ISE31/20-21
| Subject: | health services, youth development, mental health |
- Mental health is crucial for young people to mature and develop as future pillars of the society. Yet half of all mental illnesses begin by 14 years of age,1Legend symbol denoting See World Health Organization (2020). where most cases go undetected or untreated and thereby adversely affect the young people concerned as they grow into adulthood. Stepped care is a popular model for supporting youth mental health in many developed places. It mainly comprises a hierarchy of detection and intervention of varying intensity to match the level of patient needs.2Legend symbol denoting The primary goal of stepped care is to organize services, given limited resources, such that the appropriate form and intensity of care are provided in response to an individual's needs. The least resource-intensive treatment is delivered first, with the option to "step up" to intensive/specialist services after severity of symptom is assessed.
- Hong Kong currently adopts a three-tier stepped care model for youth mental care services, consisting of:
(a) universal prevention, early detection and intervention (Tier 1); (b) targeted assessment/intervention and service linkage (Tier 2); and (c) specialist intervention (Tier 3).
However, the alleged service gaps in Tiers 1 and 2 have pushed young patients towards Tier 3 services, resulting in heavy reliance on specialist services as evidenced by the long waiting time for both assessment and treatment in the public health system. - Meanwhile, some overseas places like Australia and England of the United Kingdom ("UK") have sought to ease the burden on specialist services3Legend symbol denoting Australia and England also adopt a tiered/stepped approach in mental health services, and it is noted that, similar to Hong Kong, specialist services would be placed at the highest tier/step as a last resort. More specifically, Australia follows a five-step approach of self-management (Level 1); low intensity services (Level 2); moderate intensity services (Level 3); high-intensity services (Level 4); and acute and specialist community mental health services (Level 5). For England, it adopts a four-step model which includes identification and assessment (Step 1); low intensity treatment (Step 2); moderate-to-high intensity treatment (Step 3); and highly specialist treatment (Step 4). through initiatives that aim at:
(a) enhancing access to primary mental health care for early detection and intervention; (b) improving the coordination of service across stepped care; and (c) bolstering the multi-disciplinary mental health workforce. - This issue of Essentials begins with an overview of the development and current situation of mental health care for young people in Hong Kong. This is followed by a discussion of the reform measures adopted by Australia and England in strengthening their capacity, coordination and manpower of primary mental health care for young people.
Mental health services for young people in Hong Kong
- According to statistics, some 10%-20% of adolescents worldwide suffer from mental disorders,4Legend symbol denoting The World Health Organization defines adolescents as those people between 10 and 19 years of age. See World Health Organization (2020). compared with that of 10.7% for adults.5Legend symbol denoting See Our World in Data (2018). It is therefore essential to address young people's need for mental health services, given the apparent higher prevalence of mental health issues and ramifications on their adult lives if the problems were left unresolved.
- In Hong Kong, the Government seeks to protect the mental wellbeing of young people with the stepped care model and facilitates multi-disciplinary collaboration in the delivery of youth mental health services. The stepped care model comprises prevention, detection and intervention, with services which range from the least to most intensive that are delivered by the healthcare, education and social sectors:
(a) Tier 1 refers to universal prevention, early intervention and mental health maintenance strategies that aim to prevent behavioural and emotional problems from developing in young people; (b) Tier 2 serves as a bridge between Tier 1 and Tier 3 to provide (i) more structured and targeted assessment and intervention for young people in need; and (ii) treatment in primary care settings for relatively complex cases identified by Tier 1; and (c) Tier 3 provides specialist intervention to moderate to severe mental health cases, usually in the form of crisis resolution, in-patient and day care services.
