per cent of estimated prevalence to 35 per cent based on the 2004 Office for National Statistics (ONS) prevalence survey. Almost 560,000 children and young people received at least one contact from NHS-funded services in 2019/20, 391,940 of which had two or more contacts. This activity represents an access rate of 36.8 per cent in 2019/20 – the NHS has thereby exceeded the FYFVMH access target of 35 per cent of prevalence by 2020/21.
17. Progress against FYFVMH, including the 2019/20 access rate of 36.8 per cent, continues to be based on prevalence data extrapolated from the 2004 prevalence survey, 2016 ONS population data and annual clinical commissioning group (CCG) plans that were available at the time.
18. Based on more recent prevalence headlines from the 2017 ONS, NatCen and NHS Digital Children and Young People’s mental health prevalence survey, and on more recent population figures, we estimate the 2019/20 access rate to be approximately 34.7 per cent of prevalence. It is worth noting that the FYFVMH set an expectation of 34 per cent access for 2019/20 in the trajectories.
19. Although two contacts is viewed as a proxy for starting treatment, more recent evidence shows that in many cases one contact can deliver appropriate support or treatment depending on the nature of the presenting problem.
20. Whilst there was a drop in referrals to CYP MH services early in the pandemic, referral rates recovered and then exceeded pre-pandemic rates. CYP mental health services maintained access to services, thanks also to an increase in digital access to services.
21. The CYP MH workforce benchmarking report for HEE reported a 22 per cent increase in headcount and 23 per cent increase in Whole Time Equivalent (WTE) across the NHS in dedicated CYP MH posts, and a 17 per cent increase in WTE across the whole system between Dec 2015 and Dec 2018[]. Following an assessment of training demand, HEE has secured additional funding for 20/21 to increase its commissions to 388 recruit-to-train staff and 318 children’s wellbeing practitioner training places.
22. As of early 2021 more than 3,960 existing staff, and 1800 new staff have been trained in evidence-based interventions. These new staff include both children’s wellbeing practitioners, of which 668 have been trained and 420 began training in 19/20, and recruit-to-train staff undertaking a CYP Increasing Access to Psychological Therapies (IAPT) course. The existing staff have been trained through CYP IAPT courses, as well as a broad range of short continuing-professional-development courses in evidence-based interventions.
23. Crisis services across the country are continuing to develop and expand services in line with the LTP ambition so that by 2023/24 there will be 100 per cent mental health crisis provision for children and young people that combines crisis assessment, brief response and intensive home treatment functions.
24. In response to the pandemic, 24/7 all-age urgent mental health locally-run helplines were set up across the country in 2020. Through the helpline, people experiencing a mental health crisis, including children and young people and their parents or carers, can access advice, support and triage. The 24/7 urgent mental health lines for children and young people are an NHS Long Term Plan ambition brought forward from 2023/24.
25. NHSEI has encouraged services to be universal and deal with all calls, including from people with co-existing conditions. This includes making appropriate adjustments to support calls from autistic people. The work to encourage services to be universal has been further reinforced by a series of support webinars and various tools aimed at newly established local open-access crisis services.
Eating disorder services
26. More than 70 new or extended community eating disorder services for children and young people have now been commissioned, covering all local health systems across England. The evidenced model for delivery was published in 2015/16 to improve swift access to treatment at the earliest opportunity. The evidence shows this improves outcomes, prevents the development of entrenched illness, reduces relapse rates and need for long stays in inpatient settings.
27. In October 2020, we announced plans to implement early intervention services for young people, aged 16-25, with eating disorders in an additional 18 sites across the country. Following the progress made in expanding services for children and young people with an eating disorder, this model, First Episode Rapid Early intervention for Eating Disorders (FREED), aims to contact patients within 48 hours and begin treatment, for those who are eligible, within two to four weeks. FREED is for 16-25-year olds who have experienced an eating disorders for less than 3 years. Evidence shows that this model reduces the waiting times for assessment and treatment and that patients experience better outcomes.
28. Nationally, we have set up the first waiting time standard to improve access to eating disorders services for children and young people so that, by 2020/21, 95 per cent of children with an eating disorder will receive treatment within one week for urgent cases and within four weeks for routine cases.
