Take a moment to think about this problem: 2.6 million UK citizens currently have an open referral within the mental health services. 560,000 of these people are under the age of 18 and 75% of those are not receiving treatment. This failure directly lead to over 6,000 under 18’s committing suicide in 2017, and that number is growing rapidly. Statistically and in reality the chances are that 25% of your friends/associates have children with mental health issues, whether that be Depression, Anxiety, Bipolar, Bulimia, Anorexia, PTSD etc.
Is this growing level of despair in young people acceptable to us? And it is “us” not “them”. It’s a problem we all need to solve.
Schools are becoming “waiting rooms” for children with mental health issues charities have warned, with a rising tide of young people unable to access the services they need.
Repeated funding cuts to the NHS, most often landing on this misunderstood sector of the health service, is set against growing demand, with the additional burden that treatment is often needed immediately following diagnosis. When that’s not available the backstop is admittance to a mental health hospital to make the young person safe, but the result is bed occupancy which has risen for the fourth consecutive year and is now standing at 94%.
By 2020/21 the Five Year Forward Plan is to have at least 70,000 more children and young people receiving access to high quality mental health care. The goal is for young people to have access to a caring, inclusive environment to promote and reinforce positive mental health.
Realistically the NHS can’t achieve this alone. A fundamental change in the way services are commissioned with a greater emphasis on prevention is called for with the NHS working with partners to fund and implement the whole system approach.
Youngkind are currently in discussions with the NHS, government officials, journalists, but the education sector is also where Youngkind believes we can make a real impact. It’s often at school that problems become visible, where the child can reach out, talk to friends and teachers. We need to be at that point of need. What we want to create is a practical referral programme where a teacher that identifies a risk to a student knows how to reach out to Youngkind so that professional support can be arranged immediately in partnership with the school as a trusted resource.
Youngkind has been set up in direct response to this growing need for national reform with the specific intent of unlocking the resources of over 10,000 counsellors, social workers and psychologists that provide private treatment in a patch work fashion today. If you’ve ever tried to find a therapist it’s hard. Do they have the experience and skills you need? Are they local? Are they available? Are they someone who the young person can bond with, trust? It’s a maze, it’s foreign, it’s often beyond the confidence and skills of those in need or their families to struggle through. And that’s before we think about cost.
In response, as our first phase we are developing ground-breaking technology to help a young person investigate and assess what they face and then to match them with an appropriate therapist to enable the delivery of immediate, appropriate, relevant, local help in partnership with the NHS and other institutions. We’ll use proven digital delivery channels and methods that the young are familiar with and have access to – an intuitive mobile app and a powerful web experience, leveraging AI, to provide search, reviews, video’s, summaries from the therapists of their focus and specialisation, Q&A, and links to other related services.
We are building on the successful experience of other digital business including on-line travel agents like Expedia and Trip Advisor and other booking unicorns like Uber and Airbnb, which have emerged to enable the link between the provider and the consumer.
We’ll use technology that is friendly and secure to provide the means for children that are currently being failed and can feel that self-harm or worse is the only way out to find the help they need, when they need it, confident that they are not alone.
That in itself is hugely valuable as step one. But now let’s talk cost. If the young person needing help has the ability, directly or through their family, to meet the cost of treatment, then they get the additional benefit of lower charges. Where they can’t meet some or indeed any of that fee, we’ll cover it. We will ask them to pledge that when they are well, back at work or able to repay, that they do so, to the best of their abilities, so that the “pot” can be refilled for the next child that needs help.
What we need to do then is raise funds through the public but also funding bodies that exist to help sponsor such charitable work. If we can help keep beds available through our efforts, avoiding all that cost, the NHS could be a source too as they rebalance where money is spent. To achieve this, we need a number of things, including the right help, partners, visibility and support.
Youngkind will offer professional mental health services in partnership with the NHS. The current pathway typically has long wait times for treatment, an average of 13 weeks to a first appointment. We plan to cut this through the following measures:
- Unlock private sector services: The Youngkind app/website will include a directory of professional Psychologists, Counsellors, Social Workers, Psychotherapists.
- Make finding professional help easy: With pictures, qualifications, accreditation, location, availability, video’s, areas of specialisation, reviews, charges, contact details etc., all to enable a qualified search and selection process.
- Helping find that match: Our platform will develop ground-breaking technology that helps the individuals to understand the specific problem, before searching and presenting matches to appropriate treatment options locally.
- Reduce wait times: With tens of thousands of professionals available in the private sector, we aim to have a person referred to us and receiving treatment within a maximum of one week by marshalling these resources.
- Support schools: Youngking will enable schools to interact directly with our services, refer (with the individuals consent) to us for advice and possible referral for treatment. We will promote positive mental health within the education sector and offer ambassadors to educate and promote across student bodies.