Service gaps in the stepped care model
- In April 2017, the Review Committee on Mental Health released its Mental Health Review Report6Legend symbol denoting To ensure that Hong Kong's mental health regime can rise up to the challenges arising from various demographic changes, the Review Committee on Mental Health chaired by the Secretary for Food and Health was set up in May 2013 to review the existing policy on mental health with a view to mapping out the future direction for development of mental health services in Hong Kong. An Expert Group on Child and Adolescent Mental Health Services was set up under the Review Committee to develop more focused and in-depth studies on the subject concerned. The work of the Review Committee and Expert Group cumulated in the release of the Mental Health Review Report in April 2017. See Food and Health Bureau (2017). ("the Report") which identified a number of service gaps in the stepped care model for youth mental health services in Hong Kong. Specifically, the Report found that inadequate capacity and limited coordination of primary mental care (i.e. Tiers 1 and 2)7Legend symbol denoting In Tier 1, universal services have limited capacity in terms of professionals available to cater to the needs of the general population. Meanwhile, Tier 2 has been identified as the weakest link among the three tiers due to inadequate coordination of services. had led to heavy reliance on Tier 3 services, resulting in inefficient use of resources and long waiting time for specialist services. This runs contrary to the perceived advantage of the stepped care model, which aims to leverage low-intensity services at Tiers 1 and 2 to tackle youth mental health issues at an earlier stage, so as to stem the flow of referrals to the more intensive services under Tier 3.
- To improve existing services, the Report recommended strengthening the stepped care model by better matching youth mental health needs with appropriate levels of intervention. This would help provide more effective gatekeeping and prevent unnecessary escalation of cases to levels that require specialist care. Among others, the Report suggested the Government to:
(a) build up the capacity of primary mental care with an emphasis on timely and targeted intervention; (b) set up youth-friendly platforms to facilitate detection and encourage help-seeking; (c) improve coordination and interface between different tiers of the stepped care model; and (d) expand the role of multi-disciplinary team in the provision of mental health care. - Following the release of the Report, the Government has implemented a number of new initiatives and expanded the existing scope of mental health services. The Advisory Committee on Mental Health8Legend symbol denoting The Advisory Committee comprises members from various sectors with a great wealth of expertise and experience, including professionals from the healthcare, social and education sectors, representatives from patient and carer advocacy groups, and lay persons with interest in mental health. was appointed subsequently in December 2017 to advise and assist in the development of policies to enhance mental health services in Hong Kong, as well as follow up on and monitor the implementation of recommendations set out in the Report.
Existing and new initiatives on youth mental health services
- Universal prevention, early detection and intervention: At present, primary and secondary students receive annual appointments at Student Health Service Centres of the Department of Health ("DH") to undergo physical examination and psychological health assessment which facilitate early identification of potential mental illness cases. Students found to have mental health issues may be referred to the Hospital Authority ("HA"), schools, Social Welfare Department ("SWD") or non-governmental organizations ("NGOs") for further assessment and follow-up.
- Within the public health system, Child Assessment Centres of DH also provide comprehensive assessment and diagnosis for children aged below 12 referred from various channels9Legend symbol denoting These channels include Maternal and Child Health Centres, HA, private practitioners and psychologists. who are suspected to have developmental problems (including mental health issues such as attention-deficit and hyperactivity disorder). Those who are assessed to have mental health needs will be referred to relevant professionals for appropriate support.
- School-based assessment and intervention: The Education Bureau ("EDB") has been encouraging schools to direct their resources for addressing students' mental health needs on three levels, namely "promotion at the Universal level", "early identification at the Selective level" and "support at the Indicated level". At the Selective level, EDB has since 2017-2018 provided teachers of primary and secondary schools with the "Professional Development Programme for Mental Health" to better identify and support students with mental health needs.10Legend symbol denoting The Programme is a foundational psychological training course in the training curriculum for primary and secondary teachers. It includes three-day elementary training for teachers at large and five-day in-depth training for designated teachers, with a view to raising their awareness of mental health and enhancing their professional knowledge and skills to identify and support students with mental health needs. At the Indicated level, starting also from 2017-2018, the Learning Support Grant covered students with mental illness so that schools can have additional resources to strengthen support for the learning, social, emotional and behavioural needs of relevant students.11Legend symbol denoting EDB introduced the Learning Support Grant in 2003-2004 to enhance the support for students with special educational needs. The 2017 Policy Address delivered in January 2017 announced that the Learning Support Grant for public sector ordinary primary and secondary schools would also provide support for students with mental illness starting from the 2017-2018 school year.
