To deliver the commitments in its long-term plan the NHS will need to use the voluntary sector.

The role of civil society in improving services for children’s and adolescent’s mental health.

Yesterday and today I am exploring two of the commitments already made by the Government which will be a part of the NHS long-term plan announced in December. In particular I am explaining why – for me at any rate – these improved health care outcomes cannot be achieved without extensive partnerships with the voluntary sector and civil society organisations.

I make this point to emphasise how even a very large state organisation such as the NHS is not able to solve some important healthcare problems without an extensive relationship with external voluntary endeavours.

Yesterday I looked at the role of ‘social prescribing’ as outlined in the Prime Minister’s plan to attack loneliness. Today I want to look at the pledge to improve services for children’s and adolescent’s mental health services.

This has been announced in general terms by the Prime Minister on a couple of occasions and is certain to form a part of the long-term plan. There is a general feeling beyond the NHS that nowhere near enough is being done to assist children and young people with mental health problems.

This doesn’t just come from people’s experience of mental health services, but from a widespread belief that children and young people in 2018 are facing much greater challenges to their mental health than have previous generations. Thus, first and foremost, there is the issue of economic, social and environmental pressures on young people’s mental health, and a secondary issue of mental health services.

The first is one that goes much, much wider than the NHS and involves very deep and important changes in our society. Civil society, already engaging with this issue, will have to be much more extensively involved.

However whatever civil society may do, the truth is that within the NHS itself, there are nowhere near enough resources to provide anywhere near adequate mental services for children and adolescents. The NHS 10-year plan is therefore bound to announce a considerable increase in NHS resources to meet the shortfall. We need more extensive mental health services for children and young people and they need to involve all aspects of mental healthcare from the light to the heavy end of interventions.

There are however two problems.

First it will take years (maybe all 10 years of the long-term plan) for there to be a sufficient increase in trained nurses and other professional mental health staff. Last week it was reported that the number of psychiatrists working with children and young people has declined over the last year. So if we want to greatly increase the numbers of trained psychiatrists it will probably take longer than the duration of the plan.

Overall, as of autumn 2018, the NHS is short of 40,000 nurses. Most of the pledges in the long-term plan will include extra professional staff and given the changes in the international terms of trade for these people, the English NHS is as likely to lose staff over the next decade as to gain them. Whilst the plan will argue for many more professionally trained mental health staff, it is unlikely they will all be found by 2028.

Second, society as a whole has already made a number of wider non-medical connections about mental health that they have not made for physical health. Whilst many people are afraid of mental health issues, most recognise that stress, bullying and abuse are drivers of mental ill health. The public therefore recognise the importance of non-medical drivers for mental health issues, and perhaps a bit less so for their solutions. This is especially the case for children and young people.

Given there will not be enough trained professionals, and that society recognises the importance of wider non-medical influences on improving children’s and adolescent’s mental health, it will be possible to develop a relationship between those civil society organisations that are concerned with children and young people and the pledges about mental health.

This could take the form of specific organisations, or local groups of them, demonstrating how they play a role in improving children and young person’s mental health and in particular how they might play a role – as in social prescribing – in helping mental health services work with children and young people who are mentally distressed.

In some parts of the country there are already such organisations. But to ensure that they are present nationally will take investment. If we were to draw up a wider social plan for improving mental health services for children and young people, buying new professionally qualified staff to be employed by the NHS would only be a part of this process, not its entirety.

And, just as the NHS would have to pay professional staff as a part of that plan, so it will have to pay civil society organisations to provide mental health services.

To succeed, the long-term plan will have to include this in its financial planning for the next 10 years.

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