Children and young people’s mental health is one of the major health challenges facing the UK today. We are seeing increased waiting times, a rise in school-led referrals and according to UNICEF, some of the lowest youth wellbeing in the developed world.
Yesterday, the Government responded to a green paper on children and young people’s mental health, which as a community paediatrician, treating children with mental health problems, I hoped would provide some hope for the future. However, what was revealed was a disappointing response that focused too narrowly on the education sector.
Don’t get me wrong, I agree there is a need for mental health support in educational settings. After all, in May this year, a FOI request to NHS Trusts in England found schools are on average making 183 Child and Adolescent Mental Health Services (CAMHS) referrals every school day. Worryingly most referrals (56%) came from primary schools. However, children and young people’s mental health cannot be supported by one service alone. Several teams including primary care, child health services, local authority services and the voluntary sector are required to work collaboratively to provide children and young people with poor mental health with the best possible outcomes.
The Government needs to re-think its approach to this important issue and whilst they’ve missed an opportunity with the response to this green paper, it can address it with the upcoming long-term 10-year plan.
The Government must address three key areas.
A whole-systems approach
The green paper proposes a “brand-new workforce” of mental health workers based in schools, focused on low-level intervention. But these workers will function within a wider system, which was found by the Care Quality Commission (CQC) to be fragmented to a degree that is an “obstacle to progress”. The green paper does not address this fragmentation, and by concentrating purely on schools and specialist CAMHS, an opportunity is lost to mobilise local teams into a coherent local system around children and young people, preventing the new mental health support workers to function effectively. To put it another way, it feels like we have taken an exhausted, misfiring car to a mechanic, and been presented with a shiny 5 wheel, with no clear idea how it connects, or how it will help.
The role of the child health workforce
Paediatricians’ support and contribute to the mental health system with 40% of paediatric outpatient consultations relating to emotional/behavioural factors, and a growing number of children in crisis seeking help in A&E. Community paediatricians like me are responsible for the assessment and support of neurodevelopmental disorders and disability, including most autism spectrum disorder, and an increasing proportion of ADHD work. Community child health services are responsible for the healthcare of looked after children, who often have high levels of complex mental health difficulty. Health visitors and school nurses are often the first port of call with emotional and behavioural issues.
Any reform that ignores these members of the workforce is incomplete and will not lead to the transformational change required. The Government had previously recognised that CAMHS depend on a whole system approach so for this to be omitted in the green paper, feels like a backwards step.
Support for all children
The green paper lacks provision or attention for our most vulnerable young people, who are less likely to engage in mainstream services, or be in a mainstream school. This includes children with disability, refugees, children in care, those in the justice system, and those struggling with physical problems.
By choosing to prioritise the most easily helped over the most needy, the implicit message of the green paper is very much that only certain sorts of mental health problem are to be focused on. This may lead some to suspect that this is a political decision to process as many children through the system as possible, so that an increase in capacity can be announced and the problem “put to bed”. I couldn’t possibly comment.
Mental health is one of the child health crises of our time and is an area deemed of ‘major concern’ to the children and young people the RCPCH woks with. The Government has an opportunity to respond to young people’s concerns by implementing policies that support prevention whilst following a joined-up and fully inclusive approach. This includes all young people with mental health difficulties, wherever they are and however they present. Failure to do so will have catastrophic effect on the current, and future, generations of children living in this country.