A Call to Action: Commissioning Mental Health Services for 16-25 year-olds

The following publication is produced by the YoungMinds Stressed Out and Struggling (SOS) Project, which

is funded by the Big Lottery Fund. The project aims to highlight the mental health needs of 16-25 year-olds,

and campaigns to improve access to and acceptability of mental health services for this age group.

YoungMinds believes that this group requires particular consideration because of the stresses and strains

they face in making the transition from adolescence to adulthood, which can compound problems already

faced by young people who are vulnerable to mental ill health.

YoungMinds is the leading children’s mental health charity, which is working within the Every Child Matters five

outcomes framework to improve the mental health of all children and young people. If you would like to find out

more about YoungMinds, please visit www.youngminds.org.uk

Other publications produced by the SOS Project include:

• Perspectives on the Causes of Mental Health Problems in Children and Adolescents, in which leading

figures from the fields of psychiatry, nutrition, foetal development, psychotherapy, attachment theory and

evolutionary psychology give their views about the causes of mental health problems.

• Higher Education Institutions and International Students’ Mental Health, which suggests ways in which

higher education institutions can help support the mental health of international students.

• Information for Higher Education Institutions on Helping Students with Personality Disorder or

Personality Difficulties.

• The Stressed Out and Struggling Mentoring Guidelines – of interest to those involved in the running and

funding of mentoring schemes.

• A briefing paper which summarises recent findings from the field of neuroscience into adolescent and young

adult brain development.

• The findings from the YoungMinds Stressed Out and Struggling Service-mapping Exercise is an invaluable

resource for all those interested in how services are meeting the needs of this age group.

• The Stressed Out and Struggling Focus Group Report – the SOS team met with a range of ordinary young

people in England and Northern Ireland to discuss what the transition from adolescence to adulthood felt like,

and what was difficult and what was easy. The report draws conclusions for policymakers about the stresses

and strains young people face today.

For further information about the project or to download these publications, please visit:

www.youngminds.org.uk/sos

STRESSED OUT & STRUGGLING: A Call to Action 1

Executive summary

Who and what is this document for?This document is for commissioners of Child and Adolescent Mental Health Services (CAMHS)

and commissioners of services for ‘Adults of Working Age’ (also known as Adult Mental Health

Services or AMHS) who, between them, commission services for young adults. The purpose of

the document is to highlight the mental health needs of young adults aged between 16 and 25

and to encourage joint working by commissioners with statutory, voluntary and private sector

providers to meet these needs.

This publication is one of several reports from the Stressed Out and Struggling (SOS) Project,

funded by the Big Lottery Fund. The project aims to raise awareness of mental health issues for

young people aged 16-25 among the general public, service users and service providers, and to

encourage better, more targeted provision of services for young adults.1

Why is commissioning so important? Commissioners are central to the planning of effective services. Their overview of local

resources and networks supports joint planning and closer working relationships between

agencies. Commissioners work with housing, education, recreation and employment services,

as well as with dedicated mental health services, to develop effective provision.

What do commissioners need to consider?We suggest commissioners and providers should constantly be asking themselves the following

question: “What would I want for myself as a young person or for a member of my family?”

• Would I want treatment from a service that is interested in my views and feedback?

• Would I want a hospital out-patient appointment at a time that suits me, and quickly, or in

three months’ time?

• Would I want a choice of evidence-based treatment, including ‘talking therapies’, with clear

advice about the strengths and weaknesses of each approach?

• If I had a severe mental illness, would I want to keep using a service that usually engaged

me through coercion or hospitalisation?

• Can I still have hope for the future – that I will go to college, get a job, be in a relationship?

• Is it acceptable that services refuse to talk to me, as a parent of a service user, on the

grounds of confidentiality, but expect me and my family to cope as the key supporters; or

indeed that they offer me no support to deal with the impact on my family and me?

Why is it so important to get services right for 16-25 year-olds?Young people in the UK between the ages of 16 and 25 are in a state of transition:

• From the world of education to the world of work.

• From a dependent relationship, being parented in some form, to being independent and,

for some, to being a parent.

• From dependent living in a home environment, to independent living and creating their

own environment.

2 STRESSED OUT & STRUGGLING: A Call to Action

Commissioners of services for young adults need to be aware that:

• The brain is still developing up to the age of 25 and beyond, with the early adult years being

critical for the formation of self-image, social skills and impulse control.2

• Adolescent mental health in the UK is deteriorating, with emotional problems and conduct

problems worsening over the past 25 years.3 Research suggests a subtle and complex

interplay of factors existing behind such trends.4 Mental health services need to be able to

offer support to young people who are struggling to achieve psychological maturity, as well as

to those who are suffering from a severe and potentially enduring illness such as psychosis,

providing interventions early enough to prevent enduring and chronic ill health from

developing further.

What is the current picture?There has been considerable financial and policy investment in statutory services for children,

young people and adults since the publication of the National Service Framework (NSF) for

Adults of Working Age, published in 1999, the more recent NSF for Children, Young People and

Maternity Services, published in 20045,6 and Every Child Matters7. Even so, mental health

services still offer limited choice of treatment modality and location.8 A recent mapping by the

SOS Project of services for 16-25 year-olds highlighted the low overall level of services

commissioned for this age group.9

There are a number of national drivers for change. Local services for children and young people

are, or will be expected to:

• Improve life outcomes for adults with mental health problems, by ensuring that all those who

need them have access to crisis services by 2005; and for children and young people, by

ensuring a comprehensive CAMHS by 2006.10

• Increase CAMHS provision by 10% per annum from 2002/3 to 2005/6. This can be measured

in terms of capacity and activity.10

• Extend CAMHS to include provision for 16 and 17 year-olds by 2006.11

• Reduce the suicide rate and the number of deaths by undetermined causes by 20%

by 2010.10

• Improve access to general community mental heath services.10

• Reduce the duration of untreated psychosis to a service median of less than three months

and a maxiumum of six months, and provide support for the first three years for all young

people who develop psychosis, by March 2007.12

• Offer crisis resolution services to all eligible patients by 2005.10

• Increase breaks for carers and strengthen carer support and networks to those caring

for people on the Care Programme Approach.10


How are services provided and commissioned?In the current planning and purchasing structure, CAMHS and AMHS commissioners are the

lynchpin of a complex interplay of agencies, including:

• Provider services – statutory and voluntary.

• Their own organisation planning and financial management.

• Local strategic partnerships across health, social care and for CAMHS commissioners,

with education.

• Local council members’ interests and aims.

• Service users.

By 2008, CAMHS will be commissioned within a Children’s Trust from a pooled budget,

simplifying some of the organisational relationships. Children’s Trusts will be responsible for

services up to the age of 19 - or 25, for those with learning difficulties/disabilities.

Commissioning for young adults will still require the commissioner within a Children’s Trust to

work closely with the commissioners of AMHS.

The reorganisation of the health and social services adds further complexity to the picture, as

Practice Based Commissioning, Primary Care Trust (PCT) reconfiguration, local authority

enhanced coterminosity, Direct Payments and Payment By Results come into play.

