Experiences of commissioning mental health services for children and young people in England: qualitative study of commissioners’ perspectives

TL;DR

This study explores the experiences of commissioners responsible for mental health services for children in England, highlighting the challenges they face and how they respond to changing needs.

Contribution

The paper provides new insights into the perspectives and challenges of CAMHS commissioners, emphasizing the need for better data and stakeholder collaboration.

Findings

Commissioners face challenges in balancing investment between prevention and specialist services.

They rely on insights from providers and are increasingly focused on managing relationships within the system.

Changes in child mental health and the political environment are key factors shaping their work.

Abstract

Commissioners play a central role in coordinating and planning CAMHS. However, there is little research on their experiences and approaches to understanding the needs of their populations. An improved understanding is likely to benefit the translation of research into practice, by ensuring research outputs meet the needs of key stakeholders and in optimising the sharing and use of data to improve services.

To better understand commissioners’ experiences of commissioning child and adolescent mental health services (CAMHS) and the challenges they face.

Between May to June 2023, we conducted twelve individual, semi-structured interviews with Integrated Care Board commissioners of CAMHS across England. We analysed data using framework analysis; a qualitative analysis method which involves systematically charting and organising data using a framework to generate themes.

We generated five core themes from the data: 1) ‘Reflections on role’ – how commissioners’ roles are informed by their background and ‘positioning’ within the system in which they work, 2) ‘Priorities and Tensions’ – the wider context in which commissioners work and how this may present challenges, 3) ‘Insights and evidence’– how commissioners develop an understanding of child mental health need and the different roles of quantitative and qualitative data, 4) ‘Children’s mental health in the limelight’ – commissioners’ perceptions of changes in child mental health in their populations, 5) ‘Responding to need’ – how commissioners are addressing the needs of their populations and the challenges they perceive.

CAMHS commissioners are negotiating a complex and changing political, social and economic environment with differing priorities and pressures. Commissioners draw heavily on insights from providers and their role is shifting towards managing relationships and bringing the system together. A key challenge is balancing investment in prevention/early intervention versus specialist services needed by children with more severe and complex problems.

None Declared