Although a formal committee of Brighton & Hove City Council, the Health & Wellbeing Board has a remit which includes matters relating to the Integrated Care Board (NHS Sussex,) the Local Safeguarding Boards for Children and Adults and Healthwatch.
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Title: Children & Young People Mental Health & Wellbeing Report
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Date of Meeting: 11 Feb 2025
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Report of: This report has been compiled as a partnership approach between BHCC (Children, Families & Wellbeing), Sussex Partnership Foundation Trust, NHS Sussex Integrated Care Board, Public Health & VCSE partners
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Contact: Chas Walker
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Email: Chas.walker@brighton-hove.gov.uk
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Wards Affected: All
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FOR GENERAL RELEASE
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Executive Summary
Children & young people’s mental health and emotional wellbeing (CYP MH & EWB) is one of our health & care partnerships population health priorities. This report builds on and reports back on our progress on our partnership work, including:
· CYP MH & EWB elements of our Joint Health & Wellbeing Strategy · The CYP elements of our 2022 Mental Health Joint Strategic Needs Assessment · The aims of our Integrated Care Strategy with specific reference to CYP MH & EWB
The report demonstrates that we are making good progress against the ambition set out in these partnership strategies, acknowledging the difficult financial environment partners are working with. It highlights the work to better integrate the assets we have across the city to maximise our reach and impact. It also sets out the challenges we face with increasing levels of children and young people needing support for their mental health and emotional wellbeing in the city and the associated impact of this on the ability to access existing services, the impact this is having on individual young lives, and the longer-term implications as young people transition into adulthood with underlying mental health and emotional wellbeing needs with the impact this will have on our health and care system and wider society.
This report provides Health & Wellbeing Board (HWB) members with:
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Decisions, recommendations and any options
Brighton & Hove Health and Wellbeing Board is recommended to note the report for the purposes of information and engage in a partnership discussion to consider how we can continue to develop our partnership work to improve children and young people’s emotional health and wellbeing. |
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- Population health context
Mental health and wellbeing
1.1. Mental health problems are common - nearly two in three of us will experience a mental health problem during our lives. Stigma and discrimination can make a person’s mental health problems worse or delay them seeking help. Mental health issues affect, and are affected by, our relationships with family, friends and communities and they are both a cause and a consequence of social inequalities.
1.2. Starting Well- the foundations of life-long wellbeing are laid down in infancy and childhood. The first 1,000 days, from conception to age two, is a critical phase and secure baby and infant attachment is paramount. The needs of infants differ from primary school aged children and differ again from young people of secondary school age and above. Early adulthood for young people (between 16 to 25) is a key life stage: Half of lifetime mental health problems are established by age 14 and three quarters by age 24. Young people are making important transitions in their lives and becoming more independent. Ages 15 to 23 is a period of significant development of capabilities such as planning, self-control, flexibility, and awareness which help adults to manage life and work effectively
Level of need in the city
1.3. Our shared understanding of mental health needs in the city is informed by the all ages Brighton and Hove Mental health and Wellbeing JSNA published in 2022.[1] The JSNA showed that for children and young people in Brighton and Hove, need is higher compared to England and the South East, that it is worsening and demand is rising.
1.4. Based on national surveys of the prevalence of mental health conditions in children and young people, it is estimated that Brighton and Hove has around 7,000 children and young people aged 2 to 19 years with a mental health condition. The estimates vary by age from around 1 in 20 (5.5%) pre-school children aged 2 to 4 years to almost 1 in 6 (17%) young people aged 17 to 19. Young women aged 17 to 19 are at highest risk with an estimated 1 in 4 (24%) having a mental health condition.
1.5. There is evidence from both national and local surveys that prevalence worsened significantly for children and young people during the pandemic particularly for older age groups
1.6. The JSNA identified communities at greater risk of poor mental health and those who experience disadvantage and stigma. For some groups at higher risk of mental health problems, for example, those with special educational needs, those with experience of care, children with neurodivergence, the city has larger communities (by proportion) compared to England overall. There is a dedicated section of the assessment covering children & young people’s mental health that focuses on Improving the care and support offer for young people ensuring that they and their families are at the heart of an integrated service approach. The recommendations from the JSNA are covered in section 3 of this report
1.7. Since the publication of the JSNA, our understanding of need has been deepened through more recent local surveys and insights: the 2023 Brighton & Hove Safe & Well at School Survey (SAWSS) of pupils aged 8 to 18 years and 2024 Health Counts survey of people aged 18 years and above in the city. The SAWSS survey is conducted every two years, the most recent findings are from November 2023.[2] The Health Counts survey is conducted every 10 years and the most recent findings are from April 2024. These surveys along with national indicators and service usage data evidence that the need in the city is high and growing.
