Young people attempting to access mental health services in the United Kingdom often find traditional models of care outdated, rigid, inaccessible and unappealing. Policy recommendations, research and service user opinion suggest that reform is needed to reflect the changing needs of young people. There is significant motivation in the United Kingdom to transform mental health services for young people, and this paper aims to describe the rationale, development and implementation of a novel youth mental health service in the United Kingdom, the Norfolk Youth Service. The Norfolk Youth Service model is described as a service model case study. The service rationale, national and local drivers, principles, aims, model, research priorities and future directions are reported. The Norfolk Youth Service is an innovative example of mental health transformation in the United Kingdom, comprising a pragmatic, assertive and "youth-friendly" service for young people aged 14 to 25 that transcends traditional service boundaries. The service was developed in collaboration with young people and partnership agencies and is based on an engaging and inclusive ethos. The service is a social-recovery oriented, evidence-based and aims to satisfy recent policy guidance. The redesign and transformation of youth mental health services in the United Kingdom is long overdue. The Norfolk Youth Service represents an example of reform that aims to meet the developmental and transitional needs of young people at the same time as remaining youth-oriented.

Aim: Pathways to care (PtC) are a means of examining and understanding routes into mental health care. It is important to examine PtC in order to identify ways in which individuals access services, as well as highlighting barriers or delays to appropriate treatment. This study aimed to examine PtC experienced by young people accessing a pilot specialist youth mental health service (SYMHS) for those with non-psychotic, severe and complex mental health conditions in Norfolk, UK. Methods: Data were collected on a subsample of referrals accepted into the pilot SYMHS (n = 94) over a 12-month period. Duration and number of PtC were assessed using a semi-structured interview augmented by health record examination. Measures of premorbid history, symptoms and functioning were also collected. Results: The mean length of PtC was 3.74 years, and a mean of 5.53 pathways was experienced before appropriate services were accessed. Individuals were most likely to first seek help from their general practitioner followed by an educational provider. There were no associations between PtC and current symptoms, although individuals with a premorbid history of mental health problems experienced shorter PtC. There was a trend suggesting that individuals with long pathways had poorer functioning compared with those with shorter pathways. Conclusions: Pathways to care are variable in a group of young people presenting to mental health services. A majority of participants experienced ‘long pathways’, which may negatively impact on outcome. The results indicate the need to improve access to appropriate services by overcoming pathway barriers. Service implications are discussed

Clinical Implications Psychotic-like experiences are common in young people with severe non-psychotic mental health problems and should be routinely screened in mental health services. Psychotic-like experiences were found to be more prevalent when using a self-report screening tool compared to a clinician-rated measure. The presence of psychotic-like experiences may reflect more severe and complex mental health problems and may also cause delays in young people accessing the right kind of support. ;Limitations This study only assessed the presence or absence of psychotic-like experiences. Further studies should use more detailed assessments to understand more about the nature of such experiences and how they are appraised and responded to. This study is cross-sectional, and therefore, the direction of the relationships between psychotic-like experiences and depression, anxiety, functioning, and trauma cannot be specified. Longitudinal studies are needed to examine the impact of psychotic-like experiences on long-term outcomes.

This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Evidence of efficacy for high‐dose antipsychotic therapy (HDAT) and antipsychotic combinations (AC) is lacking, while evidence of harm is compelling. Significantly higher proportions of Norfolk and Suffolk NHS Foundation Trust (NSFT) patients were being prescribed HDAT and AC compared with the national averages. Here, the authors describe a quality improvement program to rationalise and reduce HDAT and AC prescribing in NSFT, to bring it in line with, or below, the national average. The initiative demonstrates that prescribing culture can be improved through a sustained multi‐professional team approach involving education and training, a targeted campaign, a proactive clinical pharmacy team and pharmacists' support.