Deepening understanding of children and young people experiencing mental health crisis

When a young person presents in mental health crisis, what we see in that moment is one snapshot of a longer journey: from the young person’s experiences in the lead up to that moment, to their experiences of care beyond it. 

For those admitted to acute hospital beds at the point of crisis, putting in place the right ongoing support is key. However, discharge can be delayed for months due to a combination of factors around a young person’s needs, social situation, and the scarcity of suitable placements for them.

Our research project, funded through Q Exchange, involved working closely with the local authority in Harrow, Imperial College London and NHS North West London. 

Together we developed a deeper understanding of this cohort, the factors contributing to their escalation to crisis, and their interactions across health and social care services. 

We began our work by gathering insights about the touchpoints children and families have throughout their care journey. 

This involved undertaking a longitudinal analysis of NHS and local authority data to consider the whole patient journey for these children and young people. It focused on three areas:

1. Reasons for presenting to A&E with mental health concerns and other acute health needs
    
2. Patterns of contact with other services, including frequency
    
3. Individual risk factors contributing to crisis presentations.

In addition to data analysis, we brought together health and local authority stakeholders through sensemaking sessions to gain richer insights into our findings. 

We were fortunate in that we had a very strong foundation from which to work. Years of partnership working has created trusted relationships that enabled this collaboration between the NHS, local authority and academia.

Trusted relationships enabled us to navigate data sharing challenges and link data sets that are rarely connected across the NHS and local authorities. These relationships were central to navigating the inevitable challenges that come with cross-sector collaboration. 

For example, we found that key concepts were interpreted differently across sectors; the term ​‘crisis’ carried different meanings depending on the context. The strength of existing relationships enabled open, constructive conversations that led to agreement on shared definitions. 

This agreement was critical in establishing a system-wide understanding. Consequently we were able to capture the right data to map risk factors and identify opportunities to continue improving the experience of care for these children and young people.

Following this work, we have been reflecting on learnings that could be transferable in addressing challenges within the neighbourhood health agenda, both informing more effective multi-agency data sharing and supporting stronger collaborative working across sectors.

Shifting care to a neighbourhood-based health model presents a new opportunity to improve care outcomes, but there are numerous challenges that the health system must overcome to make neighbourhood health a reality. 

These include: 

• difficulty evaluating success in ways that move beyond activity-based measures;
• challenges with data sharing;
• misaligned financial incentives across different parts of the health system;
• the need for meaningful coproduction with citizens and staff to ensure that implementation leads to sustainable and lasting impact. 

Practitioners need to be able to see key data from across sectors in order to assess risk and share decisions about patient care. 

As such, data and information sharing across sectors, including the NHS, local authorities and voluntary, community and social enterprises (VCSEs), is critical in the set-up of multidisciplinary teams that support neighbourhood priority areas. 

The learning from our Q Exchange project could help to address some of the challenges when it comes to multi-agency data sharing. This could be from navigating approaches to setting up the underlying data infrastructure and trusted relationships, to mapping shared language and service design at the interface of sectors.

If we are to have a care model with the child or young person at the centre, all practitioners involved need to be able to see the same data. Working for an organisation focused on enabling systems change, we know that this type of data sharing is one part of the puzzle. 

Once we have effective data systems in place, we can define funding models that better support the neighbourhood health vision of shifting to community-based, preventative care. 

To date, these models have often run up against a number of barriers: 

• misaligned financial incentives act as a barrier to collaboration; 
• a focus on short-term metrics provides insight into activity, but less focus on outcomes; 
• one-year funding cycles make it difficult to invest in prevention. 

Our long-standing work in developing outcomes-based partnerships aims to tackle these barriers by aligning partners around shared outcomes that improve patient care while also considering system savings. 

These outcomes-based partnerships also allow for an extended horizon, usually at least three to five years, enabling partners to invest in prevention and track evidence of impact over a longer period. 

The Neighbourhood Transformation Fund reflects the latest innovation in these partnerships, embedding key principles for neighbourhood health: investing in prevention, local ownership, and community integration. 

Together, these foundations of data sharing and outcomes-based funding enable partnerships to focus on meaningful co-production with patients, families, carers, and staff. This is central to driving long-term system change, ensuring that the shift towards neighbourhood health is sustained well into the years and decades to come.

If you’d like to talk to us about this work, please do reach out. Click on our author profiles on this page and send us a message.