1.8.
More detailed information about
local needs is available here
· Mental health JSNA 2022 full report FINAL.pdf
· Safe & Well at School Survey 2023 by Brighton and Hove City Council - Infogram
Some of the key findings are outlined below:
· Hospital admissions for self-harm in those aged 10 to 24 years are statistically significantly higher in Brighton and Hove than England and the South East, with rates in the city in 2022/23 1.5 times higher than England
· SAWSS 2023 found whilst the majority of pupils reported good wellbeing in the latest survey in 2023 a significant minority of 12-16 yrs (12%) sometimes or often self-harm and of pupils aged 14-16 yrs (18%) experience suicidal thoughts. This peaked in the 2021 survey return and improved in 2023, however the long-term trend is negative. Struggles with issues related to food and body image were also significant for young people.
· For Health Counts respondents aged 18 to 24 years, the most commonly reported health condition was mental health (36%). Over a quarter (27%) of Health Counts respondents aged 18 to 24 years indicated they had self-harmed in the last 12 months and over one in five (23%) indicated they have ever made an attempt to take their life.
· Some groups are disproportionately affected and consistently reported higher levels of mental health problems and/or lower wellbeing: Communities identified at higher risk for children and young people (in SAWSS) were similar to those identified at higher risk for young adults (in Health Counts). SAWSS 2023 identified the following groups for children and young people: girls; older pupils, pupils who do not identify with the gender given at birth; LGB+ pupils, young carers; those who receive extra help at school; children in care and care experienced. The Health Counts survey identified similar groups for adults: Those living in more deprived areas; Adults from Mixed/multiple ethnic groups and Gypsy, Roma or Irish Traveller adults; Trans, non-binary or intersex adults (TNBI); Lesbian, gay, bisexual, queer or other non-heterosexual orientation (LGBQ+) adults; Adults with a disability; Adults with Autism and or a learning difference; Those living in temporary or emergency accommodation; Those with experience of the care system as a child/young person; residents of some areas of the city including Moulsecoomb and Bevendean, Coldean and Stanmer, Kemptown, and Central Brighton
Voices of children & young people
Insight from the Mental health and wellbeing JSNA
1.9. As part of the JSNA, views were gathered from a review of 11 recent engagement projects lead by children and young people. The engagement projects span 2020-2022 and involved hundreds of young people in primary and secondary schools and older young people aged up to 25 in the city.
1.10. Key themes:
· Equity and equality of inclusion: Work with young people whose voices are less often heard; recognise the impact of racism, take a gender sensitive approach to support the needs of young men.
· Getting help early: Ensure there is timely and tailored support; increase awareness of services in children and young people and parents; provide relatable self-care strategies; address the stigma around youth loneliness and social isolation; increase understanding of the impact of a death of a parent and going into care; expand “friends with training” to support those with eating difficulties
· Co-design and co-production and meaningful engagement: Expand involvement of peers and people with lived experience in designing and commissioning services; expand development of peer support The importance of the education setting
· Ensure a whole school approach to mental health: staff to reflect diversity of the communities they serve; train more people to be Wellbeing Ambassadors; recognise importance of transition support (primary to secondary)
Insight gathered from Young Health Watch and VCSE partners on the voice of young people
1.11. The third sector are uniquely placed to support our health & care partnership to develop important insight from young people on their MH & EWB needs. The national and famous #IAMWHOLE campaign was a VCSE and Brighton & Hove Clinical Commissioning Group collaboration. In more recent times we had the Hope Hack event that brough together 60 youth ambassadors from schools and colleges across the city, where mental health was one of the core themes. Overarching themes from CYP insight, developed by the VCSE sector,include:
· Stigma and lack of understanding prevents young people from seeking and accessing the help they need
· Cost of living is impacting and putting pressure on families. That pressure is have a direct impact on young people’s emotional wellbeing as families cut back
· Safe spaces and increased support and understanding in our schools and colleges to help young people manage their MH & EWB needs
· Young people do experience significant social isolation and need opportunities to make friends, experience new things and socialise
· Help when young people need it, waiting lists for support mean young people can wait months to get the help they need, exacerbating their MH & EWB needs. Can more be done to support CYP when they are waiting for specialist support?
