A trial of a new mental health drop-in service for children around England shows significant reductions in emotional and behavioural difficulties and improved quality of life, with the cost of treatment reduced by half.
Innovative new drop-in service originally conceived by Cambridge Children’s Hospital clinician, Professor Isobel Heyman
Clinicians behind the trial were inspired by the comic Peanuts character Lucy and her psychological booth – where she provides advice to other characters’ problems. The original pop-up ‘Lucy Booth’ was first piloted in the reception of Great Ormond Street Hospital (GOSH) in London and funded by GOSH Charity. It was then extended to six paediatric settings across England with 120 families consenting to take part in the study.
Professor Isobel Heyman, Clinical Co-Lead for Mental Health at the new Cambridge Children’s Hospital conceived the idea for the ‘Lucy Booth’ after watching the Peanuts cartoon. Cambridge Children’s Hospital aims to treat the whole child — providing integrated care for both physical and mental health. The drop-in model of the Lucy Booth to treat mental health needs of children with physical health conditions, embodies and achieves this goal.
Globally, 15-20% of children and young people have a long-term physical health condition, and in the UK around 50% of these children will meet the criteria for at least one mental health condition. Due to the lack of current service provision, children with long-term physical health needs can struggle to find adequate mental health support.
The mental health drop-in service aimed to address these issues quickly and enable children and families to self-refer and access treatment, with wait times of less than two weeks. Most children had an initial assessment, followed by an intervention such as low-intensity Cognitive Behavioural Therapy (CBT), referral to other mental health services or signposting to support groups and charities. Parents were also able to access mental health support via the hub.
After six months, the clinicians found that the children and young people who accessed the interventions had significant improvements in emotional and behavioural symptoms. Parents also reported lower levels of depression and anxiety. The cost of treatment per patient was reduced by half, compared to a typical course of psychological therapy, based on health economic analysis (opens in a new tab).
Professor Isobel Heyman, who is also a Honorary Professor at UCL GOS Institute of Child Health and at the University of Cambridge, said: “I was inspired by the character Lucy from the Peanuts cartoon, who set up her own drop-in booth to help with the mental health needs of her fellow Peanuts characters! The sign above her booth said 'the doctor is in'! That was our aim — to be available and accessible to all.”
By meeting children and their families with emotional and behavioural problems before they were too severe, we could treat them early and prevent them getting worse. We have effective psychological therapies in child mental health, but these treatments are not accessed by children with physical ill health. We wanted to change that inequality.
Professor Isobel Heyman, Clinical Co-lead for Mental Health, Cambridge Children's Hospital
Lead author, Dr Anna Roach, who delivered the project for her PhD at University College London (UCL) said: “It was an absolute joy to lead the roll out of drop-in mental health services across paediatric healthcare settings. It was inspiring to see that some settings were able to reprioritise resources to provide the service without additional funding, including training for non-mental health clinicians to deliver support under supervision.
The flexibility in delivering the service enabled clinicians to adjust to their local need and providing integrated care for physical and mental health with positive outcomes for children and their families.
Dr Anna Roach, University College London
As part of her evaluation Dr Roach collected direct feedback from children and families and she says that “obtaining this feedback was one of the most encouraging and positive aspects of the study”. Examples from a parent include: “The Lucy Project has completely changed my daughter’s mental health in such a positive way. She is a happier and more confident girl who is able to manage her worries and emotions.”
Aoife Regan, GOSH Charity's Director of Impact and Charitable Programmes, said: "It's wonderful to see the positive influence that offering mental health support at the time of need can make to patients and their families with chronic health conditions. Here at GOSH Charity, we are proud to have funded such an impactful project that begins to address the barriers in access to mental health treatment for children and young people across the country.”
Cambridge Children’s Hospital
The approach used in the trial — enabling self-referral and quick access to mental health treatment for children with long term physical needs — will continue across England, including at the new Cambridge Children’s Hospital.
Cambridge Children’s Hospital will be a world-first hospital that cares for children’s physical and mental health together under one roof, alongside research. It will be the first specialist children’s hospital for the East of England and is scheduled for completion by 2030.
The aim at Cambridge Children’s Hospital will be to ensure that all children, regardless of their condition, will have a mental health assessment as part of routine care. As clinicians from mental health and physical health will work alongside one another, teams of therapists will be able to offer the types of interventions used in the trial to nip problems in the bud and avoid unnecessary onward referrals.
The Lucy Booth in Peterborough
One of the pilot sites for the Lucy Project roll out was the Peterborough Child Development Centre, run by Cambridge Children’s Hospital partner organisation Cambridgeshire and Peterborough NHS Foundation Trust (CPFT). The Centre offers appointments and assessments to children who have complex needs, including autism and learning difficulties.
They rolled out the Lucy Project at the City Care Centre, with posters put up in clinics and waiting rooms, and flyers available. Clinicians could make referrals or families could self-refer.
The Lucy project saw a range of referrals for very young children up to teenagers, including anxiety and behavioural issues. Before the Lucy Project started, children would have been placed on the lengthy Child and Adolescent Mental Health Services (CAMHS) waiting list or signposted to other services.
The Lucy Project has brought mental health to the forefront of people’s minds. Clinicians are increasingly aware of the psychological needs of children and young people, and now they have somewhere to refer them. Before this project, there was a limit to what could be offered within our team.
Dr Rebecca Webster, Clinical Psychologist, CPFT
Dr Venkat Reddy, Clinical Director for Children’s Services at Cambridgeshire and Peterborough NHS Foundation Trust said: “I see children every day whose problems need both 'mind' and 'body' to be taken into account and to provide holistic, integrated care to improve their education, health, functioning and participation. The Lucy Project provides easy access, rapid, evidence-based treatment for the mental health needs of children and families with complex long-term physical health problems."
Clinical effectiveness of drop-in mental health services in paediatric healthcare settings: a non-randomised multi-site study for children, young people and their families (opens in a new tab) by Anna Roach, Sophie Bennett and Isobel Heyman et al is published in the BMC Health Services Research.