Title: Crisis care for children and young people with mental health problems: national mapping, models of delivery, sustainability and experience (CAMH-Crisis2)
Funder: Health and Care Research Wales (Welsh Government)

Abstract: Background There has been a sharp and worrying increase in mental health problems experienced by children and young people. Before the pandemic, one in eight 5-19 year olds in England was likely to have a mental health problem. In 2020, this figure rose to one in six 5-16 year olds. Among those with a mental health difficulty, almost half of older teenagers and a quarter of 11-16 year olds report having self-harmed or attempted suicide. Extreme emotional distress, with or without self-harm,?is?often referred to as a ‘crisis’.?Services for young people in crisis are a priority in the UK with services expanding. However, little is known about what crisis services currently exist, who uses them, or what type of service works best for children and young people and their families. Aim and objectives This project aims to explore the types of mental health crisis services currently available to children and young people up to the age of 25 in England and Wales, and to examine how they are organised, perceived and integrated within other local care systems. The objectives are to: 1. Find out what NHS, local authority, education and charity sector crisis services exist for children and young people across England and Wales, to describe the services and to create a database of them. 2. Identify eight contrasting services from the database and evaluate how these services are organised, perceived and integrated within local care systems. 3. Compare and contrast these services with the available international evidence, drawing out clear implications for the design and delivery of future crisis responses for children and young people and their families. Methods We will meet?objective 1 by using a?survey to?create a database of crisis response services?across England and Wales?including how they?are?organised,?implemented and used.?To meet objective 2,?from?the database?we will?identify?eight?contrasting?services selected for variety in terms of:?geography and wealth of the setting (England/Wales, urban/rural, and relative wealth/poverty);?populations served (including ethnic diversity);?and the nature of the service (including the charity sector and/or social care involvement).?Treating?each?as a case study,?we will conduct interviews with children and?young people?and?family members?who have used the service as well as managers?and?staff.?We will look at how the services work and gather data?on how?they are used and by whom.?In our analysis we will focus on understanding?how?each?crisis service?is?provided,?perceived and implemented.?To meet objective?3, we will?compare?and contrast each case?study?and?compare what we find with the findings of other research studies from around the world. We will finish by?drawing?clear, actionable,?lessons for the future provision of?high-quality crisis services which are sensitive to the support needs of a diverse range of children and young people receiving care from a range of services.? Patient and public involvement This study has been co-designed with young people who advise on research, some of whom have used crisis services themselves. Dissemination Our findings will be shared nationally and internationally via webinars, podcasts and written publications.

Lay abstract: There has been a sharp and worrying increase in mental health problems experienced by children and young people. Prior to the pandemic, one in eight 5-19 year olds in England had a probable mental disorder. In 2020, amongst 5-16 year olds this figure had risen to one in six. Amongst those with a mental health difficulty, almost half of older teenagers and a quarter of 11-16 year olds report having self-harmed or attempted suicide. Extreme psychosocial distress, with or without self-harm, is often referred to as a ‘crisis’. Services for young people in crisis are a UK priority, and provision is expanding. However, very little research into crisis services for young people has been undertaken. We therefore do not know what crisis responses currently exist, who uses services, or what works best for children and young people and their families. This project will answer the question: ‘How are mental health crisis responses for children and young people up to the age of 25 sustained, experienced and integrated within their local systems of services’? We will work with a group of young people who advise on research, some of whom have used crisis services, to address the following three objectives: 1. To describe and map NHS, local authority, education and third sector approaches to the implementation and organisation of crisis care for children and young people across England and Wales. 2. To identify eight contrasting case studies in which to evaluate how crisis services have developed and are currently organised, sustained, experienced and integrated within the context of their local systems of services. 3. To compare and contrast these services in the context of the available international evidence, drawing out clear implications for the design and delivery of future crisis responses for children and young people and their families. To help us meet our objectives we will make use of normalisation process theory. This supports studies into what helps, and what hinders, the implementation and sustainability of new approaches to care. We will meet our first objective using a survey, creating a detailed record of crisis responses across England and Wales and how they are organised, implemented and used. To meet our second objective, from the detailed record created in meeting objective one we will identify eight contrasting services selected for variety in terms of: geographic and socioeconomic setting (England/Wales, urban/rural, and relative affluence/poverty); populations served (including ethnic diversity); and service configuration (including third sector and/or social care involvement). Treating each as a case study, we will interview young people and family members who have used the service. We will also interview commissioners, managers and practitioners, including those providing a crisis response and those working in other parts of the local system. We will gather operational policies and related documents, and data on how each service is used and by whom. In our analysis we will focus on understanding how each crisis service is provided, experienced, implemented and sustained. To meet our final objective we will compare and contrast each case study, closing our project by drawing clear, actionable, lessons for the future commissioning and provision of high-quality crisis responses sensitive to the support and access needs of a diverse range of children and young people receiving care from a range of services.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH