Mental health disorder can start at an early age and have lifetime consequences. A ground-breaking early intervention in mental health service has been developed in Birmingham to offer mental health services for young people, 0-25 years. This is based on research findings by Warwick academics supporting the need for early intervention and a redesign of the service architecture to avoid difficulties when transitioning between child (0-16) and adult mental health services (16+). Professor Max Birchwood designed the new service and is leading an evaluation.
Clinical evidence suggests that half of all lifetime mental health illness begins by the age of 14 and three quarters by age 25 (with the exception of dementia). In parallel, referral rates to Child and Adolescent Mental Health Services (CAMHS) have significantly increased in recent years.
Research evidence generated through the Collaboration for Leadership in Applied Health Research and Care West Midlands (CLAHRC WM) shows young people who present with first psychotic symptoms experience long and damaging treatment delays due surprisingly to bottlenecks within the specialist mental health services, as well as due to poor help-seeking behaviour.
Research findings and evidence
Findings from Professor Swaran Singh of the CLAHRC research group showed significant numbers of young people being ‘lost’ and becoming ‘disengaged’ at the period of transition between child (0-16) and adult mental health services (16+) when they are actually at their most vulnerable. The research group also showed that ‘Did Not Attend’ rates where highest in the 16-24 age group in the Birmingham population, especially among BME groups.
Furthermore, findings from a detailed examination of the care pathways of young people with the most serious of mental health difficulties, psychosis, showed that long treatment delays were caused by poor help-seeking behaviour and by significant delays within the specialist mental health services in Birmingham.
An experimental youth pathway (‘YouthSpace’) was co-produced with service users in Birmingham and Solihull Mental Health NHS Foundation Trust including a dedicated youth team and using an interactive website to provide interventions in youth-friendly, low stigma channels. Alongside this, a public health campaign was trialled to increase the mental health awareness in some areas in Birmingham with a view to change the help-seeking behaviour of, and access to treatment among, young people in the early stage of psychosis. This youth pathway alongside the mental health awareness campaign, led to a significant reduction in treatment delay for psychosis, from 285 to 104 days, compared with no change in the control arm and was associated with high acceptability among all users of the service.
A ground-breaking early intervention service
CLAHRC WM held a knowledge exchange forum at the Birmingham Botanical Gardens in 2011 to promote these findings among Birmingham young people, families, commissioners and clinicians. This was written up as a special issue of the British Journal of Psychiatry. Dr Diane Reeves, Chief Accountable Officer for Birmingham South Central CCG, became aware of these findings at a dissemination event held by the CLAHRC on 5 September 2013. Dr Reeves has described this as a ‘key plank of local, high quality research which influenced the development and re-commissioning of youth mental health services in Birmingham to provide services to Children, Young People and Young Adults (CYPYA) from 0-25 years’. This impact is also an example of international quality research alongside local input leading to major change of services.
Many other CCGs across England are planning to re-commission mental health services to improve provision for young people in light of the Birmingham model. A ground-breaking service for young people in Birmingham emerged from this and other related developments, to provide services up to the age of 25 and to build this around public mental health and early detection principles.
This new service, 'Forward Thinking Birmingham', is being led by Birmingham Children's Hospital NHS Foundation Trust and aims to respond predominately to domain 2 of the NHS Outcomes Framework – to enhance quality of life for people with mental illness - but it is also likely to affect elements from all of the 5 domains. Professor Max Birchwood was one of a number of experts who supported the CCG through the commissioning process.
The new 0-25 years Birmingham model was highlighted in the recent Government policy paper published in March 2015 ‘Future in Mind’ aimed at improving mental health services for young people, which stated ‘we also note that in some parts of the country, such as Birmingham and Norfolk, there is a move to develop mental health services for 0-25 year olds. This new development will be watched with considerable interest’.