- Moreover, the Food and Health Bureau, in collaboration with EDB, HA and SWD, has launched the "Student Mental Health Support Scheme" ("SMHSS") in 2016-2017 to provide appropriate support services for students with mental health needs through a school-based platform. Under SMHSS, a multi-disciplinary team with a psychiatric nurse, designated teacher and school social worker is formed in each participating school. The team convenes regularly to discuss the latest development of student cases and provide support services for students according to the integrated care plans which are formulated to cater to their various needs.12Legend symbol denoting The team may also work closely with the psychiatric team of HA and social workers from relevant social service units to provide support to students with mental health needs in the school setting. As at 2020-2021, the Government had extended SMHSS to 210 publicly-funded schools13Legend symbol denoting According to the Food and Health Bureau, government, aided and caput primary/secondary schools, as well as primary/secondary schools under the Direct Subsidy Scheme are eligible for joining SMHSS., representing just around one-fifth of the total number of publicly-funded schools in Hong Kong.
- Community-based intervention: As for community mental care for young people, the Integrated Children and Youth Services Centres ("ICYSCs") subvented by SWD mainly provides developmental, preventive, supportive and remedial services for young people in the community. Since 2019-2020, the Government has also extended the service coverage of Integrated Centres for Mental Wellness ("ICCMW")14Legend symbol denoting ICCMWs provide one-stop district-based community support services for persons with mental health problems and their families/carers as well as local residents through a spectrum of services ranging from early prevention to risk management. to secondary school students with mental health needs.
- Specialist intervention: The government-funded HA is a major provider of specialist mental health services in Hong Kong covering both inpatient and outpatient modes of care. The demand for HA's youth mental health services has been on the rise in recent years, due in part to better awareness and detection of mental health issues. The number of persons who attended HA's child and adolescent psychiatric specialist outpatient clinics increased by 162% over the past decade to 40 300 in 2019-2020. Among these young psychiatric patients, attention-deficit hyperactivity disorder was the most common mental issue (43%), followed by autism spectrum disorder (35%), and behavioural and emotional disorders (7%). The remaining 15% suffered from other types of mental illnesses such as depression and schizophrenia.
Issues of concern
- Notwithstanding the new initiatives and enhancement measures introduced in recent years, Hong Kong has also seen its mental health service capacity lagging behind growing demand, attributable partly to limited healthcare manpower15Legend symbol denoting As at end-December 2020, the number of psychiatric doctors and psychiatric nurses at HA increased by a modest 14% and 20% versus 2013-2014 levels respectively. According to HA, it has also strengthened the multi-disciplinary manpower of child and adolescent psychiatric teams in the past few years. and an apparent over-reliance on specialist modes of care.
- Indeed, capacity constraints have emerged at different points of the stepped care system. For instance, only 49%-65% of new cases at DH's Child Assessment Centres completed assessment on their suspected developmental problems within six months during 2018-2020, falling short of the Government's performance target of 70%16Legend symbol denoting The performance target was originally set at 90% but lowered to 70% in 2020 (see Estimates of Expenditure, various years). In order to cater for the increasing number of referrals, DH has begun the construction for a new Child Assessment Centre in Siu Sai Wan with target commencement date at 2024. A temporary centre was set up in Ngau Tau Kok in January 2018 to cope with the demand during the construction period.. The backlog at the specialist care level is even more acute, where the median waiting time for routine new cases17Legend symbol denoting HA received a total of 11 835 new cases in 2019-2020, of which 89% were triaged as routine cases and 11% triaged as urgent or semi-urgent cases. at psychiatric outpatient clinics for children and adolescents increased from 23 weeks in 2012-2013 to 80 weeks in 2019-2020. The prolonged wait for services could be detrimental to young people who require timely treatment for their mental health problems.