- Support and compliment the NHS: Youngkind will work with the NHS mental health services so that we can free up occupied beds. The first step is preventative care, the second step is supporting patients while admitted to hospital, the third step is to offer treatment services to patients that have been discharged and on the road to recovery.
- Reduce cost all the way to free: We don’t want cost to be a barrier to treatment. Evidence shows that such costs can easily exceed £1000 for a course of treatment, which prohibits most. Through the Youngkind Pledge either the individual will pay a reduced fee for treatment once the necessary appropriate professional specialist has been identified, or they will receive the treatment at no charge, covered by Youngkind.
The mission of Youngkind is the pursuit of the following principles:
- Commitment: Youngkind commits to help alleviate current waiting times, matching those needing treatment with the best possible resource available in the shortest period of time, lowering fees all the way to zero through public and private sponsorship, working in partnership with the NHS to bridge the funding gap, ensuring that any person discharged from mental health services remains under the support of professionals.
- Responsibility: The focus of Youngkind is to help young people in need, supporting the mentally ill in ways that deliver a meaningful and positive change that helps solve the burgeoning mental health crisis amongst the young.
- Support: An individual is dramatically influenced by their support system. Youngkind wants to surround young people in a caring, inclusive learning environment.
Keys to Success
- Building a network of professional psychologists, counsellors, social workers and psychotherapists that will pay a yearly fee to be included in the Youngkind database.
- The professional therapists will offer a discounted rate to Youngkind for the referrals that emanate from the charity.
- The support from trusts, investors, donators and the NHS to be able to grow our access to treatment services.
- Quality of care is of paramount importance, ensuring that all professionals are registered with a certified body, before being able to register with the Youngkind database, and that they are then monitored / measured against their services delivered.
- Promotion of Youngkind services by the press, governing bodies, education establishments and local councils, so that it can a known, trusted, ubiquitous soute to help – like Childline has achieved.
- Adoption of Youngkind services by the community, NHS, schools and councils to be seen as the leading source of care access and monitoring.
The Patient Pathway
The current patient pathway is hampered and constrained leading to long waiting times. From as little as 4 weeks to as long as 4 months in some areas. Patients admitted to hospital are often stuck as there is no support available in the community for long periods of time and therefore they are forced to remain in hospital on the waiting list until community treatments become available. This clearly is a massive burden on the NHS but also can be disastrous for patients. In a survey of 2,000 patients, one in six said they had attempted suicide while waiting for treatment, four in 10 said they had self-harmed, and two thirds said their condition had deteriorated before they had a chance to see a mental health professional.
The graphic below outlines the current mental health patient pathway:
Youngkind will address the waiting period by dovetailing into the current NHS system. Our goal is to prevent hospitalisation wherever possible by arranging for treatment of patients that are not displaying an immediate risk to life, before that has a chance to change and they become a serious risk to themselves through the lack of immediate treatment.
We do not seek to replace the Crisis team or emergency services, but rather work alongside them to help young people in emergency care. We will also support outpatient services by offering a fall-back option if outpatient therapy isn’t immediately available. And we will work with any Home Treatment or Community Teams to support patients that have been discharged from hospital and awaiting professional therapy. Our vision to compliment and alleviate the current resources and pathway can be represented as:
Website purpose and pathway
Refer: The client is referred to Youngkind from GP, school, workplace, family or themselves. Contact is made with the individual as a first triage point. The client will input responses from queries and grant consent in order for the website to work through its algorithms.
Match: Each member of the Youngkind database will have completed their profile to match tags, queries and confirm accreditation. The website will run through queries that consider distance, area of expertise, previous working history, success rate, treatment demographics and availability. The patient will be presented with search results so that they are able to make an educated selection for who to commence treatment with, guided by the Youngkind team.
Assess: Care provider will assess and confirm the needs for the client and confirm a treatment plan with the client. A diagnosis report would have been completed by GP, or other medical professional and will be shared with the chosen therapist to begin treatment with the clients consent.
Treat: The care provider will commence the treatment plan, will post an hourly log of therapy sessions, a progress update of the client and will confirm next appointment for therapy with the client.
Discharge: Once treatment has been completed and the care provider is happy to discharge the client, they remain on our database for regular follow up communication to assess and prevent any regression in symptoms.
Cost of Treatment – Psychologist Case Study
Once we have established Youngkind we intend to focus on reducing cost to the individual for treatment delivered. To do that we need to find an agreeable charge point with our registered therapists. Our aim is the negotiate a standard 20-25% discount for treatment that results through Youngkind, controlled in the mid-term by the fact that Youngkind will be responsible for making payment.
Considering that psychologist rates vary nationally between £70 – 150 per hour, such a discount can be meaningful when the average number of sessions is 8-10.
