The success of a community-embedded, youth mental health hub in South London, evaluated by CEI, provides lessons for the growing challenge of providing timely and equitable early intervention services for children and young people.
A holistic, open-access service for 4- to 25-year-olds funded by Southwark Council since 2020, The Nest provides integrative counselling, family systemic therapy, individual art therapy and school-based music therapy, among a range of other services.
The Nest’s goal is to improve access, reduce waiting times, and support individuals typically underserved by traditional mental health services. Children and young people can refer themselves for assessment at The Nest, or be referred by professionals such as doctors, social workers or teachers; all referrals are triaged within one working week.
“The demand for mental health services for children and young people in England continues to exceed availability,” explains Dr Katherine Young, CEI Principal Advisor. “According to the latest estimates, 18% of 7- to 16-year-olds and 25% of 17- to 24-year-olds in England are living with mental health issues. But only a third (32%) of those referred for services enter treatment within 12 months, and almost one in four referrals (39%) are closed prior to the young person receiving any treatment.”
“Early support hubs, embedded in local communities, have good potential to help fill gaps in high-quality, early-intervention mental health care. However, the evidence for such hubs’ effectiveness is still developing. We also need to identify which principles and features of these services lead to optimal community engagement and impact, so we can work out how best to implement and scale successful models.”
The Nest’s evaluation, commissioned by non-profit health equity advocate Impact on Urban Health, showed the Southwark hub is greatly valued by young people it has supported and by local professionals as well – particularly for the ability to address inequalities in access to mental health care.
“Professionals praised The Nest’s flexible scheduling and approach, the welcoming and informal environment, central location, and consciously less ‘clinical’ care – all seen as strong enablers of child and youth engagement,” notes Tamara Pemovska, CEI Advisor. “The Nest was also viewed very positively by young people, who applauded the accepting and person-centred therapeutic approach, comfortable environment, service flexibility, and the relatable and empathetic staff from a diverse range of backgrounds.”
The evaluation recommends The Nest be supported to continue offering its high-quality services for young people up to age 25, including the drop-in service (which is unique in the local area).
The Nest’s volunteer Youth Forum is a key driver of connection with its user-base, and a strong foundation for increasing the level of community engagement and youth involvement.
“Exploring how The Nest can better communicate and integrate with other local practitioners and services will be important in its next phase, as well as why some groups are less engaged – for example, under 11s, and young people experiencing low school attendance,” says Katherine.
“The evaluation findings will be useful in continuously improving implementation of The Nest, as well as informing similar models of care.”
Summary findings and recommendations
The evaluation investigated The Nest’s reach and accessibility, how young people experience the service, and the impact on individuals and the wider community.
Key findings were:
- Almost 1,000 children and young people and more than 150 families have been supported by the service since 2020. Wait-times between referral and treatment for those aged 11 to 25 years averaged 3.5 months, compared with 12 to 18 months at the local Child and Adolescent Mental Health Services (CAMHS).
- The Nest engages with diverse ethnic groups (41% black ethnicity) and genders (67% female).
- 95% of young people reported a good experience with the service.
- 64% of young people aged 11 to 25 achieved a reliable improvement in psychological distress, a very positive indication of an effective service. Positive changes in distress level were found across ethnic groups, genders, and within typically underserved groups (including young men, and black and minority ethnic groups).
- Wellbeing improvements were described by young people receiving care (and by professionals), including positive impacts on anxiety and mood, better day-to-day functioning and coping strategies, and improved self-understanding. Young people also reported being more open to talking about mental health support, and more aware of and willing to access future support.
- All professional groups involved in The Nest shared the view that it is an important addition to mental health provision in Southwark.
Key barriers to greater reach and access were perceived to be financial (impacting staffing and amenity), some challenges in accessing language translation services, a lack of clarity around referrals and wait times, and the boundaries of service for higher risk individuals.
About the evaluation
CEI was commissioned by Impact on Urban Health to conduct an independent, mixed methods evaluation, with the key aims of:
1) Gathering evidence to inform recommissioning of The Nest
2) Building on the evidence base for open access models of early mental health support
The evaluation used a combination of routinely collected and publicly available quantitative data, as well as 17 qualitative interviews with 27 participants, including service users, members of The Nest’s Youth Forum, staff of The Nest, and a range of referring professionals (such as GPs, Child and Adolescent Mental Health Services (CAMHS) staff, school staff, and Family Early Help staff).
The report, “Evaluation of The Nest: A community-based model of holistic, open access, early mental health support for children and young people”, was co-authored by Dr Katherine Young, Tamara Pemovska, Dr Stephanie Smith and India Thompson from CEI, and commissioned by Impact on Urban Health, an independent health foundation working in the London boroughs of Lambeth and Southwark.