Mental health support for young people and working-age adults

The context

The Bridge is one of seven PCNs in Milton Keynes. It began as a primary care home, the precursor to PCNs, and has been working on developing support for young people and working-age adults. 

The PCN started by undertaking population health work to understand the population and their needs, aiming to build up mental health support in the community. Taking a bottom-up approach, the PCN worked with several local partners including the public health team, the parish council, local schools, and voluntary and community sector organisations.

All partners agreed that the priorities were supporting the mental health of children and young people and working-age adults.

Nationally, the number of children and young people accessing mental health support is a concern as only around 37 per cent of children and young people are accessing specialist mental health support at present. The LTP commits to increasing this to 40 per cent by 2023/24 and to 100 per cent by the end of the decade. To help reduce this current level of unmet need, the PCN and its partnership developed two community-based approaches to increase the number of young people they support.

Talk for Sport: exercise-based therapy

Talk for Sport is an exercise-based therapy programme that provides eight weekly gym sessions for young people aged 11 to 18 with low to moderate mental health issues. The aim was to use these sports sessions as a way of providing education and support on topics such as mental health and resilience, nutrition and bullying. 

The PCN developed the programme with a private enterprise, which provided most of the funding and marketing materials, and the PCN provided a clinical questionnaire for the group to measure outcomes. The cost to the PCN to support the programme was only £1,000, which meant the partnership approach was very cost effective.

The PCN engaged with local schools about this service. Schools can refer students directly to the project and, as part of their contribution, schools have provided a bus to transport young people to and from the gym. Local GP practices can also refer young people and make use of the bus service. 

This programme has been evaluated and includes data from pre- and post-course questionnaires, which measured both physical and mental health.  The pre-course questionnaire found that 72 per cent of the young people had used CAMHS, and 46 per cent had consulted their GP in the last six months for depression or anxiety.  72 per cent of young people were doing less than the recommended amount of exercise per week. They used the Personal smile survey, which measured current mood, and this score was 48 per cent. 

The post-course questionnaire found that 100 per cent had reached the minimum recommended amount of exercise per week, 69 per cent had improved their mental wellbeing, 76 per cent made new friends and 76 per cent enjoyed being part of a group. The Personal smile survey score of current mood was 64 per cent. 

Evaluation found that 83 per cent of young people would choose a Talk for Sport option before seeking a health care professional. This is largely consistent with national findings, where children and young people with a mental disorder said that they would rather speak to and get help from a teacher than a mental health professional.

Headstart: art-based therapy

Not everyone is interested in exercise, so the Bridge PCN worked with a local voluntary sector organisation, Arts for Health, to develop Headstart; a 12-week course that provides an arts-based therapy for young people aged 11 to 18. It was an existing project, which ran as part of the Arts on Prescription programme, provided by Arts for Health, but it has been personalised for the PCN.

Again, by working in partnership, the PCN only had to contribute £1,700 per 12-week course, for ten young people.

The programme moved online during the pandemic, and while attendance did drop, four young people finished the course. One of these young people went on to complete a diploma in art.  The PCN is currently evaluating the project and assessing outcomes.

Adult mental health CBT therapist in primary care

The PCN partnered with a local mental health provider and secured a CBT therapist to work in the PCN. The aim was to evaluate the impact and roll it out to all PCNs, but the programme has been delayed and only one PCN currently has a CBT therapist. However, they have received positive findings from that PCN.  There is better engagement, which resulted in fewer missed appointments than seen in the mental health trust.  The therapist attends the monthly multiagency team meetings in the PCN to discuss cases. This helps give a more holistic view in managing the patient. They work with some more complex patients, such as those with borderline personality disorder or underlying mental health issues, who are unlikely to be referred to specialist mental health services.

The recovery rates for the CBT therapist are 56 per cent, compared to the IAPT service, which is 45 per cent.

Primary care adult mental health services

The mental health practitioner in The Bridge PCN started as a pilot programme, which has been in place for around ten months.  It is now embedded in all but one of the seven PCNs in the area.

The aim is to improve the GP and mental health practitioner interface when managing patients with mental health needs.  The GP provides support for the patient’s physical health, and the mental health practitioner provides support for the patient’s mental health. The programme also supports the GP and practice staff by improving their knowledge and confidence around mental health.  It has resulted in bringing some patients back to primary care who were being supported in secondary care.  This has helped reduce demand on secondary care services.

In both of the adult mental health programmes in The Bridge PCN, the therapists are employed by the mental health trust, so there was no cost to the PCN, but they have had huge benefits for primary care and patients.

“There is a willingness to work together, and so the costs are ‘mates’ rates.  Working with local partners has meant low or no cost to the PCN.”

PCN Clinical Director