The service provision structure of CAMHS does not match that of AMHS. Access to CAMHS is

often described in terms of four Tiers, first defined by the Health Advisory Service in Together

We Stand.13 CAMHS aim to work in a holistic/multi-systemic way, with the child, family and at

times the school, supporting both the young person and their environment/system through the

process of change.

AMHS are organised around teams and services offering a range of specialist interventions, as

laid out in the Mental Health Policy Implementation Guide.14 Service users may move between

services and may be in receipt of more than one service at a time. Care co-ordination for those

under the Care Programme Approach is in the hands of one professional.15

What characterises much of adult mental health services is the level of severity of the illness

that a service user must demonstrate in order to be accepted by teams other than the GP.16

Young people transferring from a CAMH service to an AMH service may find that they no longer

meet the threshold for clinical teams, thus leaving them unsupported.

Will better service provision result in savings?There is a hidden economic cost involved in not providing services for vulnerable young people.

Long-term mental health problems often manifest themselves in childhood and adolescence.17

The NHS is under pressure to contain costs. It is difficult, at a time of financial crisis, to invest in

services when the imperative is to deliver short-term savings. However, even in the medium

term, investment in community and primary care-based mental health services should deliver

savings within the NHS and to society as a whole, as well as deliver a more humane service that

alleviates misery.

Finance directors in the NHS and local authorities who have doubts about investing in mental

health support and ill health prevention must consider the long-term social cost to service

users, their families and communities if those service users are unable to access a model of

care that supports recovery and rehabilitation.

What should services for 16-25 year-olds look like?Designing services that are acceptable, accessible and appropriate for young adults is key to

enabling them to receive help sooner rather than later.

Services for 16-25 year-olds, or which have 16-25 year-old users, should have the following in

common; they should:

• Routinely involve young people in their planning and outcome measurement. Service

providers need to be ready to be challenged by young people and need to be ready to

change their planned approach if it is not working.

• Be easy to access, with clear and readily understood protocols that make sense to young

people, as well as to professionals.

• Be able to respond in a crisis.

• Be provided in an age-appropriate environment.

• Invest in training and service development to improve pathways from community agencies to

mental health services.

• Be provided in a non-stigmatising environment.

• Be aware of the cultural needs of the young people who should be accessing the service.

• Be able to work systemically with the family and social network, as well as with the individual.

• Be recovery and rehabilitation-focused – to give young people the hope and belief that they

can move on.

• Be multi-agency, multi-problem and multi-disciplinary.

• Be prepared to cross service provision boundaries.

• Offer a range of treatment modalities.

• Offer in-patient services that are age appropriate.

What do we want commissioners to do?• Establish the nature and size of the local problem with a thorough needs assessment

involving young people. Partnerships between AMHS and CAMHS commissioners can

expand on the data in the existing Children and Young People’s Plan to develop a needs

assessment up to the age of 25.18

• Create a partnership for young adults to identify young people up to 25 who either cannot

access or who reject statutory mental health services. The partnership will need to include

education, health and social services, the YOT (Youth Offending Team), all services working

with young adults, such as Connexions, Supporting People, and housing teams and services

provided by the voluntary sector and faith communities.

• Learn from other services: there is a range of existing services for 16-25 year-olds around the

country, which have grown up in answer to local need. Information about these services is

available in the Emerging Practice Guide and via the NCSS website.19, 20

Changing the way services are provided is not just about money. The process of coming

together of CAMHS and AMHS practitioners, service users, carers and commissioners to audit

the picture for 16-25 year-olds will lead to a closer understanding of the problems and the

drivers that individuals face.

4 STRESSED OUT & STRUGGLING : A Call to Action


• Involving young people and their parents and carers who are using the service or who have

been through the service will give service providers the opportunity to learn what is good

about their service and what could be improved.21 Building in regular feedback from service

users and carers will enable services to monitor improvement and practice.

• Transition protocols will be examined, challenged and improved.

• Services need to review their referral policy.

• Involving other providers of services for young people with mental health problems will help

the locality to develop holistic pathways of care. Seconding sessions of CAMHS and AMHS

professionals into substance misuse or learning difficulties teams could allow non-specialist

mental health teams to improve early identification and prevention, as well as to hold more

difficult cases with multi-factorial problems.

• Particular attention must be paid to the needs of young people in further or higher education.

• Outreach in environments that young people already use – for example, drop-in centres,

youth clubs, further education (FE) and higher education (HE) colleges and areas where young

people congregate socially, such as nightclubs.

• Work in the local area on stigma and discrimination.

• If there is money available, the first call will be those areas which affect performance rating,

i.e. the development of a comprehensive CAMHS and Early Intervention Teams. However,

Early Intervention Psychosis (EIP) work can be delivered within a larger team with

responsibility for more than just psychosis. A 16-25 service can deliver crisis support,

outreach and a psychosocial, multi-systemic model to young people with other mental health

problems, as well as with psychosis.22

A Call to Action Commissioners need to support service providers to ensure that appropriate services are

available and that the complex web of local agencies is united to take account of young

people’s needs, rather than provide a one size fits all solution that fails to deliver help when it is

most needed. CAMHS and AMHS commissioners need to unite to support young people and to

create an integrated system of local planning that includes the widest possible networks of

agencies that work with young people. CAMHS and AMHS commissioners need to make sure

that they are working together to support young people in transition, rather than allowing age-

related commissioning to exacerbate fragmentation of care.

Young people want services to be accessible when they need them, in an environment that

shows they are worthy of respect, rather than one which stigmatises them further. Young people

want to be consulted, to be involved in the development of services, and commissioners will

find that this involvement will help shape and guide improvement. This does not always cost

money, but does require a willingness to examine and change practice.

There is a growing body of evidence supporting the economic argument – treatment at an

earlier stage is likely to be more effective and less costly than that which will be needed over a

lifetime, if this opportunity for early intervention is missed.16, 23 For those with mild to moderate

illness, going untreated could mean dropping out of college or losing their job. Although they

may never be admitted to hospital, the overall effect of their mental ill health on their life could

be catastrophic. For PCTs, the long-term costs of allowing mental ill health to go untreated until

a young person is in crisis will contribute to financial pressures.


However, both the policy imperative and economic argument underpin one fundamental

proposition: young people are in every sense the future. We can do so much to help them when

they stumble to prevent them from falling, but, when some fall, we must extend a hand to pull

them up to walk independently again. Mental health service providers in the statutory and

voluntary sectors cannot create the network of support young people need without the

assistance and commitment of commissioners to establish strategic leadership that crosses

traditional boundaries. Commissioners have the power to shape and develop existing and new

services to enable young people to recover and reach their fullest potential. We call on them to

use this power wisely and well.


IntroductionThis document is for commissioners of Child and Adolescent Mental Health Services (CAMHS)

and commissioners of services for ‘Adults of Working Age’ (also known as Adult Mental Health

Services or AMHS) who, between them, commission services for young adults. It is one of

several reports from the Stressed Out and Struggling (SOS) Project, funded by the Big Lottery

Fund. The project aims to raise awareness of mental health issues for young people aged 16-25

among the general public, service users and service providers, and to encourage better, more

targeted provision of services for young adults.