- Meanwhile, there have been suggestions for a more accessible and integrated youth-friendly platform where a wider range of prevention, detection and low-intensity intervention (including medical and psychological consultation) can be made available to young people in need. For example, while both SMHSS and ICYSCs aim at providing mental health support through existing platforms (i.e. schools and community service centres respectively), the designated social workers and/or teachers are already tasked with myriad responsibilities such as catering to students with special education needs or offering guidance/counselling and socialization programmes. These workers may not be endowed with the time, resources or expertise required to treat mental health issues common to young people, such as mood and anxiety disorders. Similarly, given that ICCMWs target a broad range of clients, they might not be youth-friendly enough to appeal to young people with mental health needs to access services by self-referral. Shortfall in effective and timely low-intensity care would eventually lead to more patients needing specialist care, further straining the capacity constraints at the high-intensity end of the service spectrum.
Youth mental health services in Australia and England
- Australia began to reform its youth mental health services as early as in 2006, in recognition of the need to respond to young people's then-high prevalence of mental health issues18Legend symbol denoting According to the earliest data available, about one in four Australians aged 16 to 24 years had mental health issues in 2007. See Australian Bureau of Statistics (2008). and low engagement with care services. The reform focused on developing an integrated primary mental health platform for young people, and leveraging primary care practitioners to provide treatment for less severe cases. In order to fund these measures, recurrent spending on mental health care for persons aged under 25 had doubled since 2006 to reach A$784 million (HK$4.38 billion) in 2019.19Legend symbol denoting See Australian Institute of Health and Welfare (2021).
- In the UK, the government published a mental health strategy in 2011, "No Health Without Mental Health", which sought to mainstream mental care in England and achieve parity of esteem20Legend symbol denoting "Parity of esteem" is defined as valuing mental health on equal policy grounds as physical health, meaning those with mental health problems will benefit from equal access to the most effective and safest treatment, equal efforts to improve the quality of care and equal status in the measurement of health outcomes. between mental and physical health. Specific reform measures have been implemented to improve access to mental health services for young people through multi-disciplinary services and coordinated intervention across different tiers of care. Overall, the reform measures have helped reduce the average waiting time for specialist psychiatric services for children and adolescents aged under 18 from around 11 weeks in 2012-2013 to just 8 weeks in 2018-2019.21Legend symbol denoting See Education Policy Institute (2020).
- In a nutshell, the major thrust in the mental health reforms in Australia and England is on strengthening the capacity, coordination and manpower of primary mental health care for young people. This is based on the understanding that primary care settings are often first ports of call for those with mental health needs, and effective early intervention can help prevent the escalation of mental health issues to the specialist level. The salient features of primary mental health services for young people in Australia and England are discussed below.
Enhancing access to primary mental health care
- Both Australia and England have invested heavily on strengthening prevention, early detection and low-intensity intervention over the years. As mentioned above, Australia was one of the first places to provide integrated primary mental health care for young people in need. As early as in 2006, the federal government established Headspace centres as primary care platforms providing tailored and holistic mental health support to young people aged 12-25. Since then, the government-funded Headspace centres have been functioning as one-stop shops where young people can visit for early identification and intervention. These centres are staffed with a multi-disciplinary team of general practitioners ("GP"), nurses and allied health professionals, who provides services ranging from counselling, psychological therapy, general practice consultation to treatment for early psychosis. The majority of services, moreover, do not require referral from a GP or paediatrician.
- In order to encourage more young people to access psychological services, Headspace centres also provide consultations on physical health and vocational support which act as "soft" entry points for help seeking. Headspace centres also operate a network of online and telehealth services which allow young people with mental health needs to talk to a Headspace psychiatrist, privately through a phone or video call rather than visiting in person.
