Findings from the early evaluation of the UK Children and Young People's Mental Health Trailblazer programme

Globally there is an increasing focus on the mental health and well-being of children and young people as youth mental health problems have replaced childhood mortality as the most significant challenge for society (WEF, 2020). Dr Sarah-Jane Fenton (@S_JFenton) with Jo Ellins (@DrJoEllins) and the Health Services Management Centre (@_HSMCentre) present findings from the early evaluation of a UK programme, which offers valuable insights.

Photo by Devin Avery on Unsplash

Covid-19 has been reported to have triggered a 25% increase in the prevalence of depression and anxiety worldwide (World Health Organisation, 2022). In the UK, research and the recent mental health survey highlight a deterioration of children and young people's mental health before the pandemic (Ford T, John A, Gunnell D, 2021; Newlove-Delgado et al., 2022). There is an increasing focus on what can be done, particularly what support could be offered in education settings, including schools and colleges, as these are where children and young people spend a great deal of their time (World Health Organization, 2021).

The Trailblazer programme, launched in 2018, is led by the Department of Health and Social Care, the Department for Education and NHS England and Improvement. It is funding the creation of mental health support teams (MHSTs) and training education mental health practitioners (EMHPs) to work directly in educational settings. The MHSTs have three core functions:

1) To provide direct support to children and young people with mild to moderate mental health problems to support educational settings;

2) to introduce or develop a whole school or college approach to mental health and well-being;

3) to advise staff in educational settings and liaise with external specialist services to help children and young people get the right support and stay in education

The programme is being implemented across 11 waves, and there are now over 400 teams across England.

We undertook an early evaluation of the Trailblazer programme to examine the development, implementation and early progress of the programme and to see how MHSTs were being set up and running in the Trailblazer sites. 

How did we do it?

A team from the BRACE Rapid Evaluation Centre at the University of Birmingham and a team from the Policy Innovation and Evaluation Research Unit at the London School of Hygiene and Tropical Medicine partnered to undertake an early evaluation focused on the first 25 'Trailblazer' sites. The team partnered with the University of Birmingham Institute for Mental Health Youth Advisory Group, which led the Patient and Public Involvement and co-produced part of the research.

To do this work, we did 144 interviews with national and regional leads, local stakeholders and wider partners across the sites. We did a documentary analysis and analysed programme monitoring data. We undertook surveys of participating schools and colleges and of people involved in implementing MHSTs in the trailblazer sites. We also sought the view of children and young people and ran online focus groups with 32 children and young people.

What did we find?

We looked at how the service had developed, and we found that:

• Schools and colleges welcomed the funding of additional capacity to provide in-house mental health support and the programme's focus on prevention and early intervention.

• Before Covid-19, Trailblazers were making good progress in implementing MHSTs. The recruitment, training and transition into practice of the first cohort of EMHPs was widely regarded as a significant achievement, and all teams were operational by early 2020.

• Good progress has been made in implementing MHSTs, despite challenging circumstances. Within 12 months of the first cohort of EMHPs starting their training, all 58 MHSTs were operational.

 When we examined implementation, we found that:

• Covid-19 had a major impact on programme implementation and day-to-day delivery of the MHST service. Coupled with the impact of lockdown, some MHSTs found it harder to build relationships with staff in schools and colleges and establish the new service. In response to COVID-19, MHSTs switched to delivering remotely to allow them to continue to provide support; however, it was clear this approach could not work for all groups and in all situations.

• There had been initial concerns that recruiting senior staff to MHSTs from other local mental health services could create staffing shortages elsewhere in the local system. But many had come to the view that the movement of staff between services was positive inasmuch as it had helped build understanding and relationships.

• Despite intentions, the involvement of young people, parents and carers in the design and delivery of MHSTs was variable and often low.

• MHSTs spent more time providing direct support (on average 52% of their time) than on their other two functions (24% on whole school support and 23% on giving advice and liaising with external services).

 When exploring early progress, we found that:

• There was a view that local governance and leadership were not yet genuinely shared across health, education and other key stakeholder groups. Instead, it was dominated by the NHS and mental health services.

• Children and young people were not always aware that there was an MHST in their school or what it did. However, those who had direct contact with the MHST universally reported their experience as positive.

• Education settings reported positive effects from participating in the programme, including staff feeling more confident talking to children and young people about mental health issues, being able to access advice about mental health issues more easily, and having quicker access to support for children and young people with some mental health problems.

Reflections on what we found out

We discovered through our research that the programme was making good progress and that the additional support provided by MHSTs was welcomed by schools and colleges as well as children and young people. In fact, the young people told us they would like more time with MHSTs!

There were some challenges, in particular some children and mental health problems that were more serious than 'mild to moderate' but could not access other more specialist support. The MHSTs could not reach everybody, and sometimes the support they could offer was unsuitable for all children and young people.

In terms of the programme delivery, there were challenges in retaining staff in the MSHTs. Teams themselves reported spending proportionately more time providing direct 1:1 support for children and young people than on the other two functions of their roles.

Education settings generally reported being satisfied with MHSTs and spoke positively about the work. However, the scope of 'mild to moderate' and the lack of provision for children and young people with more complex needs created tension. This issue of the 'missing middle' is not peculiar to the UK but exists as a challenge in other health systems (McGorry P, 2021). However, staff in education settings reported that they felt more confident talking to children and young people about mental health issues and were pleased when they had quicker access to support for children and young people with mild to moderate mental health problems.

For more information about this research

You can visit our webpage, where you can find an infographic that overviews the key findings and a copy of the full report. We have also produced a short animation in partnership with members of the Institute for Mental Health Youth Advisory Group. It shares the findings from the BRACE evaluation of mental health support teams in schools and colleges. You can watch the video summarising our key findings here:

References

Ford T, John A, Gunnell D, 2021. Mental health of children and young people during pandemic. Br. Med. J. 372.

McGorry P, 2021. The reality of mental health care for young people, and the urgent need for solutions. Med. J. Aust. 216, 78–79.

Newlove-Delgado, T., Marcheselli, F., Williams, T., Mandalia, D., Davis, J., McManus, S., Savic, M., Treloar, W., Ford, T., 2022. Mental Health of Children and Young People in England 2022 - wave 3 follow up to the 2017 survey.

WEF, 2020. A Global Framework for Youth Mental Health: Investing in Future Mental Capital for Individuals, Communities and Economies.

World Health Organisation, 2022. COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide [WWW Document]. URL https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide (accessed 4.27.23).

World Health Organization, 2021. Mental health in schools: a manual. Cairo: WHO Regional Office for the Eastern Mediterranean.

 Posted by Lisa Wheildon (@DrLisaWheildon).