This document proposes that young adults aged between 16 and 25 have particular needs

which require statutory health services from CAMHS and AMHS to work together and with local

authorities and the voluntary sector to ensure that services are accessible and are available

quickly. Services must present themselves in a way which young people who are using mental

health services find acceptable, rather than a source of shame or stigma. Commissioners play a

central role in supporting this process – not just when there is new investment available but in

encouraging local reconfiguration and joint working. Commissioners have an overview of all that

is available within the local arena and of the networks available to bring interested parties

around the table to enable joint planning and closer working relationships between services. We

want commissioners to recognise that this is not just a health service development agenda, and

to see that influencing local authority housing, education, recreation and job opportunities is

critical to the recovery and successful management of these young people’s difficulties.

We suggest commissioners and providers should constantly be asking themselves the following

question: “What would I want for myself as a young person or for a member of my family?”

• Would I want treatment from a service that is interested in my views and feedback?

• Would I want a hospital out-patient appointment at a time that suits me, and quickly, or in

three months’ time?

• Would I want a choice of evidence-based treatment, including ‘talking therapies’, with clear

advice about the strengths and weaknesses of each approach?

• If I had a severe mental illness, would I want to keep using a service that usually engaged me

through coercion or hospitalisation?

• Can I still have hope for the future; that I will go to college, get a job, be in a relationship?

• Is it acceptable that services refuse to talk to me, as a parent of a service user, on the

grounds of confidentiality, but expect me and my family, as the key supporters, to cope, or

indeed that they offer me no support to deal with the impact on my family and me?

In this document we have explored the key issues for young adults, making the case for a new

approach and more targeted services. We have included what aspects of ‘Must Dos’ are

relevant to this age group, some of which require extra resources, but we also consider ‘No

Money’ options to improve services for young people, which can be achieved by localities

working smarter, not harder. We have also detailed the emerging economic arguments which

suggest that investing in services to support young people at an early stage will enable PCTs to

save money in the long term. For commissioners requiring a more detailed, toolkit approach

there are a number of documents available: the Commissioning Friend,24 underpinned by

Standard 9 of the NSF for Children, Young People and Maternity Services;25 the Mental Health

Policy Implementation Guide (MHPIG);14 the protocols being developed by HASCAS;26 the Joint

Commissioning Framework;27 and Every Child Matters.7


Why is it so important to get services right for 16-25 year-olds?Young people in the UK between the ages of 16 and 25 experience profound changes

that move them from the world of the child into the world of the adult. There is a general

societal expectation that, by the time they are 25, most young people will have made three

significant transitions:

• From the world of education to the world of work.

• From a dependent relationship, being parented in some form, to being independent and, for

some, to being a parent.

• From dependent living in a home environment, to independent living and creating their

own environment.

There is no other period in life where such transitions are expected to be the norm. At other

points of age-specific transition, such as starting school, starting secondary school or retiring,

most can expect the transition to change only one part of their life – for example, a child starting

secondary school is still within a dependent relationship and a dependent living environment.

Research suggests that the brain is still developing up to the age of 25 and beyond, with the

early adult years critical for the formation of self-image, social skills and impulse control.2 The

timing of the ‘normal’ maturation of brain structures suggests that society’s expectations for

young people’s planning, organisational and self-regulating capacities can be misplaced.28

Indeed, adolescent mental health in the UK is deteriorating, with emotional problems and

conduct problems worsening over the past 25 years.3 The fact that research reveals these

increases NOT to have been caused by changes in family make-up (e.g. increases in single

parent families) or by factors relating to socio-economics points to a subtle and complex

interplay of factors existing behind such trends.4 Young people are experiencing increasing

pressure in relation to scholastic achievement and greater choice in terms of major decision-

making (drugs, sex etc.), and many are financially dependent on parents into adulthood.

They may be affected by environmental factors such as greater cultural conflict, media images

at odds with reality, toxins and pollutants, greater affluence and a decline in social cohesion

and responsibility.

Young people who find society’s expectations of them overwhelming may be left with a

relatively poorly developed capacity to regulate their emotional responses; young adults who

lack the requisite emotional and psychological maturity to surmount the predictable and usual

social challenges they face will be unlikely to fulfil their potential and contribute as meaningfully

as they might otherwise have done to society. If we are to intervene early enough to prevent

chronic ill health from developing further, mental health services need to be able to offer support

to young people who are struggling to achieve psychological maturity, as well as to those who

are suffering from a severe and potentially enduring illness, such as psychosis.

One of the difficulties for commissioners of young adult services is to establish accurate

prevalence figures. There is no national data set primarily concerned with young adults, so

statistical information has to be gathered from a range of sources. The following statistics are

not a comprehensive picture and are probably an underestimation of need, but they illustrate

how many vulnerable young adults there are:

• 16-25 year-olds account for 12% of the total population – approximately 7 million.29

• 0.2% have had an assessment of psychotic disorder in the past year, or two or more

indicators of psychosis – approximately 13,000.30


• The average age of first onset psychosis is 22. The average time it takes for a young person

experiencing psychosis to receive help is 18 months. 80% are hospitalised during their first

episode of psychosis. 50% of young people admitted to hospital are admitted under the

Mental Health Act.14, 31

• 13.3% of 16-19s, and 15.8% of 20-24 year-olds have a neurotic disorder – approximately

946,000.30

• 1.4% of 16-19s, and 1.5% of 20-24 year-olds have a generalised anxiety disorder –

approximately 94,000.30

• 1.7% of 16-19s, and 2.2% of 20-24 year-olds have had a depressive episode – approximately

127,000.30

• 3.4% of 16-34 year-olds have a personality disorder – approximately 450,000.30

• Between 1 and 2% of young women have anorexia, and between 1 and 3% of young women

have bulimia.32

• Just over 2 million 16-25 year-olds are full time students; 55% of 16 to 19 year-olds are full

time students; and 20% of those aged 20-24 are full time students.33

• Approximately 2.1 million of 16-25 year-olds are in full time employment; 327,000 are

unemployed; 213,000 are economically inactive and looking after the home/family; and

62,000 are permanently sick or disabled.33

BackgroundThere has been considerable investment in statutory services for children, young people and

adults since the National Service Framework (NSF) for Adults of Working Age was published

in 1999 and the more recent NSF for Children, Young People and Maternity Services, which

was published in 2004.5, 6 CAMHS have benefited from the CAMHS grant and the money

given to PCTs, with targets attached to demonstrate growth in services.34, 35, 36, 37 Every Child

Matters includes good mental health as an element of one of the five key outcomes.7 Despite

this policy attention and financial investment, mental health services still offer limited choice

of treatment modality and location.8 Overstretched services have to concentrate on those

who are perceived to be most needy. Service users with severe and enduring problems often

present late and in crisis, absorbing most of the funding. Many areas struggle to deliver

the innovative services, detailed in the Mental Health Policy Implementation Guide (MHPIG)

and the comprehensive CAMHS, which must be in place by 2006.14,11 Several recent reports

have highlighted poor levels of service, poor transitions and poor choices for this age group.38, 39

