Access to services

Our alternative to admission report reviews the progress of community-based and crisis intervention models commissioned by NHS Wales' Joint Commissioning Committee (JCC) and delivered across all health boards in Wales. The initiative sought to develop models to provide safe, non-clinical environments (such as Sanctuary-based services and Intensive Community Treatment services) that de-escalate crisis, support immediate distress, and prevent inappropriate hospital admissions.

While the review commends the enthusiasm, creativity, and positive impact reported by staff, young people, and families, it notes that data collection across health boards has been highly variable and insufficient in quality.

Consequently, the report outlines key recommendations for the Welsh Government and JCC, including refining commissioning principles, establishing national core delivery standards, improving data collection, and implementing specific analysis to better measure service impact.

Additionally, it highlights critical links to wider structural challenges, such as the rising rates of school absenteeism and barriers to attendance in Wales.

Our 'from crisis to care' report summarises the international roundtable, that focuses on international approaches to youth mental health crisis interventions. The session primarily compared two newly implemented 24/7 support models: Wales’ '111 Press 2' mental health support line and Western Australia’s 'CAMHS Crisis Connect (CCC)'.

In its first year, the 111 Press 2 service handled over 100,000 calls, successfully reducing distress in 99% of cases, with half of the calls resolving through self-care advice and only 10% requiring immediate crisis intervention. Meanwhile, Western Australia’s CCC, developed to divert unnecessary emergency department (ED) visits, utilised Interrupted Time Series (ITS) analysis to demonstrate a 29% reduction in ED presentations and a 28% drop in inpatient admissions following its introduction.

Through comparative analysis, both teams identified shared challenges in service accessibility, digital engagement, and the need for seamless integration with broader mental health systems. To build on these insights, the partnership established several 'forward looking' action points to shape future commissioning. These priorities include co-producing service designs directly with young people, developing robust economic cases based on ED avoidance, and utilising advanced data analytics to map local deprivation and forecast service demand during external crises (such as climate-related hazards or economic shocks like mass redundancies). Ultimately, this cross-national exchange aims to drive data-informed service improvements and establish evidence based best practices for youth mental health care across both countries.

The roundtable was a collaboration between Dyfodol and the CAMHS Service of the Government of Western Australia. The roundtable was supported by the Learned Society of Wales.

Our school attendance policy briefing outlines the current landscape of school attendance in Wales, emphasising that regular attendance is vital for academic, social, and long-term health outcomes.

While average attendance for the academic year showed a slight rise to 91.7%, it remains significantly below the pre-pandemic 2018/19 rate of 94.3%, with secondary school absences and persistent absenteeism remaining key areas of concern.

The briefing identifies several interconnected barriers contributing to these trends, including poverty and socioeconomic disadvantage, escalating mental health and wellbeing challenges, family issues, additional learning needs (ALN), rising rates of bullying, and logistical hurdles related to school transport.

To combat absenteeism, the Welsh Government utilises a multi-agency approach focused on prevention, early intervention, and statutory guidance, backed by targeted investments like the School Essentials Grant and funding for Family Engagement Officers.

Furthermore, a review of randomised controlled trials (RCTs) highlights the relative effectiveness of various intervention strategies: responsive/targeted approaches and parental engagement programmes show solid positive impacts, while social and emotional learning and extracurricular activities are supported by most studies. Conversely, meal provision showed no direct effect on attendance, and tools like fixed penalty notices are strictly maintained as a last resort.

The Interventions to Improve School Attendance report updates previous evidence reviews by synthesising data exclusively from 61 randomized controlled trials (RCTs) published between 2000 and 2024. Driven by rising post-pandemic chronic absenteeism and health inequalities, the review categorizes various strategies, such as mentoring, parental engagement, and meal provision, to evaluate their impact on student attendance and highlight paths for future education policy.

The meta-analysis demonstrates that parental engagement interventions, particularly messaging strategies like text alerts, yield a small but statistically significant positive effect on school attendance, especially within primary and middle school settings. Other approaches, including mentoring, social-emotional learning, and behavioral programs, show mixed or modest benefits with varying levels of evidence certainty, while meal provision schemes generally show little to no direct effect on days attended. We emphasise that because student absence stems from diverse, complex causes (ranging from poverty to mental health challenges), a 'one size fits all' approach is ineffective, and we recommend further UK based trials to guide future interventions.

This review was a collaboration between King’s College London, Institute of Psychiatry Psychology & Neuroscience; Public Mental Health Implementation Centre; Royal College of Psychiatrists; Population Health Improvement UK (PHI-UK); National Collaborating Centre for Mental Health; National Centre for Suicide Prevention and Self-Harm Research, Swansea University; Dyfodol

Our NHS 111 Press 2 review, evaluates the first 12 months of operation (July 2023 to June 2024) for the national mental health crisis line. Commissioned by NHS Wales, the service provides an all-age, 24/7 single point of access to mental health practitioners, adopting a 'no wrong door' approach to streamline urgent care and relieve pressure on emergency services.

During its first year, the service handled over 100,700 calls with an average call duration of 19 minutes, successfully answering 70% of calls within two minutes. Crucially, outcome data demonstrated that 99% of callers who provided a distress score experienced a reduction in emotional distress by the end of their call, showing an average reduction of 28%.

While the review praises the model's effectiveness and strong regional governance, it highlights ongoing challenges such as system integration hurdles, staff capacity, and variable call-handling practices across local health boards, ultimately recommending expanded staffing resources and a focus on long-term sustainability. The review also highlights the need to focus upon accessibility, and further research on people's preferences and habits in seeking support.