Crisis care for children and young people with mental health problems: national mapping, models of delivery, sustainability and experience (CAMH-Crisis2)

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. However, 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.

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:

1. 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.

2. 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.

3. To compare and contrast these services in the context of the available international evidence, drawing out clear implications for the design and delivery of future crisis responses for children and young people and their families.

To help us 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 the detailed record created in meeting objective one 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 interview

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, closing our project by drawing clear, actionable, lessons for the future commissioning and provision of high-quality crisis responses sensitive to the support and access needs of a diverse range of children and young people receiving care from a range of services.