A recent mapping by the SOS Project of services for 16-25 year-olds highlighted the low level

of services commissioned for this age group.9

Although NHS and local authorities have not been set explicit targets focusing on the 16-25 age

group, this group’s needs fall into a range of performance measures against which

commissioners will be monitored.40, 41 Commissioners need to consider how they will meet the

needs of young adults in order to fulfil the following:

• Improve life outcomes for adults with mental health problems by ensuring that all patients

who need them have access to crisis services by 2005, and all children have access to a

comprehensive CAMHS by 2006.10


• CAMHS are expected to grow by 10% per annum from 2002/3 to 2005/6. This can be

measured in terms of capacity and activity.10

• CAMHS must extend to include services for 16 and 17 year-olds by 2006.11

• Reduce the suicide rate and number of deaths by undetermined causes by 20% by 2010.10

• Improve access to general community mental heath services.10

• Reduce the duration of untreated psychosis to a service median of less than three months

and a maxiumum of six months, and provide support for the first three years for all young

people who develop psychosis by March 2007.12 This is the key target that unites CAMHS

and AMHS, as both services should be present in an EIP team.14

• Offer crisis resolution services to all eligible patients by 2005.10

• Increase breaks for carers and strengthen carer support and networks to those caring for

people on the Care Programme Approach.10

Service users who straddle the transition from CAMHS to AMHS seem particularly hard for

services to cope with – despite the need for services to have robust transition protocols on the

ground. Young people and their families can find themselves in limbo, as AMHS, CAMHS and

commissioners argue about whose budget or service takes responsibility. Some young people

who would have been assessed as needing mental health support or who have been supported

by a CAMHS team are not deemed to be ill enough to receive a service from an AMHS team.

For service users developing severe mental illness, the consequence of poor transitions is that

commissioning decisions are made around the needs of the service providers, rather than

around the young person and their family.

The tensions of the current structures for commissioning and provision

The role of the commissioner is critical in supporting and leading the changes that are

necessary to improve access to mental health services at this key time. Commissioners are the

midwives of NHS and social services planning and service development. Usually in the

background, rarely credited for their role in successful services, the role of commissioners and

their importance in shaping and developing services was acknowledged in the NSF for

Children, Young People and Maternity Services.6 Commissioners walk a tightrope, the best of

them balancing the creative tension that is necessary between the practitioners working in the

micro scale and the commissioners working across a local authority or PCT base, or, in the

case of specialist services, on a macro scale.

In the current planning and purchasing structure, CAMHS and AMHS commissioners are the

lynchpin of a complex interplay of agencies, including:

• Provider services – statutory and voluntary.

• Their own organisational planning and financial management.

• Local strategic partnerships across health, social care and for CAMHS commissioners,

with education.

• Local council members’ interests and aims.

• Service users.


By 2008, CAMHS will be commissioned within a Children’s Trust from a pooled budget,

simplifying some of the organisational relationships. Children’s Trusts will be responsible for

services up to the age of 19 - or 25, for those with learning difficulties/disabilities.

Commissioning for young adults will still require the commissioner within a Children’s Trust to

work closely with the commissioners of AMHS.

The reorganisation of the health and social services adds further complexity to the picture, as

Practice Based Commissioning, PCT reconfiguration, local authority enhanced coterminosity,

Direct Payments and Payment By Results come into play.

Commissioners are used to operating within a challenging framework and focusing on

performance-related objectives. The increased speed of change is coupled with the perverse

nature of some targets, which place short-term financial savings against long-term investment

in prevention and recovery-based services. Commissioners and their communities are often

aware of what services they would like to see in place, but struggle to fulfil that vision.

Commissioning mental health services is commonly divided into three age-related bands:

• Child and Adolescent Mental Health Services (CAMHS) – for 0-16s or 0-18s, (the age break

depending on local historical practice, but now required to be up to 18th birthday by the NSF).6

• Services for ‘Adults of Working Age’, also known as Adult Mental Health services or AMHS

from 16/18 to 65.

• Older People’s Services – for those over 65 or suffering from Early Onset Dementia.

There is a range of models for commissioning AMHS and CAMHS. Commissioning can be

carried out by joint social services and PCT commissioners, or by representatives from each

agency who work together when appropriate, but who otherwise work separately in different

organisations. Commissioners may plan and purchase for one client group – for example,

commissioners of children’s services may have CAMHS in their portfolio, and commissioners

for adult services of working age often have drug and alcohol services within their brief.

In the case of CAMHS, this will change with the introduction of Children’s Trusts, where officers

working for the Director of Children’s Services will have overall responsibility for purchasing

from within a pooled budget.

In the future, Practice Based Commissioning may see GP practices purchasing adult mental

health services or ‘buying back’ into PCTs and local authorities for services that need to be

provided on a locality basis. However, where commissioning is divided along the age breaks,

there is a danger that, as each commissioner is charged with staying within budget, a silo

mentality develops between commissioners from the same locality, with each commissioner

protecting his or her budget.

The service provision structure of CAMHS does not match that of AMHS. Access to CAMHS is

often described in terms of four Tiers, first defined by the Health Advisory Service in Together

We Stand.13


The four CAMHS Tiers

These Tiers have caused confusion, as an increase in the tier number implies an increase in

severity, rather than a model based on access. To counter this, some services are now

beginning to describe their services as universal, targeted or specialist. CAMHS teams have

received extra funding over the last five years and may include, at Tiers 3 and 4 (targeted or

specialist), services for special needs groups such as Looked After Children, Eating Disorders,

Learning Difficulties/Disabilities, and Adolescent Outreach. However, there is no defined

structure for a CAMHS team, no universally understood menu of services other than that which

is described in the NSF for Children, Young People and Maternity Services under

Comprehensive CAMHS, based on that from Together We Stand.11,13 This is in contrast to the

Mental Health Policy Implementation Guide, in which service models are described in depth,

so that commissioners and providers have a clear idea of what it is they are expected to provide

and fund.14 CAMHS aims to work in a holistic/multi-systemic way, with the child, family and, at

times, the school supporting both the young person and their environment/system through the

process of change.

Tier 4:Specialist

services: out-patient and in-patient requires

referral from Tier 3.

Tier 3: Specialist CAMHSpractitioners working in a multi-

disciplinary team. Usually requiresreferral from a Tier 1 or 2 professional.

Tier 2: Specialist individual practitioner working witha service user/family. The practitioner may be attached

to a non-CAMHS team e.g. within a YOT, or to a CAMHSteam or network. Usually requires referral from Tier 1.

Tier 1: Professional with knowledge of and training in children’sissues, but not a specialist CAMHS practitioner,

e.g. GP, social worker. Users and carers may self-refer.


Mental health services commissioned for adults of working age AMHS is organised around teams and services offering a range of specialist interventions, as

laid out in the Mental Health Policy Implementation Guide:14

• Forensic Mental Health Services for service users who have committed a serious crime during

the course of a severe episode of mental illness.

• In-patient services for service users for whom hospital care is the best or only option to allow

them to engage with services – admission can be voluntary or involuntary under the Mental

Health Act. This may include in-patient rehabilitation wards and specialist services, such as

for Eating Disorders.

• Assertive Outreach Teams working with service users with severe and enduring mental health

problems who fail to engage with community mental health teams.

