A UCL-led 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.
Clinicians behind the trial were inspired by the Peanuts comic character Lucy and her therapy booth - where she provides advice to other characters' problems.
The first 'Lucy Booth' drop-in service was piloted in the reception area of Great Ormond Street Hospital for Children (GOSH) in London. Resembling a large photo booth, the centre was painted a vibrant purple and featured words of encouragement and useful information scattered across its facade to increase visibility. The centre was run by a multidisciplinary team of volunteers and staff who were available to patients and families, throughout the day.
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 receive adequate mental health support. Inspired by the original 'Lucy Booth' mental health drop-in services were implemented at six paediatric settings across England with 120 families consenting to treatment.
The 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.
The trial results, published in BMC Health Services Research, found that 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.
At the same time, the cost of treatment per patient was reduced by half, compared to a typical course of psychological therapy.
Co-author, Professor Isobel Heyman (UCL Great Ormond Street Institute of Child Health and Cambridge Children's Hospital), 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 on 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."
Lead author, Dr Anna Roach (UCL Great Ormond Street Institute of Child Health), said: "It was an absolute joy to lead the roll out of drop-in mental health services across paediatric healthcare settings. One of the strengths of the project was using existing resources to provide a holistic model of care; we embedded the project in current services and provided training for non-mental health clinicians to deliver support under supervision. It was fabulous that we provided integrated care for physical and mental health, leading to reduced symptoms and positive feedback from children and their families."
The approach used in the trial - enabling self-referral and quick access to treatment from children with long term physical needs - will continue across England, including at the new Cambridge Children's Hospital.
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.
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 do the referrals or families could self-refer.
The Lucy project saw a range of referrals for very young children up to teenagers, including for 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.
Rebecca Webster, Clinical Psychologist at Cambridgeshire and Peterborough NHS Trust said: "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 to. Before this project, there was a limit to what could be offered within our team."
The project was funded by GOSH charity.