The four likely professional groups that would deliver treatment to Youngkind clients include:
- Psychologist appointments: £80 per hour (RRP) | £65 per hour (Cost to Youngkind)
- Psychotherapist appointments: £55 per hour (RRP) | £40 per hour (Cost to Youngkind)
- Counsellor appointments: £45 per hour (RRP) | £35 per hour (Cost to Youngkind)
- Social worker appointments: £30 per hour (RRP) | £20 per hour (Cost to Youngkind)
In the mid-term when Youngkind is established as a primary route to treatment access and delivery, we’d like to set a national charge. Today the average session fee is £80 session. We’d therefore be looking to set a benchmark at £65 for such treatment, although there may be variance dependent on the professional qualifications and experience of the provider, which can include where there is the ability to deliver new treatments such as EMDR. We anticipate potential hourly fluctuation not exceeding 20%.
Charges levelled on Professionals
Over time our aim is to achieve a 30-40% professional adoption rate onto our database, with this group being the primary source of treatment provision for those accessing Youngkind. As a note we would also operate on an ad-hoc basis where necessary. For example, where we were approached for services that were not available through the registered professionals, then we would use the British Psychological Society database (and those of other suitably qualified bodies) to make contact with an appropriate therapist in order to make a referral.
With such an adoption rate Youngkind would register 1004 Chartered Psychologists:
Youngkind would use a tiered pricing structure for professionals to be listed on our database:
- £200 per annum where less than 10 appointments per year
- £500 per annum where less than 25 appointments per year
- £800 per annum where less than 50 appointments per year
- £1000 per annum where more than 51 appointments per year
Each band would be incremental.
Based on £500 mid-tier listing price for less than 25 appointments per year
Psychologists = £500 x 1,004 registered = £502,000 in fees to Youngkind
Psychotherapists & Counsellors = £500 x 3,000 registered = £1,500,000 in fees
Social Workers = 300 x 403 registered = £121,000 in fees
Total yearly fee revenue (mid-rate adoption assumption of £500 per year) = £2,123,000
Total yearly fee revenue (top-rate adoption assumption of £1000 per year) = £4,246,000
Psychologist based case study:
National average sessions per treatment: 8 sessions per patient
Existing typical charging for a psychologist: £80 x 8 sessions = £640
Youngkind charging for a psychologist: £65 x 8 sessions = £520
Typical saving: £120 for a course of treatment
Funding for Treatment
The immediate phase of Youngkind is to provide access to those in need with qualified and relevant treatment providers. Immediately or as a following phase the charity will seek to negotiate discounted rates. And the final phase will be to meet those fees.
At the outset Youngkind will operate a pledge policy. Initially this will be a code of conduct for the young person – it will outline the services available, their responsibilities which can include rating services delivered, providing suitable feedback and so forth. But as we move into a position where Youngkind can make payment to the professional deliverer of treatment, that Pledge takes on a deeper commitment.
It is anticipated that the majority of young people who could benefit from the access provided by Youngkind will not (easily or at all) be able to pay for the cost of treatment, so we will then want to cover those charges. This will be on the understanding (the Pledge) that those receiving treatment will pay back those charges, as little or as much as they can afford to pay when they are back to good health, working or with a sustainable income. Payments can be made via a one-off payment, or a monthly/weekly direct debit for an agreed period.
For those that can afford the cost of treatment having used the app/website as a search and matching tool, then they will be receiving treatment at a discounted rate established between Youngkind and the professional therapist. This will work as an honesty box.
Case study 2: What do we need to raise?
Psychologists signed to Youngkind: 1004
Working days per year: 200
Hours per day available Youngkind: 2
Billable cost: £65 per hour
If 85% of young people looking to access services are unable to fund treatment, then the charity needs to raise £22,188,400.
Clearly not all services will be delivered by Psychologists, but this gives an idea of the monies Youngkind will be looking to raise as it moves forward.
That equates to helping more than 50,000 young people per year get the treatment they desperately need.
We need to establish contacts and raise funds through the public and trusts that exist to help sponsor such charitable work. We believe that the NHS can be a major source of funding, as we work in partnership with the health service to keep beds free, increase the turnover rate of admission to discharge and offer support services to patients that are discharged, therefore freeing up these NHS services to the emergency response.
However, we need to go much broader to achieve the levels noted above. For that we will need the right help from appropriate partners to get the visibility and support to reach the network of young people in need. Our aim is to become the first point of call for patients that aren’t in an immediate risk of life, working with GPs, Schools, Councils, Government, Mental Health Units and CRHTT’s.
The NHS Five Year Forward Target of helping an extra 70,000 patients to receive treatment per year, can now be seen in context in regards to what Youngkind seeks to help meet.
We would then be looking at our pledge policy, trusts, media donations, charities and the NHS to increase the funding gap to be able to accept as many referrals as possible.