29. In the context of the pandemic, all areas have been asked to continue to prioritise children and young people’s eating disorder services, and Children and Young People’s Community Eating Disorder Teams have remained open, with all teams reported having shifted to digital working, including delivering assessments and therapy via online delivery tools when clinically appropriate, while maintaining face to face appointments for urgent cases. NHSEI continues to monitor the impact of the pandemic on children, young people and their families/carers as well as services delivering care.
30. During the first 9 months of 2020/21, a total of 7,555 children and young people started treatment and 84.7 per cent started treatment within the standard timeframe. This compares with 5,831 children and young people starting treatment in the first 9 months of 2019/20 and shows a significant rise in demand. Community eating disorder services continue to step up and improve access to treatment for an increasing number of children and young people and their families.
31. The £79m additional funding for CYP MH services in 2021/22 will be used in part to boost CYP Eating Disorder services and help to address these pressures, providing services for around an additional 2,000 children and young people in 2021/22.
Perinatal mental health and early years
32. We know that maternal – and parental – mental health can be important for the mental health of children, and good mental health in early life can play an important role in later life.
33. We remain committed to improving perinatal mental health services for new mothers and their partners. From April 2019, new and expectant mothers have been able to access specialist perinatal mental health community services in every part of the country.
34. The NHS Long Term Plan includes a commitment for 66,000 women to be able to access specialist perinatal mental health care by 2023/24. Specialist care will also be available from preconception to 24 months after birth, which will provide an extra year of support. There will be increased access to evidence-based psychological therapies within specialist perinatal mental health services, and partners of women accessing these services will be offered an assessment for their own mental health, signposting to support as required.
35. NHS England has expanded the capacity of inpatient Mother and Baby units, which support women with serious mental health issues, keeping them together with their babies. An additional four eight-bed units are providing specialist care and support to mothers who experience severe mental ill health during and after pregnancy in areas of the country that had particular access issues.
36. Since 1 April 2020 it has been a contractual requirement for GPs to offer a maternal postnatal consultation at 6-8 weeks after birth which should focus on a review of the mother’s physical and mental health and general wellbeing.
37. For children aged 0-2 years old, the Secretary of State for Health and Social Care and the Prime Minister jointly commissioned the Early Years Healthy Development Review in the summer of 2020. Chaired by Rt Hon Andrea Leadsom MP, the Review looks across the ‘1,001 critical days’ from conception to the age of two, ensuring babies and young children in England can be given the best start in life. Phase 1 of the Review is in its final stages.
Support for university students
38. The transition to university can pose real challenges and we must ensure people retain access to services as they move around. In the event that students cannot access their usual university GP outside of term time then they can receive care by registering as a temporary resident elsewhere.
39. The Department of Health and Social Care and NHSEI are part of the strategic Universities UK Mental Health in Higher Education Advisory Group, which has a strategic aim for UK universities to be places that promote good mental health and wellbeing, enabling all students and all staff to thrive and succeed to their best potential.
40. NHSEI is working collaboratively with Universities UK to improve student mental health and reduce student suicides, which includes joint work to address recommendations set out in their recent report “Minding our Future”.
41. The Government is providing £1 million funding to the Office for Students from 2021/22 to 2022/23. The funding has been made available to higher education providers through a funding competition for digital and innovative proposals that drive improvements in mental health support and early intervention for higher education students.
42. To support those in Higher Education during the COVID-19 pandemic, the Office for Students provided up to £3 million to fund the Student Space platform to bridge gaps in mental health support for students. Student Space provides access to dedicated support services, resources and information to help students manage the challenges of student life.
Services for 18 – 25-year olds
43. We know that the transition from children’s mental health services to adult mental health services can cause distress to young people and young adults, which is why the NHS Long Term Plan commits to services being adapted to create a comprehensive offer for 0-25-year olds.
44. NHSEI commissioned the National Collaborating Centre for Mental Health to undertake a review of existing young adult services. The findings set out general principles and key considerations to inform the development of new MH services for young adults up to 25 which should take account of local context, including consideration of existing services
45. All STPs/Integrated Care Systems (ICSs) will benefit from three years’ increasing amounts of transformation funding to deliver these new models of primary and community mental health care between 2021/22 and 2023/24.
