This week is Children’s Mental Health Week. The latest figures show that 800,000 children in England have mental health disorders and between a sixth and a quarter of children referred to specialist treatment are turned away. Seventy-five per cent of lifelong mental health conditions develop by age 18, and people with serious mental ill-health live 10 to 20 years less than mentally healthy people. Figures released last week show a significant rise in self-harm in children as young as three.
The week is run by school counselling provider Place2Be – and provides a good opportunity to review the latest developments on children and young people’s mental health.
The publication in December of the long-awaited Green Paper, ‘Transforming children and young people’s mental health provision’ has reinvigorated focus on this issue. The paper includes a three-pillar plan to be rolled out in a minority of areas by 2022/23: incentivise all schools to identify a Designated Mental Health Lead, fund Mental Health Support Teams catering to groups of schools and colleges, and introduce a four-week waiting time standard for all specialist treatment.
The proposals are a step toward enacting the ‘transformation’ strategy detailed in reports Future in Mind and Implementing the Five Year Forward View for Mental Health. The Green Paper demonstrates cross-departmental commitment to children and young people’s mental health, and it is vital that this focus is maintained under the new Secretary of State for Education.
Yet the paper’s proposals fall short of the system-wide approach laid out in the two reports, and the recommendations of the Education Policy Institute’s Independent Commission on Children and Young People’s Mental Health.
The Commission called for a national programme on mental health and wellbeing in schools that adopts a whole school approach – one that involves leadership, management, teaching, learning and a curriculum that champion emotional health and wellbeing, promote respect and value diversity. It includes working with parents and carers, empowering students to influence decisions and monitoring the impact of interventions.
While the government’s Green Paper acknowledges the need for a whole school approach, the proposed actions fall short.
First, schools’ mental health strategies will depend on a single individual – and identifying a lead is not compulsory. Second, the support teams will play a largely responsive role - facilitating referrals for children who require specialist treatment and providing support to those with lower-level need – and it is unclear what their level of expertise will be.
Moreover, it is uncertain how these proposals will be successfully implemented given that the accompanying £300 million in funding will not be ring-fenced, school funding has decreased in real terms and there are serious shortages in the children’s mental health workforce.
EPI’s Commission also made the case for a national waiting time standard following research identifying a postcode lottery of waiting times across the country. The Green Paper’s four-week standard will only be rolled out nationally sometime after 2023 - if approved by future spending review decisions. This means that the majority of children in England will likely not see a change in waiting times for at least the next five years.
The Commission’s recommendations covered other areas that the Green Paper did not address, including the establishment of a Mental Health Research Institute, a strategy to empower young people to live safe digital lives, kite-marked, easily accessible early intervention services in every area, and ending the practice of making young people leave their support services for adult services on their 18th birthday.
Instead, the Green Paper strategy is primarily reactive, despite the good evidence on and proven cost effectiveness of prevention and early intervention. It does not address cuts to local authority budgets which have severely reduced youth services and resulted in more children requiring specialist treatment. Children living in poverty and those with complex needs are much more likely to develop mental illness, and the paper does not sufficiently confront these inequities or how to engage effectively with vulnerable families.
As it is, the Green Paper’s strategy could lead to adverse outcomes for children.
Current child and adolescent mental health services are failing to meet need based on prevalence estimates from 2004. And a series of recent studies have found that mental ill-health in children and young people has increased substantially in the last decade. One in seven children in 2013-2014 reported symptoms of mental ill-health, and a quarter of 14-year-old girls reported high-level symptoms of depression in 2017. We will have a clearer picture of reported need when national prevalence estimates are updated this year.
The theme for this year’s Children’s Mental Health Week is ‘Being Ourselves.’ It is focused on promoting positive self-image and celebrating unique strengths to help children cope with life’s challenges and make better connections with others. Strong self-esteem and positive relationships are fundamental to children’s mental wellbeing. Schools provide an ideal environment to build up these protective factors – it’s not too late to seize this opportunity, but this means going much further than the Green Paper.