Access to mental health services for children and young people in Birmingham: what needs to change?

In December 2020, Healthwatch Birmingham decided to investigate the quality of mental health services provided by Forward Thinking Birmingham (FTB) for children and young people (CYP). The objective was to gather the views of services users and use these to drive better access to FTB’s mental health services in Birmingham. The investigation heard from service users as well as their parents and carers, and explored the range of their experience with mental health provision. These included ease of access, barriers and challenges faced, what has worked well, and what service users say needs to change to provide a better service. Research also included coverage of services provided during the Covid-19 (coronavirus) pandemic

Methodology:

A combination of an online survey and telephone interviews, between March and June 2021, were used to hear people’s experiences. In total, we heard 213 people’s experiences of FTB services. An online questionnaire was distributed widely among third sector organisations, FTB and on Healthwatch Birmingham’s social media platform. It received 203 responses, with 102 of these being children or young people, and the remainder being parents/carers. In addition, a further 10 respondents were interviewed.

Findings:

• Service users reported detecting a sense of helplessness across the service, with respondents telling us, ‘Staff have lost whatever it is that led them to work in mental health for young people’ and ‘It’s not a lack of knowledge of the issues [raised in our survey], but a lack of accountability’. Below are some of the themes from the experiences we heard.
• Long waiting times from referral to assessments are impacting the ability of the service to intervene early and prevent deterioration in the mental health of some young people.
• Lack of care plans outlining conditions, interventions, and expected outcomes for some CYP means that their needs are poorly identified which affects treatment and outcomes.
• Some CYP and parents/carers told us the mental health service is fragmented and bureaucratic, creating barriers to access and negatively impacting outcomes.
• Some CYP and parents/carers told us their mental health has deteriorated following the use of mental health services.
• Some CYP and their parents feel they have to fight and often have to rely on A & E to access mental health services. Consequently, CYP and parents/carers are unable to speak up or are unaware of their rights, in relation to using mental health services, and are unlikely to access services.
• Mental health support for CYP with other conditions needs to be reviewed and improved in order to address their specific needs i.e. autistic, Asperger’s, learning disability etc.
• Long waiting times for treatment mean some CYP and parents/carers opt not to access services with others paying for private care.
• Poor treatment from some practitioners is leading some CYP to opt out of services despite still needing support.
• Although most parents feel involved, they do not feel listened to and their views taken into consideration. Delays in support often lead to poorer outcomes for CYP, in some cases resulting in sectioning.
• Frequent staff changes means that there is no continuity in care/treatment leading to variable outcomes for some CYP.
• The service provided by the Crisis team is considered poor in its response to some CYP. This includes the time taken to respond and the opening hours of the service.
• Most CYP and parents/carers believe that face-to-face assessments and treatment are crucial for addressing mental health.

Recommendations:

CYP and parents/carers would like to see the following changes to FTB:

• Provide early intervention and prevention
• Provide treatment that is timely, comprehensive and meets individual needs
• Improve the capacity and capability of staff, including staff attitudes
• Provide personalised/person-centred care and comprehensive, outcomes-focused care plans
• Support families to cope better with mental illness, and involve them where appropriate
• Remove obstacles to support
• Ensure co-production underpins practice and decision-making
• Improve access to services, including community services, with a particular focus on parts of Birmingham
• Service review and improvement
• Introduce a model of care for young people aged 18-25 4 Birmingham
• Provide a seamless service, from prevention through to specialist interventions, for those with complex needs
• Improve crisis support
• Improve communication and contact
• Improve follow up care
• Improve the complaints system