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Improving and transforming children and young people’s (CYP) mental health (MH) services is increasing in importance. Such systems, however, are often delivered across providers and commissioned in different ways which can lead to fragmentation and complexity, ultimately impacting negatively on how young people access services. With increased demand, this means that services are more likely to operate in silos when indeed they should be better integrated. Developing systemic interventions for service leaders and commissioners may support improved integration. The paper aims to discuss this issue.

Systemic issues across a CYP MH system were assessed and formulated. As a result, using systemic theory, appreciative inquiry and organisational change theories, a “systemic conversation” intervention was developed and delivered to senior leaders and commissioners of this system. This intervention comprised three workshop style sessions with numerous tasks.

Qualitative feedback and scores in the improvement of important elements that the conversations targeted were collected and examined descriptively. Participants rated their perceived improvement in relationships, transparency, integration, helpfulness and shared vision for future development.

In transforming CYP MH services, this paper considers how the authors can intervene across organisations representing the system to further integrate and improve care for those accessing services.

The intervention described is an original way of intervening with provider representatives from across the system. The paper provides a blueprint of how this might be adopted by others.

In response to elevated local self-harm and suicide rates, and the lack of a dedicated pathway for children and young people (CYP) who self-harm, a rapid response pathway united to reduce self-harm (RUSH) was developed and implemented within Norwich (Norfolk, England). This public health case study aims to describe the pathway model and share its outcomes, learnings, and reflections over the pilot year.

RUSH was a community-based pilot pathway aiming to support CYP, 11–18 years old, engaging in or at risk of engaging in repeated self-harm and subsequently at risk of repeated attendance at local emergency departments. From May 2020 to April 2021, RUSH supported 61 CYP using funding from NHS England and Improvement.

This case study shares the pathway’s outcomes, through a mixed-method evaluation. Results indicate statistically significant reductions in self-harm frequency (p = 0.01) and anxiety and depression symptomatology (p < 0.001); a statistically significant increase in progress towards goals (p < 0.001); and a general downward trend in re-attendance at local emergency departments following RUSH. Findings also illustrate high service user satisfaction. Framework analysis of focus group data highlights positive experiences with hope for recommissioning from a staff perspective.

This study will be valuable for services looking to develop and implement a similar service provision, in response to the need to tackle self-harm rates as a broader approach to suicide prevention. In light of the NHS long-term plan (2019), it also serves as an example of how to develop and use a strategic co-production group, and work collaboratively with the voluntary, community and social enterprise sectors.