- With evidence of reduced psychological distress and improved psychosocial functioning for up to 60% of its users,22Legend symbol denoting See for example, Rickwood et al. (2015) and Hilferty et al. (2015). the Headspace model has been emulated by overseas places such as Canada, Denmark and Ireland. Within Australia, the government has allocated an additional A$279 million (HK$1.5 billion) in 2021-2022 to increase the number of Headspace service points from 149 to 164 over the next four years.
- Australian authorities also sought to improve the coordination of care services with the establishment of Primary Health Networks ("PHNs") in 2015 to ensure patients receive timely and appropriate care. PHNs are government-funded independent organizations which commission primary healthcare services for their designated regions by working with, and coordinating between, local hospitals and other service providers.23Legend symbol denoting There are currently 31 PHNs established across Australia.
- In England, the UK government has sought to integrate and expand mental health services within the existing primary care settings. A major National Health Service ("NHS")24Legend symbol denoting NHS refers to the government-funded medical and healthcare services that everyone living in the UK can use without paying the full cost of the services. initiative – Improving Access to Psychological Therapies ("IAPT") – aims to increase the provision of evidence-based psychological therapies25Legend symbol denoting In addition to psychiatric medication, some research suggests that evidence-based psychological therapies such as cognitive behavioural therapy and interpersonal psychotherapy are also effective forms of treatment for a range of mental health problems. As such, IAPT began in 2008 for the treatment of adult anxiety disorders and depression In England. In 2011, the UK government announced it was extending the IAPT project to encompass services for children and young people. See NHS (2019b). for common mental health problems, which are delivered by organizations with primary care and community links such as healthcare centres, schools, and voluntary organizations.
- IAPT is based on a triage model where low-intensity treatments such as guided self-help and group therapy are provided by trained non-clinical practitioners26Legend symbol denoting The non-clinical practitioners under IAPT are known as "Psychological Wellbeing Practitioners" ("PWPs") who are trained to assess and support people with common mental health problems in the self-management of their recovery. The core IAPT courses for PWPs are accredited by the British Psychological Society. for those with mild-to-moderate depression and anxiety disorders. On the other hand, treatment for more complex conditions are handled by high-intensity therapists27Legend symbol denoting These therapists need to have been trained in the particular therapy or therapies that they deliver in IAPT, with professional accreditation linked with the relevant professional body. such as clinical/health psychologists. In so doing, IAPT helps ease the demand for specialist care by expanding the supply of first-line treatment for lower-level common mental health issues. The triage model and flexible workforce arrangement had resulted in an 116% increase in the number of children and adolescents aged 0-17 accessing psychological therapy from 2014 to 2020.28Legend symbol denoting See NHS Digital (2020b).
Improving coordination of services across stepped care
- The availability of appropriate care plans and clear referral pathways are crucial for young people, especially those with more severe mental health issues whose problems cannot be resolved with low-intensity care. This group of young people often encounter difficulties in gaining timely access to the right services. In this regard, both Australia and England have earmarked additional resources to better integrate and coordinate services along the stepped care model.
- In Australia, PHNs mentioned in the previous sub-section are also required to observe nation-wide guidelines which focus on, among other things, operationalizing stepped care for mental health patients in primary care settings. For patients who require additional support or even specialist care, the guidelines stipulate the pathways for service referral, in addition to offering the best practices in providing initial assessment and progress monitoring. Moreover, a web-based portal has been developed by PHNs to exchange the latest information with other service providers as to the care options and referral pathways that are available for individual patients.
