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Special report: Children’s mental health

The government is set to expand its work supporting children’s mental health in schools following successful pilots in the field.

Education and Childcare Minister Sam Gyimah said this month that the Department for Education would be working with NHS England, the Anna Freud Centre, and evaluators of the pilots over the next few months “to scale up this approach” which would mean “working with more schools, including those that are harder to reach”.

The multi-million pound joint mental health pilot scheme was launched by the DfE and NHS England last December. The government placed £3 million of funding to back the Mental Health Services and Schools Link Pilots where a named single point of contact was introduced in 255 schools and in 22 pilot areas in a bid to improve joined-up working between schools and health services. The pilots were designed to ensure that children and young people have better access to local, specialist mental health provision, and that support is consistent across services.

Single point of contact

Launching the pilots Education Secretary, Nicky Morgan, said: “The development of character, resilience and good mental health is vital alongside academic success in equipping young people with the skills needed to fulfill their potential.

“That’s why I’m delighted to see these schools engaging in joined-up approaches with mental health services to ensure that children, parents and teachers know where to turn and how to access the best support for young people with mental health concerns,” she added.

Each area received a financial boost of up to £85,000 and the single point of contact in the schools had the responsibility for developing closer relationships with a counterpart in local NHS CAMHS services to improve knowledge and understanding of mental health issues, and to help ensure any referrals are timely and appropriate.

Speaking at the Anna Freud centre earlier this month, Sam Gyimah said he was looking forward to hearing the full results of the evaluation in the autumn but he hoped that through these pilots “the journey towards a better, more coherent system between schools and CAMHS”, had begun to enable people to navigate the landscape more easily.

The pilots were not easy

Gyimah admitted that eighteen months ago, the picture for local mental health provision for children and young people was “not great” with long waiting times before an initial assessment could be made, and, then, often yet another wait for young people before specialist support was available all of which created stress and anxiety for young people and their families.

The work of the cross-government task force revealed that CAMHS felt schools did not understand them and schools felt that their pupils weren’t always getting the help that they needed. “In short, the link between schools and CAMHS was not working,” he said.

Teachers are not mental health professionals yet because young people spend lots of their time in school, teachers do spot mental health problems and often parents come to teachers to voice concerns about their child. The single named professional meant teachers in each school could contact their named staff member whenever they need to, making it easier for teachers to voice their concerns with someone they know and trust.

“I know that being involved in this pilot hasn’t been easy but it wouldn’t have been needed if it were,” said Gyimah. “For some, attending the first workshop was the first time health and education colleagues had been in the same room together and this led to some very difficult conversations about why you were there and what you were supposed to be doing.

“However, as a result of your perseverance and hard work you have all reached a much better understanding of the part you play, day in and day out, in supporting children and young people with mental health issues,” he added. “These pilots have started us on the road to more collaborative working, improved conversations and better relationships, ultimately leading to improved outcomes for children and their families.”

‘Seismic shift’

Children’s mental health has been in the spotlight over the last year or so. In March last year, the then deputy prime minister announced £1 billion of funding for child and adolescent mental health services, hailing the move “a seismic shift to revolutionise children’s mental healthcare”.

Nick Clegg said the funding would be used to ensure:

  • 110,000 more children with mental health problems will receive treatment
  • Rapid access to mental health treatment will be provided for new mothers
  • Waiting time standards for children’s mental health will be introduced
  • Specialists in children’s talking therapy will be available in every part of the country by 2018
  • Access to services for children under 5 and those with autism and learning disabilities will be extended.

In February this year, the government announced an extra £1 billion will be invested in mental health care by 2021 and a million more people will get mental health support. The announcement followed the publication of a report by the Mental Health Taskforce, which reviewed mental health care and set out its vision for preventative, holistic mental health care. The recommendation, to be delivered by 2021, included providing mental health care to 70,000 more children and young people.

While the investment in children and young people’s mental health has been welcomed, YoungMinds chief executive Sarah Brennan warned that “the government’s promised improvements are not happening quickly enough”.

“Young people referred to mental health services are at the mercy of a postcode lottery, with waiting times for assessment varying from under a week to more than a year depending on where they live. Then, when they are assessed, nearly a quarter of children are refused treatment, often on the grounds that their conditions are “not serious enough",” she explained.

The government needs to overcome four key barriers

A report by the IPPR this month found that despite the growing number of children and young people who require help for mental health services, cuts to the funding of both NHS and local authority ‘early intervention’ services, which can prevent emerging mental health problems from escalating further, mean that increasing numbers of children are unable to access appropriate and timely support.

The report urges early intervention mental health services for children and young people to be rejuvenated with secondary schools playing a central role.

It highlights that schools’ inability to access sufficient funding and resources and a lack of established mechanisms by which schools can influence commissioning decisions taken by clinical commissioning groups (CCGs) are barriers to the quality of school-based early intervention provision. In addition there is inconsistent quality in the mental health support available to schools to buy in directly and a lack of external checks on the appropriateness and quality of the approaches taken by individual schools.

“The government must find ways to overcome each of these four barriers if schools are to fulfil their substantial potential for meeting pupils’ emerging mental health needs, and play a central role in the transformation of children and young people’s mental health services. This should involve guaranteeing every secondary school access to a mental health professional who delivers targeted interventions on-site, and making school counselling a regulated profession,” said the IPPR report.

Urgent action is needed now

In addition, the Education Select committee published a report earlier this month which found that the provision for looked-after children with mental health concerns is poor in many areas across England. A significant number of local authorities are failing to identify mental health issues when children enter care and services are turning away vulnerable young people for not meeting diagnostic thresholds or being without a stable placement.

The report highlights that children and young people need to be better supported as they enter and leave the care system. Care leavers should be able to access CAMHS up until the age of 25 if necessary and initial assessments of those entering care should be more thoroughly and consistently carried out, the committee recommends.

Ms Brennan also warns that the number of children turning up in A&E with mental health problems has more than doubled since 2010. Where children need inpatient care, there are often not enough beds available and Ms Brennan slams it as “completely unacceptable” that children are being placed on adult wards, or forced to travel hundreds of miles to the nearest hospital with appropriate facilities.

“The truth is that years of underfunding have left the whole system overwhelmed. The government has pledged extra money towards children’s mental health, but this money must be protected and spent where it’s needed most. Mental health problems are ruining the lives of families across the country every day, and that’s why urgent action is needed now,” she concluded.

 

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