So, an important review on mental health has been published. Eager to see what it says you open it up. It takes a while to load then you discover that it is over 600 pages. Maybe you don't have time for that today. Not a problem – we have you covered.
What has the review found?
Young people are experiencing real and rising levels of distress. 1 in 4 young people (16-24 year olds) now experience a common mental health condition such as anxiety or depression, with young women experiencing the highest rates of any group (36.1%). Self harm and eating disorders have also increased among young adults.
Rising need is not experienced equally, instead falling disproportionately on people facing deprivation, discrimination and disadvantage and interacting with ethnicity, disability and geography. Prevalence of common mental health conditions was 26.5% in the most economically deprived areas, compared with 15.3% in the least. LGBTQIA+ people experience rates of depression and anxiety around twice those of heterosexual and cisgender peers.
Waiting lists are too long and the delay itself causes harm. Too many young people are left waiting for support while their mental health worsens with consequences across their wider lives.
Investment in mental health and neurodevelopmental support has not kept pace with need, with the system often responding too late at greater human and economic cost.
The transition to adulthood has become harder and more unequal. Poverty, financial insecurity, unemployment and housing pressures have continued to affect mental health, compounded by uncertainty associated with the cost of living, climate change and wider political instability.
For our members, these findings will reinforce what you have been seeing in your services for years.
What about the recommendations?
1. More prevention and earlier support
The review calls for a much more ambitious approach to prevention, early intervention and public mental health and wellbeing.
Significantly, it recommends full national coverage of open-access self-referral early support hubs for 11-25 year olds – bringing together mental health, education, employment and physical health support with independent evaluation build in from outset.
For young people who have campaigned tirelessly for this for many years, this is an important step closer to reaching our goal. For our members, this is big recognition of the value of the model you have been delivering in communities, many for decades.
2. Tailored employment support for young people experiencing mental ill health
The review recommends high-fidelity Individual Placement and Support (IPS) adapted for young people, embedded within services used by young people and targeted particularly towards 16–25-year-olds who are not in education, employment or training and experiencing mental ill health.
Three Youth Access members are already piloting this approach, thanks to funding by the People's Health Trust - Mancroft Advice Project (MAP) in Norfolk, 42nd Street in Manchester and No Limits in Southampton.
There is a clear opportunity to build on this practice and the learning emerging from these pilots.
3. A bigger role for the voluntary and community sector and the end of short term funding cycles
The review recommends the voluntary, community and social enterprise (VCSE) sector are commissioned as core partners through stable funding.
This means: multi-year commissioning, shared governance arrangements, common outcome measures and support for organisational sustainability.
4. Support should be universal but not one-size-fits all
The review recommends commissioning explicitly applies proportionate universalism which means an approach were support is available to all whilst specifically tailored for people most underserved.
It sets out that local plans should look at access, experience and outcomes for different groups which will support responsiveness and adaptation to who is getting through the door, staying engaged and getting better outcomes.
5. Transitions should be everyone's responsibility
The review calls for transitions to be treated as a planned, shared responsibility – coordinated across organisations with services working together until a transfer is complete. It also points to more integrated 0-25 pathways where feasible – something Youth Access and members have been consistently calling for to address the cliff edge of support at age 18.
6. Mental health support needs to work for young adults and neurodivergent people
The review recommends adapting NHS Talking Therapies for young adults and neurodivergent people so they are developmentally appropriate for 16-25 year olds and adapted people with ADHD or autism and other educational needs, including intellectual disabilities and language disorders.
Member spotlight: Centre 33 (Cambridgeshire and Peterborough)
Youth Access member Centre 33 are spotlighted as one of the six good practice case studies in the report demonstrating that flexible, needs-led support can improve outcomes for young people who are typically underserved. By matching the type and intensity of support to individual need, Centre 33 achieved greater average improvements in psychological health and wellbeing.
What should members keep an eye on?
The Fonagy Review does not sit in isolation. It comes ahead of the Milburn Review expected in November and the Government's forthcoming Mental Health Strategy due before Christmas.
One to watch closely is the intersection between mental health support, benefits and employment. Young people need the right building blocks in place to stay well and engage and participate during the transition into adulthood – including financial stability. The Fonagy Review highlights research identifying that the removal of financial support for low-income young people, in the case of Education Maintenance Allowance, was associated with poorer mental health among those affected.
Reports of discussions to remove the health element of Universal Credit for under-25s are concerning. It is clear that practical and mental health support to help young people access education and employment should complement, not replace, the financial security they need while managing a health condition.
There is a lot more in the review
We’ve focused here on the findings and recommendations most directly relevant to Youth Access members. There is much more we haven’t covered, including the review’s recommendations on serious mental illness, ADHD and autism, but that we will work through closely.
Recommendations are no use sitting on a shelf. Momentum is building and Youth Access will continue working with all our partners – current and future – to push for these changes set out to become reality.
We'd love to hear from you – what are your views on the review and the recommendations, and what do you think needs to happen next?