46. All transformation plans will set out how services and systems will deliver a new integrated approach to young adult mental health services for people aged 18-25 through partnership working between adult and CYPMH commissioners and services.
47. NHSEI has established a transitions collaborative to support provider trusts to promote a coordinated approach and deliver safe and effective transitional care.
Self-harm and Suicide Prevention
48. Turning to suicide and self-harm prevention, every suicide is a preventable tragedy that has a profound effect on families and communities. We are committed to reducing suicide rates amongst all age groups, not least children and young people.
49. Although suicides among children are relatively rare, we are concerned about increases in suicide and self-harm amongst teenagers and young people.
50. Suicide rates are low amongst children and young people aged 10 to 24 years compared to other groups. Office for National Statistics publication Suicides in England and Wales: 2019 registrations shows, however, that rates have increased in recent years. Following a period of relative stability in the rate among females aged 10 to 24 years, since 2012 the rate has increased by 93.8 per cent from 1.6 deaths per 100,000 females (81 deaths) to 3.1 in 2019 (159 deaths). Similarly, the suicide rate amongst males aged 10 to 24 years increased from 6.5 deaths per 100,000 males (345 deaths) in 2017 to 8.2 deaths per 100,000 males (440 deaths) in 2018, and the rate has remained the same in 2019 (8.2) with 442 deaths.
51. Access to early data on suspected suicides can help local areas to better monitor suicide rates in real time, identify patterns of risk and causal factors, and address any suspected suicide clusters. Launched April 2019, the National Child Mortality Database (NMCD) records information about all children in England who die before their 18th birthday. Notification must be provided within 48 hours of death; this can therefore be used for the real-time surveillance of child suicide deaths. The National Child Mortality Database:
52. Through the NHS Long Term Plan, we are investing £57million in suicide prevention from 2019/20. This will see investment in all areas of the country by 2023/24 to support local suicide prevention plans and establish suicide bereavement support services. We have ensured that the suicide prevention funding for local areas includes addressing self-harm and children and young people with a Learning Disability and/or Autism as a priority focus.
53. With regard to self-harm this is a complex issue and we need to do more to understand the reasons why more young people, and especially young women and girls, are doing this.
54. We know that issues such as pressures from school, bullying, body-image and issues with sexuality can be factors.
55. We also know that self-harming can present a risk of suicide, although self-harming in itself does not mean that someone may wish to complete suicide.
56. We expanded the scope of the National Suicide Prevention Strategy in 2017 to include addressing self-harm as an issue in its own right. We fund the Multi-Centre Study of Self-harm which is the most in-depth analysis and monitoring of self-harming trends in England.
57. Within the children and young people secure estate in England, there are disproportionately high levels of mental health need, and in parallel, high levels of neurodiversity including Attention Deficit Hyperactivity Disorder and Autistic Spectrum Condition.
58. NHSEI has identified that there is a very small cohort of children within the children and young people secure estate who present significant risks and who can put considerable pressure on individual settings, impacting significantly on other children in the same settings, and on the staff who care for them. There is a need to learn how to best care for these extremely high-risk, high-harm children. These children are considered for placement in the children’s secure mental health hospital estate but often fall outside admission criteria. A clinical review of these cases was commissioned in 2018 for service improvement purposes and to inform future policy and commissioning. The final version of this report is now with NHSEI and it will be reviewing the evidence and recommendations together with its partners to evaluate next steps.
59. Girls in secure settings form a small but vulnerable cohort, with complex needs across multiple domains. To develop the evidence base to support this cohort of girls, the Centre for Mental Health was commissioned by the Youth Custody Service and NHSEI in partnership to conduct a review of the needs of, and pathways for, girls and young women in the children and young people secure estate. The final report of this work is due to be published by the Centre for Mental Health in May 2021. The recommendations will be considered by a range of organisations in partnership as they will have implications for the whole pathway for the care of these girls.