1.12. Young Healthwatch Brighton and Hove wanted to know what young people know about the mental health support available in their school, and what were their ideas around what could be improved. They worked closely with 3 secondary schools in Brighton & Hove asking students their views on wellbeing and mental health support in schools, and what kinds of school-based support worked well, what didn't, & what else could be offered. Key recommendations were
· Schools need to communicate more clearly where mental health support is available in their school.
· Identify the spaces in schools where vulnerable young people may be spending time and recognise the potential for them to provide a more supportive atmosphere and signpost to information and help.
· Provide alternative tools for understanding & managing feelings. Many students felt they lacked spaces to be angry, to cry, or to express themselves in an energetic way without causing disruption or being discouraged.
Appended is the full consultation findings are appended to this report
2.1. The THRIVE Framework is a model for providing mental health services to children, young people, and their families. It's based on the idea that mental health and well-being can be promoted across the population. The model is person-centered and needs-led, and it emphasizes prevention. A wide range of support and services is delivered to children and young people throughout the THRIVE Framework by health, care and voluntary and community sector organisations throughout a wide range of settings including within schools.
2.2. Across Brighton & Hove we have good range of services that support CYP MH & EWB. This includes significant assets across communities, schools and our mental health care services supporting early help, prevention and access for more formal therapeutic and mental health services
2.3. Our local VCSE sector provides a significant level of infrastructure and delivery assets that support CYP MH & EWB in the THRIVE framework areas of getting advice and help . A lot of these services support known areas of deprivation in the city and particular young person population groups who are at greater risk of poor mental health and emotional wellbeing. The Council have worked hard to protect investment into youth work through its community grants programme and to support new capital investment into youth work building infrastructure including the new Brighton Youth Centre development and the new youth hub investments in Hangleton and Knoll and Moulsecoomb. The VCSE sector also provides important targeted service resources through its youth advice centres run by YMCA DownsLink Group, Clock Tower Sanctuary and Impact Initiatives. These targeted services are an essential point of access for young people experiencing compounding social and mental health needs in supporting their safety. The services delivered through our youth work investment are essential to our wider aims to ensure a preventative approach to supporting CYP MH & EWB. We know that what works and creates change for CYP is relationship-based work and VCSE are experts in creating and maintaining the necessary trusted relationships.
2.4. We also have a strong CYP MH & EWB across our schools and colleges with our educational partners working closely with health, local authority and VCSE partners to ensures CYP can access support through their local schools. A lot of this work is led through the Councils Schools Mental Health Service this service works closely and in educational settings across the city providing over 6,500 contacts with children, young people and their families. The services include:
· brief interventions to support children and young people’s mental health, this can be individual or with key adults
· group work with children and young people
· mental health consultations to professionals involved with children and young people
· training and reflective practice for professionals
· workshops and groups for parent carers
· mental health consultations with parents concerned about their child or young person
In addition to the Schools Mental Health Service, schools and colleges contract directly with counsellors or specialist counselling organisations like YMCA Dialogue to provide additional support to pupils. Last year YMCA Dialogue provided counselling to 577 CYP and support to 168 parents and carers
2.5. The Brighton and Hove Wellbeing Service is a partnership between Sussex Partnership NHS Foundation Trust, YMCA DownsLink Group and Southdown. It is the front door, in the city, for all mental health referrals for children and young people (CYP) aged 4-25s in the city, including CAMHS. The service offers a wide range of short-term support options for CYP with mild to moderate mental health needs. Support is delivered through British Association of Counselling and Psychotherapy (BACP) accredited counselling and therapy services to CYP in Brighton & Hove offering one-to-one interventions in-person, group sessions in-person, online services in the community as well as in schools and colleges across the city. Wellbeing offers a range of support including Talking Therapies, Dramatherapy, Art Therapy, Parent and Family Support and has discrete treatment pathways for neurodivergent and LGBTQ+ people.
2.6. Partners have worked closely together to ensure a multi-agency triage is delivered through the Wellbeing Service working closely with the Councils Schools Mental Health Service.
