Can Sussex’s £3.1M COAST Service Revolutionize Youth Mental Health?

The mental health needs of young people in Sussex have long outpaced the region's capacity to care for them. Years of criticism have plagued the Sussex Partnership NHS Foundation Trust, with services being cut left and right while campaigners call for the investigation into the deaths of 369 patients—including several young people.

Emergency departments and inpatient units have become revolving doors for those in crisis. However, in this environment, a new model of care is being trialled.

COAST, the Crisis and Intensive Home Treatment Service, launched in April 2025, backed by a £3.1 million annual budget. The service promises to deliver urgent mental health support to children and adolescents directly in their homes. Its goals include preventing hospital admissions, improving continuity of care, and responding to crises within 24 hours.

Funded by both NHS Sussex (£900,000) and the Hampshire, Sussex and Kent Provider Collaborative (£2.2 million), COAST is a community-first experiment in a health system struggling to cope. But do experts think the project will work?

Dr. Rick Fraser, a psychiatrist with over 15 years of experience in Sussex's NHS system, says the roots of the current crisis are historical.

“The system we know is pretty broken for CAMHS,” he explains. “It was designed in the 1950s as a family guidance centre and gradually evolved, but hasn’t kept pace with the scale or complexity of youth mental health today.”

Fraser notes that in the past five years, a sharp rise in demand has collided with the “withdrawal of so many services that would have ordinarily supported lower-level mental health needs—like youth services, school services—all of these things have gradually been eroded.”

As a result, he explains, CAMHS teams are now serving only the most acute cases.

“More risky, more complex, and more acutely unwell young people. Therefore, the threshold has gone up and up. Kids who don’t quite meet those thresholds just don’t get a service,” Fraser explained. “They either get lucky and improve elsewhere, or they deteriorate, and we see them again in crisis.”

COAST aims to meet young people where they are, literally.

“COAST is designed to fill that gap,” Fraser explains. “It’s about bringing care to the young person, where they are, at home, in their community, before things escalate.”

This preventative, home-based model is a shift away from emergency-room dependency. According to a Freedom of Information response, COAST is currently structured to handle between 20 and 40 active cases at any given time. Its key performance indicators include:

Crisis response within 24 hours
Routine appointments within 72 hours
Reduction in A&E visits and inpatient admissions
Increased staff morale and retention

The service includes flexible treatment, allowing for escalation or de-escalation based on need, and aims to keep young people safely supported at home, thereby reducing dependency on inpatient beds. But can it deliver?

Fraser believes it can, with the right conditions.

“Putting young people in a general adolescent unit isn’t always the most therapeutic thing,” he says. “It’s also the most costly. And we’ve seen young people spend months in inpatient units, even turning 18 while admitted, then they’re transferred to an adult unit, which is incredibly traumatic.”

Fraser acknowledges that one of the main issues in the traditional system is fragmentation.

“A young person might go from a GP to a school counsellor to CAMHS to A&E, and never speak to the same person twice,” he says.

Harm Van Marwijk, GP and primary care mental health expert, believes that while COAST seems like a good project, “what we usually find is that [these projects] don’t necessarily achieve the aims you want, because it’s all very contextual."

Context, in this case, refers to the social and structural environments shaping mental wellbeing.

"Brighton has one of the highest rates of drug use in the country," Van Marwijk adds. "And there’s a huge socio-economic gradient to who ends up on waiting lists."

Van Marwijk also points to long wait times, where often people are on the waiting list for up to 2 years.

“Continuity of care is usually what helps people,” he says. “But the system is so fragmented. In one practice, we counted 20 different professionals handling youth mental health cases—social workers, prescribers, nurses, link workers. Unless you know how to navigate that, young people fall through the cracks.”

Fraser agrees, saying the current structure often fails young people at the moment they finally seek help.

“What we’ve seen is that when a young person finally decides they want help, that moment matters. If they’re turned away or told to come back in two weeks, we often lose them.”
He points to models like IROCK in Sussex—a walk-in service for 14 to 25-year-olds with no threshold for entry—as an example of early intervention.

“Same-day response, a simple assessment,” Fraser said.” It may not be a professor, It will [most likely] be an assessment with one of the generic youth workers, but they'll do a brief assessment of needs and of risk, and at least the young person gets something on the day they decide to present.”

Drawing from his experience leading a youth outreach team in Brighton, Fraser explains that though they had a smaller caseload, during his time at IROCK, he worked intensively, and reached people in their homes, including same-day responses to calls from young people or parents.

“It made a measurable difference. In areas without teams like ours, hospital admissions were statistically significantly higher,” he adds.

Professor Pat McGorry, one of the authors of The Lancet Psychiatry Commission on Youth Mental Health, sees Sussex's initiative as a necessary shift aligned with global needs.

“The transition from puberty through the mid-20s has always been the main period when psychiatric illnesses emerge,” he explains. “Mood disorders, eating disorders, psychosis, and personality disorders all surface, often alongside substance use.”

Describing youth as “the period of maximum vulnerability across the lifespan,” McGorry highlights added stressors such as instability in education, employment, climate anxiety, and financial insecurity.

“The health system is not structured to respond to this well,” he says. “It’s kind of strong for little kids, and strong for the over-50s, but very weak for people in this emerging adult phase.”

That being said, McGorry believes home care could be the future of care. A radical departure from the reactive mode, providing acute mental health care outside of emergency departments and inpatient units, could succeed in avoiding disruptive hospital admissions.

“It’s not just about access, it’s about trust,” he says. “Young people need to know the system won’t punish them for being unwell.”