60. The NHS Long Term Plan made a commitment to invest in additional support for the most vulnerable children and young people who have complex needs and can be described as presenting with high-risk, high-harm behaviours and high vulnerability. This commitment is an opportunity to strengthen and pull together existing provision around the child and intervene earlier in their pathways to enable better outcomes.
61. SECURE STAIRS is being mobilised across the whole children and young people’s estate in England. It delivers a whole-system approach to a framework for integrated care within that estate. As part of a national evaluation, there is already positive evidence for SECURE STAIRS emerging from settings where it is fully mobilised. An independent three-year evaluation of SECURE STAIRS was undertaken by the Anna Freud National Centre for Children and Families, with the final report is expected later in 2021.
62. Thirteen Community Forensic Children and Young People Mental Health services (known as FCAMHS) currently provide a specialist service for high-risk young people that would not otherwise be available. The services ensure there are clear links between youth justice and welfare provision (community and custodial), hospital secure or specialist settings for high-risk young people, and core provision whether within specific CYPMH services or other services. The services cover all NHSEI regions, ensuring equitable access to all who need them.
63. The intention in the NHS Long Term Plan is to apply The Framework for Integrated Care (currently mobilised in the children and young people secure estate) into the community to support trauma-informed care, and formulation-driven, evidence-based, whole-systems approaches to create change including improved wellbeing, reduced mental health concerns, reduced high-risk behaviour and increased stability for vulnerable children and young people with complex needs.
64. Implementation sites will be selected via an expression of interest. Seven areas will be selected, providing one in each NHSEI region (North East and Yorkshire & Humber, North West, Midlands, East of England, London, South East, and South West). These areas will be based on Integrated Care System footprints.
65. Sites will be required to demonstrate partnership working across multiple agencies, including health, local authority, education and crime agencies, demonstrating how they will deliver the framework and the outcomes within it. More detailed positive outcomes for young people will be developed and delivered locally as well as plans in the expansion of the framework to multiple cohorts of young people.
66. We want to ensure that more children and young people can access appropriate support in the community, and that those that require inpatient care are treated in a safe and compassionate environment and as close to home as possible.
67. We are committed to eliminating inappropriate placements to inpatient beds for children and young people, including both placements to inappropriate settings and to inappropriate locations far from the child or young person’s home (out of area treatments), and had committed to do so by 2020/21. However, the pandemic is creating pressures on services, with an impact on both service capacity and the mental health of children and young people with increases in acuity. The NHS continues to prioritise reductions in inappropriate placements, but will take longer in the light of those pressures to achieve its target.
68. For those children and young people who do require inpatient care, it is only right that they are treated and cared for in a safe, compassionate environment. We continue to take measures to ensure that restrictive interventions and restraint should only ever be used as a last resort, when all attempts to de-escalate a situation have been employed.
69. Staff’s education and training are central to promoting and supporting calm, safe and respectful environments where the use of force is kept to an absolute minimum. It is essential that staff are properly trained to provide safe, person-centred care, where children and young people, adults and older adults are treated with dignity and respect and their views and feelings are understood.
70. In October 2019, NHSEI set up the National Quality Improvement Taskforce (improving inpatient services for children and young people with mental health, learning disabilities and autism) to respond to and act upon recommendations and improvement themes identified in high-level reviews and reports by the CQC, the Children’s Commissioner, and the Joint Committee for Human Rights.
71. The five areas of ambition include workforce, care management, quality assurance, the environment (including technology) and restrictive practices (all ages). Current implementation includes specialist autism training, human rights training and a targeted ‘safe wards’ programme to reduce restrictive practices. Additional work will see a national competency framework for all staff and certification arrangements for health care assistants.
72. The Taskforce work programme is overseen by Anne Longfield the previous Children’s Commissioner and is co-produced with an established Parent’s Council.
73. The NHS has been working with arm’s-length bodies on a cross sector improvement programme to reduce reliance on restrictive practices. As part of this work and in order to ensure consistent standards across the NHS, NHSEI with HEE, the CQC, Directors of Adult Social Services, Skills for Care, and the Local Government Association, agreed to introduce new standards, and a certification scheme, to improve training that includes restrictive practices. All NHS Providers are now contractually required to ensure that staff who use restrictive practices are trained in accordance with the new national standards.