• Crisis Resolution Teams: multi-disciplinary teams working with those experiencing a mental

health crisis to support service users, wherever possible, to be stabilised within the

community, and avoid admission.

• Community Mental Health Teams (CMHT): multi-disciplinary teams working with service users

with severe and enduring mental health problems, usually after referral from a GP or

discharge from an in-patient bed.

• Out-patient clinics for service users who are not eligible for CMHT care but whom the

psychiatrist is not ready to discharge to primary care.

• Psychological therapies for service users who would benefit from talking therapy, e.g.

Cognitive Behavioural Therapy.

• Early Intervention Psychosis teams working with young people aged 14-35 experiencing

their first episode of psychosis: service users stay with the EIP team for up to three years.

• Graduate Mental Health Workers, based in primary care, taking referrals from GPs.

• Employment and training schemes and drop-in centres in the community.

• Primary care provision from GPs.

• Residential care and supported housing, supporting people schemes.

• Day hospital services.

Service users may move between services and may be in receipt of more than one service at

a time. Care co-ordination for those under the Care Programme Approach is in the hands of

one professional.15 What characterises much of adult mental health services is the level of

severity of the illness that a service user must demonstrate in order to be accepted by teams

other than the GP.16 Severe shortages in psychological therapies means that those experiencing

mental health problems, but without a severe and enduring diagnosis, are by and large treated

within primary care using medication. Young people transferring from a CAMH service to an

AMH service may find that they no longer meet the threshold for clinical teams, leaving the

young person unsupported. The issue of confidentiality means that parents and carers of young

people with mental health problems have limited rights to be consulted and involved in the

young person’s care. Although there is a growth in understanding of the need for a psychosocial

model of care – e.g. where children are seen in the contexts of family and school – limited

resources make it very difficult for clinicians to employ this model in many circumstances.

Commissioners should be aware that the particular needs of 16-25 year-olds who are struggling

to make transitions may stem from delayed emotional and psychological development, and it is

therefore all the more appropriate – and necessary – that these young people are seen ‘in the

round’ in terms of their emotional and social networks.

The two areas where CAMHS and AMHS commissioning must overlap within the current policy

and performance management framework are in commissioning Early Intervention Services14

and primary care. Early Intervention Psychosis teams should work with young people from the

ages of 14 to 35, and include both CAMHS and AMHS practitioners. Primary Care Teams work

with all age groups to provide universal services. Although some PCTs have developed creative

new services for 16 to 25 year-olds, many areas are not yet able to meet the needs of young

adults with mental health problems.19


CAMHS commissioning AMHS commissioning

The CAHMS and AMHScommissioning overlap for servicesfor 16-25s: where CAMHS andAMHS are required to work together

Early Intervention

Psychosis

Primary care

Services for 16-25s

Tier 4 In-patient and out-patient

Specialist services

Tier 3 Specialist services

CMHT

Out-patient

Assertive outreach

In-patient

Forensic

Residential care

Crisis resolution

Day Hospitalservices

Psychologicaltherapies

Graduate MentalHealth Workers

Tier 2 Targeted services

Tier 1 Universal services

Employment andtraining


Will better service provision result in savings?There is an economic cost to not providing, as well as in providing, services to meet the

needs of young people. Long-term mental health problems manifest themselves in childhood

and adolescence. The research by Kim-Cohen et al considered the age of first diagnosis of 226

26 year-olds with a mental disorder in receipt of psychiatric treatment, from a cohort of 976

people who were followed from childhood.17 Of those 226, 57.5% were diagnosed before the age

of 15; 19% between 15 and 18; 10.2% between 18 and 21; and 13.3% after 21 and before 26.

The NHS is under pressure to contain costs. It is difficult, at a time of financial crisis, to invest in

services when the imperative is to deliver short-term savings. However, even in the medium

term, investment in community and primary care-based mental health services should deliver

savings within the NHS and to society as a whole, as well as deliver a more humane service that

alleviates misery.

Previous research into the cost-effectiveness of CAMHS interventions is limited and not very

robust,42 although there are a number of studies currently underway. Clark et al determined that

the cost of services for an average child with complex mental health problems was, at 2000/01

prices, £52,884, of which 5% was a cost to health, 52% to social care, 39% to education, 3% to

criminal justice and 1% to the voluntary sector.43

In June 2004 the Social Exclusion Unit (SEU) summarised the average costs of various adult

mental health services.44

Cost per in-patient per day:

• NHS psychiatric intensive care unit = £420.

• Acute psychiatric ward = £165.

• Long-stay hospital = £141.

Costs of other mental health services:

• Cost per average stay in intensive care unit = around £5,169.

• Community Mental Health Team = around £59 per hour of patient contact.

• Privately obtained talking therapy or counselling = around £732 per year.

• Basic cost of medication treatment for depression = around £170 per year.

The Commissioning Friend states: “From these figures it is clear that, with limited resources

available to meet the needs, it is in the interests of commissioners to invest in the less costly

early interventions to support people experiencing mental health problems in order to minimise

the use made of the most expensive forms of treatment which people may require if their

conditions are left to escalate.”24

In December 2004, Lord Layard described mental health as “Britain’s biggest social problem”,

with a cost to the economy of 2% of GDP, i.e. £25 billion, and with more people drawing

incapacity benefit due to mental illness than unemployed people drawing Jobseekers Allowance.

Lord Layard called for extra provision of evidence-based psychological therapies, local self help

facilities, fast tracking of patients who do not improve within primary care to consultant-led

services, and an immediate expansion in levels of clinical manpower.16


If the arguments focusing on the effects of mental ill health and our duty of care to provide

humane and effective support to young people in distress are not enough, it is worth

considering that it makes no sense from an economic perspective to have a significant section

of the workforce unable to work due to mental health problems, many of which are preventable

or treatable. In an ageing society, future generations will need the economic capacity of the

maximum number of the population. Finance directors in the NHS and local authorities who

have doubts about investing in mental health support and ill health prevention must consider

the long-term social cost to service users, their families and communities if those service users

are unable to access a model of care that supports recovery and rehabilitation.

Services to meet the needs of the individualIndividual service users have unique needs, which require mental health professionals to

work to accommodate their needs, rather than provide a ‘one size fits all’ approach. This is

not always possible, because not all localities have access to a full range of services; for

example, EIP teams are new and fragile, and some are ‘virtual’ teams, which may take longer

to function effectively.45 The NHS is changing in its understanding of the need to involve its

users, to offer real and genuine choice. The Choice Agenda, in relation to mental health

services, will offer service users a range of choices about:8

• Life choices.

• How and where they make contact with mental health services and when and where

they are assessed.

• A range of care options and information about what is available.

It is particularly important that commissioners and providers understand what kinds of services

users are most likely to engage with. Young adults have particular issues and needs which need

to be taken into account when designing or reconfiguring services. Commissioners and

providers must be prepared to ask users and carers what services they would like to receive,

rather than designing services that meet the needs of the professional team.

What should services for 16-25 year-olds look like?Making services accessible and appropriate for young adults is key to enabling them to receive

help sooner rather than later. There is considerable research into what young people think about

current services and what needs to change.38, 46, 47

Services for 16-25 year-olds, or which have 16-25 year-old users, should have the following in

common; they should:

• Routinely involve young people in their planning and outcome measurement. Service

providers need to be ready to be challenged by young people and need to be ready to

change their planned approach if it is not working.

