Special Report: Timescales for children’s mental health reforms lack urgency

As the government has published its response to the consultation on transforming children and young people’s mental health provision, Clare Jerrom looks at reaction from the sector.

The government will roll-out its new approach to tackling children and young people’s mental health problems to at least a fifth to a quarter of the country by the end of 2022-23.

In its response to the consultation on ‘Transforming children and young people’s mental health: A green paper,’ the government said the first wave of the trailblazers for the principle aims of the green paper will be operational by the end of 2019 and rolled out to a fifth of the country by 2022-23.

‘Family crises do not wait’

However, the planned time frame has raised concerns among the sector, not least from the children’s commissioner for England Anne Longfield who said she “remains extremely concerned that significant improvements for all children are many years away”.

Chief executive of The Children’s Society Matthew Reed added: “These proposals do not reflect the urgency of the situation facing young people in desperate need of help right now and we would call on ministers to think again and strengthen these plans.”

Cllr Izzi Seccombe, Chairman of the Local Government Association’s Community Wellbeing Board said with only an estimated fifth to a quarter of the country’s children benefitting from the proposed scheme by 2022/23, this “risks leaving many young people without vital support” adding: “Children and their families need help and support right now - depression, anxiety, bereavement, and family crises do not wait.”

The government launched its consultation on reforming children and young people’s mental health provision in December 2017. The 13 week public consultation received over 2,700 responses.

The three core principles behind the government’s plans are:

  1. To incentivise and support all schools and colleges to identify and train a Designated Senior Lead for mental health.
  2. To fund new Mental Health Support Teams, which will be supervised by NHS children and young people’s mental health staff.
  3. To pilot a four week waiting time for access to specialist NHS children and young people’s mental health services.

Four week waiting time

The government said that it has looked at the current training available for Designated Senior Leads for mental health in schools and colleges and reconsidering, in light of our teaching and leadership innovation fund process, whether there are sufficient high quality courses and will work with providers of suitable courses to make sufficient places available to offer training to one-fifth of schools from September 2019.

The government added that it is “open to a range of delivery models” for the Mental Health Support Teams. For example, some teams could be led by groups of schools, others by voluntary and community sector organisations or further education colleges. The government pledged to fund Mental Health Support Teams via Clinical Commissioning Groups (CCGs), and expect schools, colleges and other local partners to have a central role in the application process and in designing and leading delivery.

“We will encourage sites in the trailblazer programme to test many of the issues raised in the consultation, such as how the teams can best work with vulnerable children and young people. We agree that the teams should only provide evidence-based interventions and are working with experts to develop an evidence-based curriculum, building on the existing Children’s Wellbeing Practitioner courses,” said the government response.

It will start recruiting trainees for the teams in autumn 2018 and expects the first Mental Health Support Teams to be operational from the end of 2019 and exact delivery models will vary in local areas. Plans to implement these teams will inform the workforce plan accompanying the long-term plan that the NHS is developing.

Furthermore, pilot areas for the four week waiting time standard will seek to start planning for and then providing access to evidence-based treatment on average within four weeks from 2018. The response said the government will ensure that this approach informs the NHS’s long term plan, including any changes to clinically-defined access standards.

Pilots will take place in some of the trailblazer areas, and are likely to cover a greater area and population than that covered by the Mental Health Support Teams, given the wide range of numbers of schools in different sized Clinical Commissioning Groups.

The waiting time ambition will apply across all referral routes available in the pilot area, including self-referral, or GP referrals. Children in crisis will continue to be seen much quicker, as is currently the case.

Trailblazers will examine ways to deliver the pledge of a four-week waiting time in a big to “mitigate the risk of unintended consequences” associated with introducing a four week time limit across the board by a set date.

“Through the pilots, and through monitoring the impact of Mental Health Support Teams on referrals and specialist NHS children’s mental health services, we aim to establish a clear understanding of the costs, benefits, challenges and indicators of success of introducing a four week wait,” said the government response to its plans following consultation with the sector.

