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Opening Doors: an update on our ‘No Wrong Door’ work

There’s not a week goes by where I don’t hear about or discuss an issue relating to children’s mental health. Too often, I hear about how children and their families who are looking for support for a range of needs find that they have to navigate a very complex system, may fall through the gaps where there are no services to meet their needs, or be on a waiting list for a long time only to be told that they were waiting in the wrong queue, or have been knocking on the ‘wrong door’ all along.

These conversations and concerns led us to undertake a major piece of work which culminated in a report, published in June 2020, about support for children with mental health, emotional wellbeing and behavioural needs, and how services could work better together to support these children. The report was called No Wrong Door – bringing services together to meet children’s needs.

To inform the report, I visited every Regional Partnership Board (whose job it is to bring services together) in Wales in 2019/20, to ask them what they were doing to meet children’s needs.

The report made a series of recommendations to Regional Partnership Boards (RPBs), and to Welsh Government.

What are the issues?

Some of the key findings from my report were that:

  • Far too often, children who need support are on a waiting list for one service, only to be told when they get there that they were waiting in the wrong queue all along and are told to wait in another queue. All the while, they are not getting the help they need. For some children this process happens multiple times before they receive any support at all.
  • Children with complex health and social care needs who need residential care are too often sent many miles away from home to placements, which don’t necessarily meet their needs.
  • There was not enough focus on children’s issues generally, from most regions. They had tended to concentrate on services for adults.
  • There were some good examples of work to try to address these issues, which we highlighted in our report, but every region still had lots of work to do.

What is a No Wrong Door approach?

I wanted to set out here some key principles behind what I describe as a No Wrong Door approach. These are:

  • When a child is in distress and they or their family are asking for help, support is given. This does not necessarily need to be from a mental health professional, and for most children and young people the support they need to address the fundamental needs behind their distress could and should be provided by other professionals.
  • This support includes services for children who are neurodiverse – they may have needs related to autism, ADHD, Tourette’s, or other conditions. Currently children often have to wait years just for a neurodevelopmental assessment.
  • One example of good practice which we feel demonstrates a No Wrong Door approach is in the Gwent region where they have panels which meet every week and bring together services such as social services, primary and specialist mental health services, substance misuse services, the local authority’s sports and leisure service, youth services, school-based counselling service, Building Stronger Families service, third sector mental health provision, learning disability transitions service, young carers organisation, housing services, and youth enterprise services. These professionals discuss the needs of individual children and young people, working together to find the most suitable support, and to provide this quickly.
  • All of these actions contribute towards ensuring that professionals and resources at the specialist end of mental health care, for those with most acute need, are able to commit themselves to that specialist role.
  • Specialist mental health professionals also have a key role in supporting other professionals like teachers and social workers to look after the children and young people in their care. They do this through training and providing advice about individual children.

What happened as a result of this work?

  • Children and young people are now firmly on the agenda for every RPB in Wales, including a dedicated sub-group in every region.
  • Every region in Wales has a plan for a No Wrong Door approach, but each region is at a different stage on their journey to put this into practice.
  • Every region is now under a duty to involve children and young people through participatory work.
  • I have been encouraged by the range of responses to my recommendations, which include a working group organised and attended by young people themselves which feeds directly into the work of the RPB; plans for better responses to children and young people experiencing a mental health crisis; advanced plans for new therapeutic residential accommodation for those children who need both health and social care support; and work to improve services for neurodiverse children.

What’s happening now?

I have now met with all of the Regional Partnership Boards again this year, and I am pleased to report some early encouraging signs of progress since my 2019-20 visits.

We are also working with the Together for Children and Young People programme (T4CYP) on their NEST / NYTH framework. You can find more about NEST / NYTH here. I am excited by this new framework which will support RPBs to create a truly multiagency ‘nest’ – putting the systems in place to make sure children’s needs are met by whoever is best placed to meet them at the time they need them, not just put on another waiting list. I will work hard to make sure it delivers on addressing the issues I highlighted in No Wrong Door.

To be successful, this framework must be fully supported by Welsh Government, and delivered by RPBs. It must be a truly whole-system venture, with every service designed to support our children and young people working together to wrap around each individual child or young person and respond in a timely way to their needs.

What are the next steps?

  • Following my visits, I have organised a meeting where a representative group of young people will put their own questions about what RPBs are doing for children and young people directly to a panel representing every RPB. We will then share a suggested lesson plan/outline with all RPBs, asking them to do their own version of this meeting, but with young people from their region so they can hold them to account directly on their work.  This should not be seen as a one-off but as a chance to develop their ongoing engagement with children and young people in their region.
  • The representative group of young people will also share their assessment of RPBs’ progress with the Deputy Minister for Mental Health and Well-being in early December.
  • In the New Year, I will be publishing a follow up report, on progress by RPBs and Welsh Government towards my calls for a No Wrong Door approach across Wales.  This will take account of the latest visits and the views from the young people we’ve been working with. I’m pleased to say that there will be further examples of good practice that have been developed over the last two years.
  • I will continue to work with the Together for Children and Young People programme on the implementation of the NEST framework, and with Regional Partnership Boards and Welsh Government to ensure it delivers.

Whilst there’s demonstrable progress, we cannot be complacent. We will not stop in supporting and seeking changes from those responsible, so that the system delivers for and meets the needs of every child, wherever they live in Wales.

In the meantime, should any young people, their parents/carers and/or professionals working with them have any worries about access to support services, you can contact my independent investigation and advice team for information, support or assistance.  You can find out more about the team here.