• Be easy to access, with clear and readily understood protocols, which make sense to young

people as well as to professionals – young people report difficulties in accessing mental

health services.

• Be able to respond in a crisis – desperate young people in a crisis are highly vulnerable and

are more likely to act on impulse.


• Be provided in an age-appropriate environment. A 17 year-old in a child development clinic

that is strewn with baby toys is not likely to feel respected or comfortable.

• Invest in training and service development to improve pathways from community agencies to


• Be provided in a non-stigmatising environment. Young people are very sensitive to the

potential impact on their social circle of being in receipt of mental health services, so a

drop-in type approach where a range of services for young people is available is much more

likely to be attractive than a hospital out-patients clinic. A voluntary sector service can be

more acceptable to young people.48, 49

• Be aware of the cultural needs of the young people who should be accessing the service –

for example, non Muslim service providers need to understand the beneficial effects of prayer

in communities where faith is a key part of their lives.38

• Be able to work systemically with the family and social network, as well as with the individual.50

• Be recovery and rehabilitation-focused – to give young people the hope and belief that they

can move on.

• Be multi-agency, multi-problem and multi-disciplinary – young people rarely have only one

problem. The transitional nature of their circumstances means that they may find their family

withdrawing, so that they lose their home, as well as their education. A number of couples stay

together until their children have left home, and then separate. This can produce a significant

sense of loss of home and security for the children, who may not yet have made a secure

home elsewhere. Services are developing for young people with a substance misuse problem

but in-patient facilities for young people with a dual diagnosis are limited and have a high cost.

• Be prepared to cross service provision boundaries – to follow someone for a period and hand

over care when it is appropriate, rather than on a date which is determined by their birthday.

• Offer a range of treatment modalities. Young people and their families want and need more

than just medication.

• In-patient services need to be age-appropriate. Young people under the age of 18 should be

admitted to an adolescent unit close to home unless there are clinical reasons which indicate

an adult ward is more appropriate.11 If young people under the age of 18 are admitted to an

adult ward, adult services need to have access to and advice from the CAMHS team; be

aware of legal issues pertaining to care for the under 18s; and ensure that the needs of the

young person are met, such as continued access to education. Small Crisis Houses – as per

the model for Early Intervention14 – rather than in-patient wards, are more appropriate for

some young adults who are too old for adolescent units than busy wards with long-term

chronic service users up to the age of 65. The Crisis House can provide short-term respite

and admission prevention, supported by mental health professionals. Young people need to

be kept close to their community to help them to reintegrate when they recover, and

commissioners need to ensure that in-patient services are part of a pathway to rehabilitation,

rather than a place where young people are stuck, by providing good outreach teams.


What do commissioners need to do?The first step for commissioners to build services that meet the needs of young adults is to

establish the nature and size of the local problem. All commissioners should have a local

Children and Young People’s Plan which can be extended to include 19 to 25 year-olds.18

Commissioners need to:

• Consult with young people who are currently in receipt of services about their experience of

aspects such as: the referrals process; making appointments; the variety of treatment

modalities available; and what they thought about the environment and the location of the

service. This will help identify areas of concern, as well as areas of good practice. Consulting

service users is not easy, but services that have done so have found the process to be very

worthwhile – see Putting Participation into Practice.21 It can also be very helpful to ask young

people who were referred but who did not attend or who refused treatment why they did not

engage with the service, in order to see if there are blocks in the system which are putting

young people off receiving treatment before they reach a crisis. 25-35 year-old service users

provide invaluable recent insight into how statutory services supported them and what

services they wish had been available to them as young adults.

CAMHS commissioning AMHS commissioning

The CAMHS to AMHScommissioning overlap: what services should becommissioned

Services for 16-25s

Tier 4 In-patient and out-patient

Specialist services

Tier 3 Specialist services

CMHT

Out-patient

Assertive outreach

In-patient

Forensic

Residential care

Crisis resolution

Day Hospitalservices

Psychologicaltherapies

Graduate MentalHealth Workers

Tier 2 Targeted services

Tier 1 Universal services

Employment andtraining

16-25s

Early Intervention Psychosis

Young adults outreach

Young adults out-patient

Age appropriate in-patient

Crisis house

Crisis service

Transition services

Counselling services

Voluntary sector services

Employment and training support

Support for parentsand carers

Primary care


• Consult with parents and carers about their experience and views about what parents and

carers need in order for them to feel confident and able to support their young people.

• Ensure that the Local Strategic Partnership is committed to meeting the needs of young

adults.51, 52 The Local Implementation Team (LIT) and CAMHS planning forum need to come

together to audit the numbers of 16-25 year-olds within the current services, the nature and

kind of presentation – how and when they presented, e.g. in crisis – and the diagnosis. The

outcome of the audit should then be compared to national prevalence figures. Consider how

many times the young person tried to access services before the referral was accepted, or

the length of time from the first onset of symptoms to treatment. Comparing CAMHS and

AMHS local ‘hotspots’, localities that generate higher than average referrals and admissions,

can help planners and service providers to target preventative work.

• Audit admission rates to determine how many young people could have remained at home in

the community or who could have been discharged more quickly if there was a dedicated

service, such as an adolescent outreach team, to support them. This data needs to be cross-

referenced with known indicators of mental disorders, such as exclusion, and poverty.

• The LIT and CAMHS planning forum will include education, health and social services and the

YOT, but the audit must include all services working with young adults, such as Connexions,

Supporting People, housing teams and services provided by the voluntary sector and faith

communities to identify young people who either cannot access, or who reject, statutory


• Learn from other services: there is a range of existing services for 16-25 year-olds around the

country, which have grown up in answer to local need. Information about these services is

available in the Emerging Practice Guide and via the NCSS website.19, 20

Changing the way services are provided is not just about money. The process of coming

together of CAMHS and AMHS practitioners, service users, carers and commissioners to audit

the picture for 16-25 year-olds will lead to a closer understanding of the problems and the

drivers that individuals face.

• Involving young people and their parents and carers who are using the service or who have

been through the service will give service providers the opportunity to learn what is good

about their service and what could be improved.21 Building in regular feedback from service

users and carers will enable services to monitor improvement and practice.

• Transition protocols will be examined, challenged and improved. Examining the admission

pathways for specimen cases will help find solutions to operational problems and barriers.

For example, the solution to the problem of funding disputes between AMHS and CAMHS

commissioners for in-patient care of young people in the year before and after transition

between services could be to establish a pooled budget, with both commissioners involved in

the decision to admit. AMHS could agree to instigate treatment for a young person who

presents at an age close to the agreed age break for transition and who is clearly going to

require treatment for a period beyond transition. CAMHS could agree to follow up a service

user who has been in receipt of care for a long period but whose treatment can be brought to

a close within a year of the transition age break.

• Services need to review their referral policy. Young adults may not turn to their GP, and those

that do find that help is limited. Although there is considerable work, for example within the

EIP programme, to support early recognition of problems, services could pilot a range of

referral options, including dissemination of information, to see if self-referral or referral from

other agencies enables young people to access help appropriately before they reach crisis.


