Written evidence submitted by YoungMinds (DEL0096)
1.0) I am writing on behalf of YoungMinds to provide a written submission to your Committee’s inquiry into delivering core NHS and care services during the coronavirus pandemic and beyond.
1.1) YoungMinds is the leading children and young people’s mental health charity in the UK, and we put the experiences of children, young people and families at the heart of everything we do. This submission will draw on the insights and lived experiences of the children, young people, parents, carers and professionals that we work with and wider research.
2.0) The COVID-19 coronavirus pandemic is the biggest health crisis for generations, and it is having a devastating impact on the lives of people across the world. The measures that the UK Government is taking to address the crisis, including restrictions on movement and the closure of schools to most students, have been necessary to save lives. However, the pandemic is also likely to have an impact on children and young people’s mental health, both now and in the future.
2.1) As the terms of the inquiry acknowledge, it is vital to ensure that the gains made over the past five years in terms of young people’s mental health are not wasted as a result of the pandemic, and that there is capacity to meet any extra demand that arises from its impact. Balancing the usual demands on the healthcare system and the extra demands which coronavirus has placed on its infrastructure is delicate and we recognise that hard decisions will have to be made over the coming weeks and months. Despite this, it is imperative that young people’s mental health remains a consideration at the forefront of decision-making.
2.2) This submission outlines the impact that the coronavirus is having on young people’s mental health. It will provide context in terms of the substantive gains made in recent years; our insights from young people and parents on their experience of service delivery during the pandemic; factors likely to create an increase in demand for young people’s mental health services during and after the pandemic; and recommendations to ensure that service delivery meets the needs of young people, particularly in the context of a likely increase in demand.
3.0) Children and young people's mental health services have historically been disjointed and inconsistent across the country, although we have seen positive changes in recent years. The Government has made real strides to improve access to, and the quality and experience of NHS services through the Five Year Forward View for Mental Health, the Green Paper on Children and Young People’s Mental Health and the ambitious proposals in the NHS Long-Term Plan.
3.1) Despite these improvements, average waiting times varied from around three weeks to around four months across CCGs in 2018/19, and there was also considerable variation in access criteria. While recent initiatives, including those outlined in the NHS Long Term Plan, aim to improve access to services, only around one-third of children and young people with a diagnosable mental health problem currently receive NHS support. Access to other forms of support, including that provided through schools or through the voluntary sector, also varies considerably across the country.
3.2) In the current extraordinarily difficult situation, NHS workers, private practitioners, school and university counsellors, charities, youth sector services and helplines are all doing their utmost to provide help where they can, often moving their support online in rapidly changing circumstances. However, many children and young people who were accessing some form of mental health support are no longer able to do so. Other young people – including those who have experienced bereavement, abuse or domestic violence – are likely to need support in future.
Our findings on access to mental health services
4.0) Research we have carried out clearly shows that the pandemic itself is having a negative impact on young people’s mental health, in addition to affecting whether, and how, young people can access core mental health services.
4.1) In March we carried out a survey with 2,111 young people with a history of mental health needs. 83% of respondents agreed that the pandemic was making their mental health worse. The key factors that young people said had affected their mental health were concerns about their family’s health, school and university closures, loss of routine and loss of social connection.
4.2) Among respondents who were accessing mental health support in the lead-up to the crisis (including from the NHS, as well as private providers, schools and charities), 26% said that they were no longer able to access any support. Some young people had experienced cancellations due to schools closing, not being able to attend peer support groups or because services that had been delivered face-to-face could not be provided online or by phone. As one young person told us, “all my appointments have been cancelled. I cannot access help at school. Helpline waiting times are really long.”
4.3) While 74% of respondents said that they were still getting some level of mental health support, for most the quality of support and frequency of support appeared to have reduced. A young person that responded to the survey told us, “I can’t have face to face contact with the mental health nurse I work with so we can only have short phone conversations, which don’t provide as much support and my mental health including anxiety and paranoia has deteriorated.”
5.0) Given the need to maintain social distancing, the most prominent medium of delivering mental health support during the coronavirus pandemic is digital support. This can be a lifeline for some young people and allows them to continue the treatment that they need for their mental health. However, our research and that of others has found that this is not always appropriate for young people with existing mental health concerns, which ultimately reduces their equality of access to the services that are instrumental to their mental health care. In 2019, it was estimated that 60,000 11-18-year olds do not have any form of internet connectivity at home, with a further 700,000 lacking a desktop, laptop or tablet at home. As the Children’s Commissioner highlights, for these young people ‘the only device might be a mobile phone. While some connectivity is better than none, these children are still very limited in what they can do online. Many websites and services cannot be properly accessed on a mobile’.
5.1) The struggle to access continued support has also been reflected in our work with parents and carers of young people with mental health difficulties. We conducted a survey with 1,679 parents and carers from Thursday 9th April to Monday 20th April to find out what impact the pandemic and the restrictions on movement were having on the mental health of the children and young people in their care. A significant issue for respondents was the lack of continuity in the contact that they had received from mental health services, in tandem with a lack of guidance on how best to support their child during the pandemic.
5.2) To address the reduction in support available to young people, NHS England has rapidly introduced urgent 24/7 mental health helplines to provide mental health support, including to children, young people and parents, across England. These helplines are welcome, but their availability has not yet been well publicised in most areas - so many young people, parents and professionals looking for support will not know about them. Equally, these helplines are only intended for use by young people that are experiencing a mental health crisis as opposed to a long term and sustained mental health intervention.
