How THRIVE will help the NHS Long Term Plan transform provision for children and young people’s mental health

The THRIVE Framework was developed at the Anna Freud Centre and the Tavistock and Portman NHS Trust as a way to provide major whole-system change for children’s mental health support. Since its creation, the Framework has been widely implemented across England. This means that currently almost half of all children and young people in England already live within a locality that is a member of the i-THRIVE (Implementing THRIVE) Community of Practice. I am delighted that the THRIVE Framework has resonated with so many people on the ground providing services for children, young people and families with mental health needs. I feel very humbled to see the way the ideas and values in THRIVE are leading to real change on the ground to improve the lot of young people with mental health difficulties. But what exactly is the THRIVE framework? The THRIVE Framework The THRIVE Framework provides a set of principles for creating coherent and resource-efficient communities of mental health support for children, young people and families. It aims to talk about mental health and mental health support in a common language that everyone understands. The Framework is needs-led. This means that mental health needs are defined by children, young people and families alongside professionals through shared decision making. Needs are not based on severity, diagnosis, or health care pathways. Our aim for THRIVE is to provide a framework to allow services to move away from traditional models of mental health care taking place through diagnosis and treatment pathways, with patients frequently waiting a long time to access help, towards a set of principles for community-based and needs-led mental health support spanning the clinic to the community. The Framework brings together all local-area agencies working with children, young people and families into a ‘one house’ approach to mental health need, using a common language. All children, young people and families who are in need of mental health support are seen as getting one of four types of help at any one time: Advice, Help, More Help and Risk Support. It also prioritises maintaining young people’s wellbeing through community-based prevention and promotion strategies for those who don’t currently need professional support. In the Framework, these young people are thought of as ‘Thriving’.

Why is the THRIVE Framework important? The THRIVE Framework is part of a paradigm shift that is desperately needed in youth mental health provision. Sites who are already implementing the Framework report that it has helped them to reduce waiting times, make better use of available resources and provide a smoother needs-led journey through mental health support options for children, young people and families. Sites have also prioritised community-based prevention and promotion programmes, such as in schools. What does this mean for a young person? A young person struggling with their mental health in an area implementing THRIVE would experience:

• No ‘wrong door’, meaning anyone they went to see for advice, whether they were a teacher, a GP or the school lunchtime assistant, would be able to provide support or to signpost a child.

• Whoever was offering them help would know the best ways to ask for their views about what was important to them and what they wanted to be different, so that there was genuine shared decision making about ways of helping.

• There would be a particular emphasis on looking at different things the young person, their family and friends could do to help including accessing community groups and resources, from drama, to sport, to volunteering.

• Whoever was providing targeted specific help to address the mental health difficulties would support the young person to evaluate progress and to check that what was being tried was helping.

• Supportive but transparent conversations about what different treatments were likely to lead to, including the limitations of treatment and the possibilities of needing to put in place management of ongoing difficulties as relevant.

For those small group of extremely troubled young people where there have been multiple problems over many years and different attempts to help have not been effective but where there are ongoing concerns about potential to the young person, there would be explicit arrangements in place to help manage that risk drawing on those the young person felt most close to in their network. How is this achieved? Implementing THRIVE is not a simple process and involves hard work and commitment from agencies across a locality to find new ways of working together and build on best practice. Areas implementing the THRIVE Framework support different professional groups to come together and use a common language to understand the mental health needs of their community and to be confident about what different professional groups can do to support these. This might involve developing ‘Systemic Champions’, as in the Tavistock and Portman NHS Foundation Trust or developing ‘cross-sector network meetings’, as in the eating disorders service in Greater Manchester. Early help seeking is facilitated by community and/or school-based initiatives, such as Unity Radio broadcasts in Manchester and the Social Mediation and Self-Help (SMASH) Programme in Hull. Shared decision making is supported by ensuring all services prioritise active participation of children, young people and families in designing services, such as the Young Advisors group in East Cheshire. Paper-based decision aids have been developed to support informed choices about their treatment options. Everyone in the system is empowered to have an active role around their own mental health and wellbeing. In particular, there is an emphasis on a move away from assuming that specialist mental health services are the only way of holding those with mental health needs, with the focus moving instead to cross-sector support plans that can be used at times of crisis. For example, Haringey Council have developed a cross-sector approach to managing the wellbeing of looked after children. Professor Miranda Wolpert MBE is the lead author of the THRIVE Framework. A Clinical Psychologist by background, today she is the Director of Innovation, Evaluation and Dissemination at the Anna Freud Centre. She is also a Professor of Evidence Based Research and Practice at UCL, the Director of the Child Outcomes Research Consortium and Co-Director of the Evidence Based Practice Unit.