• Involving other providers of services for young people with mental health problems will help

the locality to develop holistic pathways of care. Seconding sessions of CAMHS and AMHS

professionals into substance misuse or learning difficulties teams could allow non-specialist

mental health teams to improve early identification and prevention, as well as to hold more

difficult cases with multi-factorial problems.

• Particular attention must be paid to the needs of young people in further or higher education

– college counselling services need to have regular contact with agencies that can deliver

enhanced services before problems escalate.

• Outreaching in environments that young people already use – for example, drop-in centres,

youth clubs, further education and higher education colleges and areas where young people

congregate socially, such as night clubs – will both de-stigmatise mental health problems and

make services more accessible.

• The impact of stigma and the need to improve mental health literacy can have a profound

impact on young people seeking help. For instance, commissioners can encourage initiatives

whereby Early Intervention services engage with schools and colleges.

• Providing mental health services for parents and carers can deliver a dual benefit in terms of

supporting parents and carers in their role and can create a pathway for a young person into

seeking treatment themselves.53

• If the commissioners have money available to set up new services, the first call will be those

areas which affect performance rating: i.e. the development of a comprehensive CAMHS and

Early Intervention Teams.10, 12 However, EIP work can be delivered within a larger team with

responsibility for more than just psychosis. A 16-25 service can deliver crisis support,

outreach and a psychosocial, multi-systemic model to young people with other mental health

problems, as well as with psychosis.22


A Call to Action As society grows increasingly complex, more and more is asked of our young people as they

take their place as adults. The years of transition require young people to negotiate major

changes but, at the same time, more young people are suffering mental ill health and in

consequence failing to reach their full potential or achieve and maintain their independence.

Commissioners need to support service providers to ensure that appropriate services are

available and that the complex web of local agencies is united to take account of young

people’s needs, rather than to provide a one size fits all solution which fails to deliver help when

it is most needed. CAMHS and AMHS commissioners need to unite to support young people

and to create an integrated system of local planning that includes the widest possible networks

of agencies that work with young people. At the same time, CAMHS and AMHS commissioners

need to make sure that they are working together to support young people in transition, rather

than allowing age-related commissioning to exacerbate fragmentation of care.

There is now a wide range of evidence to demonstrate what young people want from services.

Much of what they want to see does not require pump priming and funds, but requires a

willingness to examine practice and change, if necessary. Young people want services to be

accessible when they need them, in an environment that shows they are worthy of respect,

rather than one which stigmatises them further. Young people want to be consulted and to be

involved in the development of services, and commissioners will find that this involvement will

help shape and guide improvement.

There is a growing body of evidence to support the economic argument – treatment at an earlier

stage is likely to be more effective and less costly than that which will be needed over a lifetime

if this opportunity for early intervention is missed. If we fail to engage with young people at an

early stage, there is a much greater possibility that their illness will become a long-term, chronic

pattern of admission and readmission. For those with mild to moderate illness, going untreated

could mean dropping out of college or losing their job. Although they may never be admitted to

hospital, the overall effect of their mental ill health on their life could be catastrophic. For PCTs,

the long-term costs of allowing mental ill health to go untreated until a young person is in crisis

will contribute to financial pressures.

However, both the policy imperative and economic argument underpin one fundamental

proposition: young people are in every sense the future. We can do so much to help them when

they stumble to prevent them from falling, but, when some fall, we must extend a hand to pull

them up to walk independently again. Mental health service providers in the statutory and

voluntary sectors cannot create the network of support young people need without the

assistance and commitment of commissioners to establish strategic leadership that crosses

traditional boundaries. Commissioners have the power to shape and develop existing and new

services to enable young people to recover and reach their fullest potential. We call on them to

use this power wisely and well.


References1 YoungMinds (2005). Stressed Out and Struggling. See: http://www.youngminds.org.uk/sos/

2 YoungMinds (2006). A work in progress: the adolescent and young adult brain: a briefing paper. London: YoungMinds.

See: http://www.youngminds.org.uk/sos/brain.php

3 Collishaw, S., Maughan, B., Goodman, R., et al. (2004). Time trends in adolescent mental health. Journal of Child

Psychology and Psychiatry, 45 (8), pp. 1350-1362.

http://www.nuffieldfoundation.org/fileLibrary/pdf/2004_seminars_childern_families_adolescents_and_wellbeing.pdf

4 Hartley-Brewer, E. (2005). Perspectives on the causes of mental health problems in children and adolescents. London:

YoungMinds. See: http://www.youngminds.org.uk/sos/YM_MH_Causes_Symposium.pdf

5 Department of Health (1999). National Service Framework for mental health: modern standards and service models.

London: Department of Health. See: http://www.dh.gov.uk/assetRoot/04/01/45/02/04014502.pdf

6 Department of Health & Department for Education & Skills. (2004). National Service Framework for children, young

people and maternity services. See:

http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGui

danceArticle/fs/en?CONTENT_ID=4089100&chk=Egpznc

7 Department for Education & Skills (2003). Every child matters. London: Stationery Office. See:

www.everychildmatters.gov.uk

8 Care Services Improvement Partnership (CSIP). Choices in Mental Health. See: http://www.mhchoice.org.uk/home

9 YoungMinds (In Press). Stressed Out and Struggling Project Report 1: service-mapping. London: YoungMinds.

10 Department of Health (2002). Improvement, expansion and reform: The next three years' priorities and planning

framework, 2003-2006. London: Department of Health. See: http://www.dh.gov.uk/assetRoot/04/05/98/31/04059831.pdf

11 Department of Health & Department for Education & Skills (2004). The mental health and psychological wellbeing of

children and young people: standard nine: National Service Framework for children, young people and maternity

services. London: Department of Health. See: http://www.dh.gov.uk/assetRoot/04/09/05/60/04090560.pdf

12 Department of Health (2006). Local delivery plans – Mental health early intervention services. London: Department of

Health. See:

http://www.dh.gov.uk/PublicationsAndStatistics/LettersAndCirculars/DearColleagueLetters/DearColleagueLettersArticle/

fs/en?CONTENT_ID=4127536&chk=jskjyL

13 Williams, R. & Richardson, G. (1995). Together we stand: the commissioning, role and management of child and

adolescent mental health services: An NHS Health Advisory Service (HAS) Thematic Review. London: HMSO.

14 Department of Health (2001). Mental health policy implementation guide. London: Department of Health. See:

http://www.dh.gov.uk/assetRoot/04/05/89/60/04058960.pdf

15 Department of Health (1999). Effective care co-ordination in mental health services: modernising the care programme

approach: a policy booklet. London: Department of Health. See:


16 Layard, R. (2004). Mental health: Britain’s biggest social problem. London: Prime Minister’s Strategy Unit. See:

http://www.strategy.gov.uk/downloads/files/mh_layard.pdf

17 Kim-Cohen, J., Caspi, A., Moffitt, T. E., et al. (2003). Prior juvenile diagnoses in adults with mental disorder:

developmental follow-back of a prospective-longitudinal cohort. Archives of General Psychiatry, 60 (7), pp. 709-717.