5.3) There is clear evidence that a disruption in care can have a lasting impact on a young person’s mental health. The risk of disengagement from services has been demonstrated in the literature concerning transitions from CAMHS to AMHS. As Singh (2009) writes, those that ‘slip through the care net’ are likely to present to adult services later, where they may have developed severe and enduring mental health problems. It is therefore imperative that young people and their families have access to continued mental health care both during and after lockdown wherever possible.
Reduction in referrals and impact on voluntary sector
6.0) Alongside the reduced availability of support for those previously accessing NHS mental health services, there is evidence of a reduction in new referrals.
6.1) Some areas, including Birmingham Women’s and Children’s Foundation Trust, have reported that there has been ‘a 50 per cent reduction in referrals since the Covid-19 crisis first struck in March’. This is likely to be because schools were a key referral route for NHS mental health services, and are now far less able to identify and refer children who are struggling with their mental health; because of reduced access to GPs; and because of young people and parents making the decision not to seek support, due to a perception that the NHS is overstretched as a result of the coronavirus pandemic, even when their mental health needs are severe.
6.2) As a result of this reduction in referrals, it is likely that there will be an increase in the number of referrals following the relaxation of the lockdown over the coming months. With our transition out of lockdown currently so uncertain, it is difficult to predict how sharp or gradual this rise will be, and should there be subsequent tightening of restrictions again, this would also likely have an impact on any future pattern of referrals.
6.3) With fewer children and young people currently accessing NHS services or support through schools, the role of charities, youth organisations and helplines is crucial. There has been an increase in calls to services like Childline, Calm and The Mix, alongside an increase in traffic to websites providing advice, such as the YoungMinds website. However, this increase in demand comes in the context of pressure on funding for voluntary and youth sector organisations.
6.4) The steps that the Government has taken to address this – including a £5 million fund for organisations providing mental health support – are welcome, but fall well short of meeting the scale of need. While many voluntary sector providers of mental health support have been quick to adapt to the changing landscape – moving support online, and using innovative approaches to safe service delivery - there remain gaps in infrastructure and funding which threaten the long term sustainability of these efforts.
Increase in mental health needs beyond the pandemic
7.0) As well as increased demand from young people with existing mental health needs, there is likely to be a rise in young people with emerging needs who will be looking to access community and NHS mental health services for the first time due to the pandemic.
7.1) A recent position paper from The Lancet and mental health research charity MQ notes that children and young people ‘will be affected by school closures. They might also be affected by exposure to substance misuse, gambling, domestic violence and child maltreatment, absence of free school meals, accommodation issues and overcrowding, parental employment, and change and disruption of social networks.’ This is particularly pertinent as schools are often the first place that young people seek help for their mental health and for young people with vulnerabilities such as special educational needs, the lack of accessible and suitable support is likely to have a deeply detrimental effect.
7.2) Additionally, as a separate recent Lancet study shows, quarantine and isolation can have negative psychological effects including on low mood, irritability, PTSD, confusion and anger. Recent research by the Mental Health Foundation indicates that the coronavirus pandemic and the measures to stop the spread of the virus are increasing loneliness and particularly for young people. Their research shows that young adults in Scotland (aged 18-24) were the most likely group of adults to experience loneliness, with 43% reporting so. Their research also suggests that feelings of loneliness have more than doubled over the lockdown period.
7.3) The environmental aspects of the pandemic are also a factor which is likely to contribute to a rise in demand for mental health services. A report by the Resolution Foundation notes that though young people can undertake physical activity indoors, it has been shown to lack the mental wellbeing benefits that exercise undertaken outdoors provides. As the report acknowledges, this will have particular repercussions for young people who do not have access to a garden and are likely to be relatively disadvantaged in terms of access to local public green spaces.
7.4) The same report also cautions that for some young people, lack of access to digital resources to complete work whilst they are not in school, and to remain connected to friends and family members, will have an adverse impact on mental health, affecting both young people with existing mental health needs and those without. A recent policy paper from the Children’s Commissioner acknowledges that as well as ensuring that young people do not fall behind with school or college work, adequate access to digital resources is a key factor in combatting mental health concerns during the pandemic.
7.5) The above clearly illustrates that there are many aspects of the pandemic which will lead to an increase in demand. Given the amount of young people that are experiencing a disruption in their care during the lockdown and the expected increase in young people with emerging mental health conditions, it is possible that services will be overwhelmed by the numbers of young people looking for support in the transitionary period over the coming months.
8.0) To address the likely increased demand for service provision for young people with existing or emerging mental health needs, there needs to be a systematic approach to enhancing community mental health support, . We recommend that the following are immediately implemented to expand the frequency and quality of care that young people are receiving for their mental health:
9.0) While the above recommendations are likely to go some way to reduce immediate demand and therefore pressure on core NHS mental health services, we know that in the long term the NHS will not be able to manage the level of need on its own. In light of this, we have produced a set of recommendations outlining measures the Government should take to both reduce the level of need and help the NHS manage demand. Over the next six months the Government must:
If you would like to discuss any of the points raised in this submission then please do not hesitate to get in contact. Additionally, if you are holding any evidence sessions with people who have accessed or attempted to access mental health support during the pandemic, we would be happy to discuss involvement from YoungMinds’ Youth Activists.
Policy and Parliamentary Officer
 The survey was conducted between Friday 20th March, the day on which schools closed to most students and Wednesday 25th March, when further restrictive measures had been put in place. Full details can be found in the report: https://youngminds.org.uk/media/3708/coronavirus-report_march2020.pdf
 Singh et al (2010) Transition from CAMHS to Adult Mental Health Services (TRACK): A Study of Service Organisation, Policies, Process and User and Carer Perspectives. Available at: http://www.netscc.ac.uk/hsdr/files/project/SDO_FR_08-1613-117_V01.pdf