2.7. The challenge we face is that even with this range of services supporting the THRIVE Framework we are still seeing growing numbers of children & young people needing to access services that support moderate and high levels of need. This growing demand is seeing waiting lists for services increase with some children, young people and their families waiting for excessive periods of time for services. This becomes a problematic cycle as children & young peoples mental health & emotional welling can further deteriorate whilst waiting for the right support. The graph below shows the growing demand on CAMHS services over the last few years. This increasing demand is against the backdrop of significant pressure on statutory partner budgets and the same increasing demand in adult mental health services
Whole family approach
2.8. Family hubs and the start of life programme is a national initiative aimed at joining up and enhancing services through local family hubs ensuring all families can access the support and help they need. Brighton & Hove Family Hubs operate across four sites in the city. A key focus of Family Hubs is the wellbeing of the whole family and the city’s Family Hubs are supported by the Schools Mental Health Service and support families to access a wide range of help and support for their MH & EWB needs
- Health & Care Partnership work to support CYP MH & EWB
3.1. The Sussex Integrated Care Strategy, Improving-Lives-Together, sets out an ambition in through its Shared Delivery Plan- we will agree and develop a system approach to children and young people requiring an acute response from CAMHS services as part of the wider support network. This ambition is aligned with the original external review, Foundations for our Future , which was commissioned by the pan Sussex Clinical Commissioning Groups and three Local Authorities in 2018/19. The Foundations for our Future strategy, which followed the review, partners agreed four key areas for change that will bring about the greatest emotional wellbeing and mental health benefits to local children, young people and families in five years (2022 – 2027). These are:
· Prevention – addressing issues that impact mental health
· Early help and access to support
· Specialist and timely support to meet high and complex needs
· Support for life transitions
3.2. The children and young people’s mental health transformation programme of work is overseen by the Sussex Mental Health, Learning Disability and Autism (MHLDA) Delivery Board, and also reports to the Sussex Children and Young People’s Board. The Sussex Children and Young People’s Mental Health Delivery Group has been established by the MHLDA Delivery Board to ensure the delivery of agreed programmes of work and achievement of required outcomes. The delivery group is multi-agency and representatives from Brighton and Hove are members for the group. Appended to this report a more detailed update on the Sussex Children and Young Peoples Emotional Wellbeing and Mental Health Development Programme that is delivered through these partnership structures
3.3. Locally our joint health & wellbeing strategy sets out under, Starting Well, the aim to reduce risks to good emotional health and wellbeing will be addressed, including parental substance misuse and domestic abuse, and mental health services will be easier to access. There is clear focus on addressing the needs of families to ensure children grow up in environments that promote their positive wellbeing
3.4. In 2022 we published the Mental health JSNA for the city. There is a dedicated section of the assessment covering children & young people’s mental health that focuses on Improving the care and support offer for young people ensuring that they and their families are at the heart of an integrated service approach. The JSNA came up with the following recommendations to respond to the assessment finding, relating to CYP
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MH JSNA recommendations for children & young people |
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5.1 |
Adult and children mental health services should have a dedicated transition function to ensure there is continuity of care for young people |
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5.2 |
Ensure that mental health services are tailored to needs of young people particularly those aged 16 to 25 |
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5.3 |
Commissioners and providers to ensure adult and children’s mental health services take a whole family approach to mental health. For example, adults’ services to take account of the potential impact of poor parental mental health on children and vice versa |
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5.4 |
Expand capacity to meet unmet need in children and young people. In particular in areas where there are rapidly growing needs or large unmet need such as substance use, eating disorder, neurodivergence assessment, self-harm, body image |
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MH JSNA recommendations service transformation |
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4.3 |
Shift the balance of investment to increase support for children and young people with mental health and wellbeing problems to bring a lifetime of benefits to young people, their families, communities and the economy. |
3.5. As well as the Sussex Integrated Care Partnership work, we have included in our local Place-based Shared Delivery Plan a specific partnership objective around the development of a joint triage for the Wellbeing Service, CAMHS and Schools Mental Health Service. As detailed in points 2.5 and 2.6 this work has been successfully implemented and we will be considering over the coming months an objective in next year’s Shared Delivery Plan to continue to support our partnership work in this area
- HWB member discussion on the progress on delivering on the recommendations from the 2022 JSNA supporting children & young peoples mental health & emotional wellbeing
Presentation will be provided on the day of the Board meeting to support the discussion
5. Important considerations and implications
5.1. Legal: The availability of assessment and treatment services in relation to mental health are important for a range of agencies to meet their legal obligations in terms of health, wellbeing, education, and support services to young people and their families.
Lawyer consulted: Natasha Watson Date:3.2.25
5.2. Finance:
There are no contractual financial implications to this report. The report identifies known pressures on statutory partner budgets impacting the ability to deliver some of the original partnership aims are set out in the main report
Finance Officer consulted: Jane Stockton Date: 3.2.25
5.3 Equalities:
Set out within the main report
5.4 Sustainability:
None
5.5 Health, social care, children’s services and public health:
Set out within the main report
6 Supporting documents and information
1 Sussex Children and Young Peoples Emotional Wellbeing and Mental Health Development Programme
2 Young Healthwatch schools wellbeing service report