18 Department for Education & Skills (2005). Guidance on the Children and Young People’s Plan. London: Department for

Education and Skills. See: http://www.everychildmatters.gov.uk/_files/58A771D2F683214338B20DA1393F9B29.pdf

19 YoungMinds (In Press). Emerging practice: examples of services for the 16-25 year age group. London: YoungMinds.

20 National CAMHS Support Service (NCSS). NCSS website. See: www.camhs.org.uk

21 Street, C. & Herts, B. (2005). Putting participation into practice: a guide for practitioners working in services to promote

the mental health and well-being of children and young people. London: YoungMinds. See:

http://www.youngminds.org.uk/ppp/YoungMinds_PPP.pdf

22 Henggeler, S., Rowland, M., Randall, J., et al. (1999). Home-based multi-systemic therapy as an alternative to the

hospitalisation of youths in psychiatric crisis: clinical outcomes. Journal of the American Academy of Child and

Adolescent Psychiatry, 38 (11), pp. 1331-1339.

23 Department of Health (2005). Evidence to inform the National Service Framework for Children, Young People and

Maternity Services: standard nine: the mental health and psychological well-being of children and young people. London:

Department of Health. See: http://www.dh.gov.uk/assetRoot/04/11/24/12/04112412.pdf

24 Haselgrove, S. & Tibbles, I. (2005). Commissioning friend for mental health services: a resource guide for health and

social care commissioners. Leeds: National Primary and Care Trust Development Programme (NatPaCT) & NIMHE. See:

http://www.natpact.nhs.uk/uploads/2005_Jan/MH_Screen_Version.pdf

25 Department of Health (2004). The mental health and psychological well-being of children and young people. Standard

nine of the National Service Framework for children, young people and maternity services. London: Department of

Health. See: http://www.dh.gov.uk/assetRoot/04/09/05/60/04090560.pdf

26 HASCAS. (In Press). Local commissioning of adult mental health services. See:

http://www.hascas.org.uk/adult/local_commissioning.htm

CAMHS to AMHS transition project. See: http://www.hascas.org.uk/camhs/transition.htm

27 Department for Education & Skills & Department of Health (2006). Joint Planning and Commissioning Framework for

children, young people and maternity services. London: Department for Education and Skills. See:

http://www.everychildmatters.gov.uk/_files/312A353A9CB391262BAF14CC7C1592F8.pdf

28 Blakemore, S.-J. & Choudhury, S. (2006). Development of the adolescent brain: implications for executive function and

social cognition. Journal of Child Psychology and Psychiatry, 47 (3/4), pp. 296-312.

29 Office for National Statistics. (2002). Census 2001. See:

http://www.statistics.gov.uk/census2001/pop2001/united_kingdom_ages.asp

30 Singleton, N., Bumpstead, R., O’Brien, M., et al. (2001). Psychiatric morbidity among adults living in private households,

2000. London: The Stationery Office.

31 Shiers, D., (Unpublished). Why young people with early psychosis should be a priority for ‘Choosing Health’: NIMHE

National Early Intervention Programme.

32 Eating Disorder Association. Eating Disorder Statistics. See: http://www.edauk.com/media/media_sub_statistics.htm

33 Office for National Statistics (2004). Census 2001: national report for England and Wales. London: Office for National

Statistics. See: http://www.statistics.gov.uk/StatBase/Product.asp?vlnk=10441

34 Department of Health. (2003). Child and adolescent mental health service (CAMHS) grant guidance 2003/04. See:

http://www.camhs.org.uk/documents%2FCAMHS%20Grant%202003%2D04%2Epdf


http://www.camhs.org.uk/documents%2FCAMHS%20Grant%202004%2D05%2Epdf


http://www.camhs.org.uk/documents%2FCAMHS%20Grant%202005%20%2D%2006%2Epdf

37 Department of Health (2002). Primary Care Trust revenue resource limits 2003/04, 2004/05 & 2005/06. London:

Department of Health. See:

http://www.dh.gov.uk/PublicationsAndStatistics/LettersAndCirculars/HealthServiceCirculars/HealthServiceCircularsArticl

e/fs/en?CONTENT_ID=4005021&chk=N%2BIVyk

38 Street, C., Stapelkamp, C., Taylor, E., et al. (2005). Minority voices: research into the access and acceptability of services

for the mental health of young people from Black and minority ethnic groups. London: YoungMinds. See:

http://www.youngminds.org.uk/publications/researchreports/minorityvoices.php

39 Social Exclusion Unit (2005). Transitions. London: Social Exclusion Unit. See:

http://www.socialexclusion.gov.uk/downloaddoc.asp?id=703

40 Audit Commission. Comprehensive Performance Assessment (CPA). See:

http://www.audit-commission.gov.uk/cpa/index.asp

41 Improvement Network. Assessing services for children and young people. See:

http://www.improvementnetwork.gov.uk/imp/core/page.do?pageId=1002520

42 Romeo, R., Byford, S. & Knapp, M. (2005). Annotation: economic evaluations of child and adolescent mental health

interventions: a systematic review. Journal of Child Psychology and Psychiatry, 46 (9), pp. 919-930.

43 Clark, A. F., O'Malley, A., Woodham, A., et al. (2005). Children with complex mental health problems: needs, costs and

predictors over one year. Child and Adolescent Mental Health, 10 (4), pp. 170-178.

44 Social Exclusion Unit (2004). Mental health and social exclusion. London: The Office of the Deputy Prime Minister.

45 Appleby, L. (2004). The National Service Framework for Mental Health: five years on. London: Department of Health. See:


46 Howarth, C. & Street, C. (2000). Sidelined: young adults’ access to services. London: New Policy Institute.

47 Smith, K. & Leon, L. (2001). Turned upside down: developing community-based crisis services for 16-25-year-olds

experiencing a mental health crisis. London: Mental Health Foundation. See:

http://www.mhf.org.uk/html/content/turned_upside_down.pdf

48 Macleod, R. J. & Parker, Z. (1986). Considerations in community mental health programming for youth. Canadian Journal

of Psychiatry, 31 (6), pp. 568-574.

49 Department for Education & Skills (2005). Youth matters. London: Stationery Office. See:

http://www.dfes.gov.uk/consultations/downloadableDocs/Youth%20mattters%20pdf.pdf

50 National Collaborating Centre for Mental Health (2003). Schizophrenia: full national clinical guidelines on core

interventions in primary and secondary care. London: Gaskell and The British Psychological Society. See:

http://www.nice.org.uk/pdf/cg001fullguideline.pdf

51 I&DeA. (2006). Healthier communities shared priorities. See:

http://www.idea-knowledge.gov.uk/idk/core/page.do?pageId=77237

52 Neighbourhood Renewal Unit. (2005). Local Strategic Partnerships. See:

http://www.neighbourhood.gov.uk/page.asp?id=531

53 Jarvis, C., Trevatt, D. & Drinkwater, D. (2004). Parenting teenagers: setting up and evaluating a Therapeutic Parent

Consultation Service: Work in Progress. Clinical Child Psychology and Psychiatry, 9 (2), pp. 205-225.


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A Call to Action: Commissioning Mental Health Services for 16-25 year-olds

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