What is it about?
Mental health care for children and young people is not only about the treatment they receive; how care is delivered and the relationships they develop with professionals can be just as important. In this study, we spoke to healthcare professionals working across Child and Adolescent Mental Health Services (CAMHS) to understand their experiences of providing intensive community-based care compared with usual mental health services. Intensive Community Care Services provide flexible support to young people in places such as their homes, schools and communities, rather than relying mainly on clinic or hospital based care. Our findings showed that trust, strong relationships and flexibility were central to engaging young people in their care. Professionals described how seemingly simple activities such as having a conversation over coffee, playing a game, meeting someone at home or taking time to understand their interests could help build the trust needed for more formal therapeutic work. Families also played an important role. Supporting parents to understand mental health difficulties, involving them in decisions and building their confidence could help them better support their young person during and beyond treatment. The study suggests that effective mental health care needs services that give professionals the time, flexibility and continuity to build meaningful relationships with young people and their families.
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Why is it important?
This research is particularly valuable because it focuses on how mental health care works in practice, from the perspective of the professionals delivering it. Rather than looking only at whether intensive community mental health services produce better clinical outcomes, we explore the relational and organisational conditions that may help these services work. The findings are especially timely as mental health services face increasing demand and pressure to provide effective alternatives to hospital-based care for children and young people. Our study shows that moving care into the community is not enough on its own. Time, flexibility, continuity, family involvement and the ability to build trust are important ingredients of effective community-based care. A distinctive contribution of the study is the idea of a “relational ecosystem”: young people's engagement and recovery do not occur solely within the clinician–patient relationship. Parents, families, peers, professionals and wider services interact to shape their experiences of care. The findings therefore have practical implications for service design. They suggest that relational care should not depend simply on individual clinicians going above and beyond. Services need to create the conditions that allow professionals to build trust, work flexibly with young people in their everyday environments, and meaningfully involve families.
Perspectives
For me, working on the IVY Trial, which housed this publication, has been great, and it reinforces an important principle that has increasingly shaped how I think about mental health care: therapeutic relationships are not simply the context in which care happens; they are an important part of the care itself. What stayed with me most was how healthcare professionals described the seemingly ordinary things they did to engage young people - meeting them where they felt comfortable, talking about their interests, having coffee, playing games, or sometimes spending several visits simply building trust before attempting more formal clinical work. It made me reflect on how easily these relational aspects of care can become undervalued when services operate under pressures around waiting lists, targets, caseloads and demonstrating measurable outcomes. For me, one of the paper's strongest messages is simple: we cannot ask practitioners to provide relational care without designing services that give them the time, flexibility, and organisational support to build those relationships.
Opeyemi Atanda
London South Bank University
Read the Original
This page is a summary of: Relational care in community mental health: Evaluating staff experiences in Intensive Community Care Services (ICCS) vs treatment as usual, PLOS One, September 2026, PLOS,
DOI: 10.1371/journal.pone.0356608.
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