The case for open access well-being services
Open access hubs are designed to offer easy-to-access, drop in support on a self-referral basis for young people with emotional health and well-being needs, up to age 25. These services can be delivered through the NHS, in partnership with local authorities, or through the voluntary sector.
This briefing intends to set out the case as to why we believe these hubs are essential for the emotional health and well-being of children and young people.
Our previous research has highlighted that children’s well-being has been in decline for much of the past decade. At the same time, there is a lack of services based in the community to support the emotional health and well-being of children and young people.
Services of this kind are crucial in providing a response and preventing escalation to later mental ill-health. Currently, emotional health and well-being needs are generally met through support in schools and by the Voluntary and Community Sector (VCS) in the community.
The responsibility for the provision of these services is shared between the NHS and local authorities, resulting in a lack of ownership and accountability in the system. This is further confused by a complicated funding environment which lacks a clear stream of funding to support children’s emotional health. As a result, the provision of these services is patchy across the country.
Much of recent Government policy has focused on mental health support within education settings and the NHS, and additional funding provided to the youth sector has focused on improving infrastructure and provision. This has been little consideration of what communities and local Government can do to promote positive well-being, and as a result, there is little space in the system for community-based emotional health and well-being services.
Given the poor progress in improving children and young people’s well-being over recent years, it is now more important than ever that a clear and well-funded community prevention and early intervention strategy to improve children’s emotional health and well-being is put in place, accompanied by the roll-out of support services. We see that there is a role for the increased provision of open access, drop-in emotional health services within the community as a way achieve this. Provision of this kind already exists in some places across the country and we want to see the wider roll-out of these services. This briefing intends to set out the case as to why we believe these hubs are an essential part of the emotional and well-being offer for children and young people, setting out the available evidence and best practice.
The case for open access - review of evidence
We believe open access models are an effective way of rolling out emotional health and well-being support in the community to children and young people. The government have also recognised the importance of these services forming part of the universal local offer by recommending in its Future in Mind strategy that the number of one-stop shop services in the community should be increased. What is more, the open access model is one that is recognised internationally with a network of these kind of services being established in Australia, Ireland, Israel and Denmark.
The following section will provide a review of the available evidence on the effectiveness of open access support. To note, evidence is still limited within this area and much of it focuses on international models.
Open access hubs are designed to offer easy-to-access, drop-in support on a self-referral basis for young people with emotional health and well-being needs, up to age 25. These services are typically run by the Voluntary and Community Sector, in partnership with the NHS or local authorities, or both, and respond to local need among young people. There is no standard model for these services, and variation exists in delivery, not only in this country, but internationally.
These services, however, do share common characteristics:
- Dedicated services for young people, often up to the age of 25
- Available to all young people without the need to meet thresholds for support
- A single, visible trusted location where services are delivered under one roof
- A safe and youth-friendly environment
- Accessible in terms of location and hours of operation
- Provide a timely response to young people
- Combine a range of expertise from youth work skills, advice workers and counsellors
- Take a youth-centered approach.
Evidence suggests there are a number of key benefits to the open access model.
Open access services have been found to achieve comparable clinical outcomes to statutory services. A recent study carried out by Youth Access and the British Association for Counselling and Psychotherapy (BACP) found that clinical outcomes in the voluntary and community sector are comparable to those reported in school-based and statutory mental health services. Whilst these services do not provide long-term clinical interventions, they do provide a safe space for young people in young-person centred environment, delivering a more flexible approach to support that is on the young person’s terms.
These services are youth-led. Research has shown that young people respond better to services that are youth specific. Many of these services take a youth work approach to support, where work is centred on the young person in terms of their strengths and needs, and listening to their voice. What is more, involving young people in the systems that relate better to their needs has been noted as an important step in engaging them in their mental health treatment.
These services are also perceived as highly accessible. A previous evaluation of the one-stop shop model stated that these services were largely described as having characteristics in line with those typically credited with increasing access, including offering walk-in sessions and self-referral, and being located centrally or close to transport. The drop-in element of these services facilitates an accessible service, where young people can get support in times of need. Many of these of these services do not require referrals meaning that young people can access support without high thresholds and long waiting times.
Open access services appear to reach marginalised groups who may not be accessing other services. The Youth Access and BACP study found that there was a higher representation of ‘older’ clients, females and those from Black, Asian and Minority Ethnic backgrounds accessing VCS support. The study suggest that VCS services may play an important role in meeting the needs of minority client groups, and may be more accessible and perceived as less stigmatising than statutory services.
This has also been found in other studies. In February 2019, Great Ormond Street Hospital introduced a mental health drop-in centre at the hospital. While this initiative was driven by the need to transform access and delivery of mental health care in young people with physical health problems, it has also generated some key learning for drop in models more widely. The pilot found that participants from a Black, Asian and Minority Ethnic background were over-represented in the drop-in, suggesting that the drop-in centre may be an effective way to increase access to mental health support amongst racialised communities.
The pilot also recognised that there are individuals with significant unmet mental health needs, who may be served by a drop-in centre. It was suggested that the drop-in centre might act as a highly visible ‘single-point-of-access’ for mental health care, guiding families to treatment pathways that they were previously unaware of.
There is growing evidence that early intervention services are associated with cost-savings. Public Health England has highlighted that evidence shows prevention and early intervention represent good value for money.
These costs savings are not only associated with a decrease in pressure on specialist services, but also with improved educational outcomes to higher employment rates to greater economic productivity.
Research from Youth Access has shown that the help provided through their YIAC services is highly effective at improving young people’s mental health, with the potential to avoid escalation of mental health issues related to common social welfare issues such as housing, debt and employment.
For those young people in the study who reported that advice had improved their stress or health, savings in GP costs alone (and disregarding the cost of other health services) were estimated to equate to £108,108 per 1,000 clients of youth advice agencies (or £108 per young person), exceeding the average cost of advice provision.