74. The Mental Health Units (Use of Force) Act, also known as Seni’s Law received Royal Assent in November 2018. The purpose of the Act is to increase the oversight, management and accountability of the use of force (restraint) in mental health units so that force is reduced to a minimum and only ever used as a last resort. Through the collection of accurate data, it will allow issues around the disproportionality in the use of force to be identified and allow targeted action to tackle them.
75. The Act requires units to produce policies and information for patients, keep a record of how and when force (physical, mechanical, chemical and isolation) is used, and improved staff training in prevention, de-escalation and the safe use of force.
76. Department of Health and Social Care officials are working closely with stakeholders to develop the statutory guidance on the Act, this includes experts in the field of restrictive interventions, people with lived experience, regulators, and the charitable sector. The statutory guidance will set out how we expect mental health services to implement the requirements of the Act. We remain fully committed to publishing the draft statutory guidance for the Mental Health Units (Use of Force) Act 2018 as soon as it is possible to do so. We will also set out a timetable for publishing the statutory guidance and commencing the Act at the earliest opportunity. Whilst awaiting the statutory guidance NHSEI has, via the Quality Improvement Taskforce described above, undertaken a gap analysis to identify areas for priority intervention to address the requirements of the Act.
77. In 2018, the Secretary of State commissioned the CQC to look at the use of restrictive interventions in places that provide care for people with mental health conditions, a learning disability and autism by undertaking a thematic review into Restraint, Seclusion and Segregation.
78. The CQC produced an interim report on the review in May 2019, ‘Segregation in mental health wards for children and young people and in wards for people with a learning disability and autism’, and DHSC accepted all its recommendations.
79. One of the recommendations was to carry out an independent Care (Education) and Treatment Review (CETR) for people with a learning disability and autistic people who were in long term segregation in a mental health inpatient setting. All 77 (11 of which were under 18) planned independent case reviews were undertaken in 2019/20 and recommendations, support and actions taken to improve care circumstances and actions taken to outline steps to move individuals to less restrictive settings. An Oversight Panel, with Baroness Sheila Hollins as independent chair, has been established to analyse the thematic findings from these independent reviews and to develop recommendations to improve the quality of care in inpatient settings and reduce the use of restrictive practices. The Panel has been meeting since June 2019 and will report its findings and recommendations soon.
80. The Secretary of State for Health and Social Care commissioned the CQC to undertake a review published on 22 October 2020 (‘Out of Sight – who cares?’), prompted by rising concerns over the use of restraint and seclusion in mental health hospitals.
81. We are committed to ensuring that people with a learning disability and autistic people receive the best standard of inpatient care possible and that their rights are protected at all times. We are already taking action on many of the recommendations made by the CQC in their report. We will formally respond to the CQC report soon.
82. For autistic children and young people and those with a learning disability, we are clear that they must receive high-quality care and support, especially those who may be at a particularly vulnerable time in their lives, in crisis or receiving treatment in mental health inpatient settings. As a response to Covid-19, further proactive admission-avoidance measures were taken, including strengthening CETR requirements and investment in short breaks in the community.
83. In 2020/21, NHSEI has piloted a keyworker programme for autistic children and young people, and children with a learning disability, with the most complex needs, starting with those in specialist mental health inpatient care.
84. When mental health inpatient care is the most appropriate option for providing care and support to individuals, we are clear that this should be for as short a time, as close to home and be as unrestrictive as possible.
 Government Response to the Consultation on Transforming Children and Young People’s Mental Health Provision: a Green Paper and Next Steps, 2018. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/728892/government-response-to-consultation-on-transforming-children-and-young-peoples-mental-health.pdf
 ‘Feeling Heard’ https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/942529/JTAI_-_partner_agencies_and_children_with_mental_ill_health.pdf
 The Five Year Forward View for Mental Health children and young people’s mental health access ambitions are framed and costed based on ONS prevalence data from 2004, with subnational prevalence and CCG ambitions derived from the 2004 position and agreed with CCGs.