- Meanwhile, England has leveraged a more school-oriented approach to provide extra capacity for early intervention and ongoing help for students with mental health needs. From 2018-2019 to 2020-2021, the UK government has committed some £215 million (HK$2.2 billion) to set up Mental Health Support Teams ("MHSTs") across England,29Legend symbol denoting The UK government's funding commitment for MHSTs is provided up to 2023-2024, but the funding figures after 2020-2021 are only indicative in nature. See NHS (2019a). which act as additional platforms in support of schools to improve their partnerships with NHS, NGOs and other service providers. More specifically, MHSTs can give timely advice to school staff and liaise with external specialist services to ensure clear referral pathways, especially where more severe cases are involved.
- Each MHST comprises a multi-disciplinary workforce of nurses, therapists, and trained practitioners serving a cluster of 10 to 20 schools, with a view to helping young people in accessing the right mental health care support and staying in education. The UK government is currently on track to expand the number of MHSTs from 182 in 2020 to 400 by 2023 to cover one-third of schools in England.30Legend symbol denoting See NHS (2021).
Bolstering the multi-disciplinary mental health workforce
- In Australia, GPs are the predominant point of first contact for young people with mental health needs, as the majority of more specialized care (e.g. psychological or psychiatric treatment) requires GP referral. To ease the pressure on specialist services, the government has since 2002 funded the General Practice Mental Health Standards Collaboration ("GPMHSC")31Legend symbol denoting GPMHSC is a professional body which accredits and sets the standards for mental health training and education for GPs. It includes representatives from general practices, psychology, psychiatry and the community. for setting up the training frameworks for GPs to deliver primary mental health services. Upon completing GPMHSC's training, GPs are accredited to offer a wider scope of government-subsidized mental health services – such as initial assessment, treatment planning and low-intensity psychological therapies – to young people in need. As at April 2019, over 91% of GPs in Australia have been trained and accredited by GPMHSC.
- In England, Health Education England ("HEE")32Legend symbol denoting HEE is an executive non-departmental body established in 2012 to oversee the planning, education and training of the health workforce in England. has collaborated with NHS to align its workforce plans with the mental health needs of young people. As the body responsible for healthcare workforce planning, HEE has strived to enhance mental health service capacity by creating recruit-to-train mental health practitioner posts to meet the manpower demand for community initiatives such as IAPT and MHST.33Legend symbol denoting Specifically, those recruited under MHST are known as "Education Mental Health Practitioners". The recruit-to-train posts are open to all degree graduates and successful applicants will undergo one year of vocational training in universities and placement at NHS-funded services. As at 2019-2020, HEE had trained 1 700 new staff with the expertise to deliver low-intensity treatment and early intervention for young people with mild-to-moderate needs, thereby help relieving the pressure on specialist care.
Concluding remarks
- Young people are inevitably met with emotional and psychological challenges as they grow from adolescence into early adulthood. In Hong Kong, the Government delivers mental health services through a stepped care model for young people in need. Nevertheless, the public health system has seen a worsening backlog in the provision of specialist care. Apart from inadequate supply of specialist service, limited capacity and coordination in primary mental health services may have led to escalation of some cases which could have been addressed through low-intensity care.
- Over the years, some overseas places have experimented with reforms to enhance the primary mental health services for young people and were able to ease the burden on specialist care. Such measures can range from (a) dedicated mental health centres catering to young people; (b) improved primary care platforms for identifying, treating and timely referral of cases with mental health needs; (c) incentivizing GPs to provide a wider scope of mental health services; and (d) equipping non-clinical practitioners to take up a bigger role in caring for mental health of young people. When properly implemented, such initiatives not only help contain the demand and waiting time for specialist care, they can also lead to better outcomes for service users including improved psychosocial function and easier access to psychological therapy.
Prepared by Charlie LAM
Research Office
Information Services Division
Legislative Council Secretariat
15 October 2021
Endnotes:
References:
| Hong Kong
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| 1. | Advisory Committee on Mental Health. (2020) Work Report of the Advisory Committee on Mental Health.
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| 2. | Bauhinia Foundation. (2017) Mental Health Care Services for Hong Kong Youth.
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| 3. | Education Bureau. (2016) Parent Guide on the Whole School Approach to Integrated Education.
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| 4. | GovHK. (2021) LCQ18: Mental Health of Students. 24 March.
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| 5. | GovHK. (various years) Estimates of Expenditure.
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| 6. | Food and Health Bureau. (2017) Mental Health Review Report.
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| 7. | Legislative Council Secretariat. (2017) Background Brief Prepared by the Legislative Council Secretariat for the Joint Meeting on 20 December 2017 – Mental health of adolescents. LC Paper No. CB(2)512/17-18(02).
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| 8. | 《am730》：學童缺乏應付壓力的資源，2017年10月18日。
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| 9. | 《香港01》：【情緒疫症．下】教師忙救學生 誰救教師？，2020年1月20日。
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| Australia
| |
| 10. | Australian Bureau of Statistics. (2008) National Survey of Mental Health and Wellbeing: Summary of Results.
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| 11. | Australian Bureau of Statistics. (2018) National Health Survey: First Results.
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| 12. | Australian Institute of Health and Welfare. (2021) Mental Health Services in Australia.
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| 13. | Headspace. (2020) Annual Report 2019-2020.
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| 14. | Hilferty, F. et al. (2015) Is Headspace Making a Difference to Young People's Lives? Final Report of the Independent Evaluation of the Headspace Program.
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| 15. | Orygen. (2021) Federal Budget 2021-22 Summary.
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| 16. | PHN Advisory Panel on Mental Health. (2018) Reform and System Transformation: A Five Year Horizon for PHNs.
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| 17. | Rickwood, D.J. et al. (2015) Changes in Psychological Distress and Psychosocial Functioning in Young People Accessing Headspace Centres for Mental Health Problems.
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| England (the United Kingdom)
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| 18. | Child Outcomes Research Consortium. (2016) Child- and Parent-reported Outcomes and Experience from Child and Young People's Mental Health Services 2011-2015.
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| 19. | Department of Health. (2011) Talking Therapies: A Four-year Plan of Action.
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| 20. | Education Policy Institute. (2020) Access to Child and Adolescent Mental Health Services in 2019.
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| 21. | Ellins, J. et al. (2021) Early Evaluation of the Children and Young People's Mental Health Trailblazer Programme.
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| 22. | House of Commons Library. (2021) Support for Children and Young People's Mental Health.
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| 23. | Ludlow, C. et al. (2020) A Current Review of the Children and Young People's Improving Access to Psychological Therapies (CYP IAPT) Program: Perspectives on Developing an Accessible Workforce.
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| 24. | NHS. (2019a) NHS Mental Health Implementation Plan 2019/20 – 2023/24.
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| 25. | NHS. (2019b) Overview – Cognitive Behavioural Therapy (CBT).
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| 26. | NHS. (2019c) The NHS Long Term Plan.
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| 27. | NHS. (2021) Funding Boost for Young People's Mental Health Services.
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| 28. | NHS Digital. (2020a) Mental Health of Children and Young People in England, 2020: Wave 1 Follow Up to the 2017 Survey.
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| 29. | NHS Digital. (2020b) Psychological Therapies, Annual Reports on the Use of IAPT Services.
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| 30. | NHS England. (2019) 0-25 Children and Young People's Mental Health Services.
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| 31. | NHS England. (2021) NHS Mental Health Dashboard.
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| Others
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| 32. | World Health Organization. (2020) Adolescent Mental Health.
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Essentials are compiled for Members and Committees of the Legislative Council. They are not legal or other professional advice and shall not be relied on as such. Essentials are subject to copyright owned by The Legislative Council Commission (The Commission). The Commission permits accurate reproduction of Essentials for non-commercial use in a manner not adversely affecting the Legislative Council. Please refer to the Disclaimer and Copyright Notice on the Legislative Council website at www.legco.gov.hk for details. The paper number of this issue of Essentials is ISE31/20-21.