‘Extremely concerned’ – Anne Longfield

Other proposals in the green paper will also be taken forward. This includes the government pledge to ensure that children will learn about mental health through the curriculum, introduce health education to the curriculum by 2020 and take action on social media and potential harms to children and young people’s mental health through its response to the Internet Safety Strategy Green Paper. The government will also support a new University Mental Health Charter in June 2018, aiming to drive up standards in promoting student and staff mental health and wellbeing and by setting up a team with representatives from across the sector to review the support needed for students in the transition into university, particularly those with or at risk of mental health issues.

Anne Longfield, the Children’s Commissioner for England, said: “While I welcome the government’s commitment to developing a new children’s mental health workforce in schools over the coming years, I remain extremely concerned that significant improvements for all children are many years away. Five years is a lifetime to a child, and even under these new plans the majority of children will see little improvement over the course of their secondary school life. Too many children will still not be able to get help or will be waiting an unacceptably long time for treatment.

“I know NHS professionals and schools are working hard to improve services and the introduction of trailblazer pilots and the training of hundreds of new counsellors will make a difference. This is a positive step in the right direction which quickly needs to be followed by a quantum leap to accelerate implementation to get help to all children who need it.

“I would like the government to set really ambitious targets that would see a counsellor available to every secondary school, so that we give children suffering from mental health problems every chance of getting better before their illness becomes worse and they reach crisis point. This will require political will and leadership and a sea change in children’s mental health care funding, to close the enormous spending gap between adult and children’s mental health services. I will continue to press the government to make the changes needed to make sure every child has access to the support and care they need as soon as possible.”

Postcode lottery will continue

Matthew Reed, Chief Executive of The Children’s Society, said the government’s proposal “doesn’t do nearly enough to address the crisis in children’s mental health services”. While hundreds of thousands of young people are experiencing mental ill-health, the plans “fall short” of what is needed to support and help young people.

With as little as one fifth of the country benefitting from the planned pilot schemes, “the current postcode lottery will continue for the foreseeable future and it could be years before the changes are rolled out,” he added.

“Many more children could be reached, and quickly, by committing to the provision of counsellors in all secondary schools and colleges as soon as possible.

“More funding is needed if trusts are to meet the four-week waiting time target, and there is little in the plans to improve early support for the most vulnerable groups of children – including those affected by sexual abuse and neglect, domestic violence, those excluded from school and refugee children – which can prevent mental health problems from escalating.

“The proposals do not do enough to improve provision for older young people, particularly in colleges, and we would urge the government to ensure all young people can access Children and Young People’s Mental Health Services up to the age of 25, rather than 18 or 16.  We have seen through our own services how this model can help address the worrying problem of young people falling through the cracks between children’s and adult mental health services.

“These proposals do not reflect the urgency of the situation facing young people in desperate need of help right now and we would call on ministers to think again and strengthen these plans,” he added.

‘We need a system that says yes to young people’

Cllr Izzi Seccombe, Chairman of the Local Government Association’s Community Wellbeing Board, said backed Matthew Reed’s call for counsellors in schools. “Measures to tackle the crisis in children and young people’s mental health are long overdue and we are pleased the government is taking steps to address this,” she said.

“However we remain concerned that the Green Paper doesn’t go far enough to tackle the challenges children and young people are experiencing to get the vital care they need. With only an estimated fifth to a quarter of the country’s children benefitting from the government’s proposed scheme by 2022/23, this risks leaving many young people without vital support.

“We need to develop a system that says yes to all children and young people, rather than no, when they ask for help.

“As a starting point, we want to see councils and schools given the funding to offer independent mental health counselling so pupils have access to support as and when they need it.

“Government also needs to work with the LGA and councils to make sure this is a local area-led approach, rather than just NHS,” added Cllr Seccombe.

Sleep-walking into a crisis

The children’s charity Barnardo’s said the government’s plan “fails to address gaping holes in mental health provision for children” and warned that “the government is still sleep-walking into the deepening crisis in children’s mental health”.

Barnardo’s is also deeply concerned that the announcement does not mention the importance of early intervention in primary schools, regarded by the charity as crucial to transforming and stemming a deepening mental health crisis.

The charity is calling on the government to use some of the £20.5 billion extra funding promised to the NHS in England by 2023/24 to help stop the children’s mental health crisis and bringing waiting times down across the country, not just in a handful of pilot sites.

Barnardo’s Chief Executive Javed Khan said:  “Theresa May has described mental illness as a burning injustice that required a new approach from government.

“However, actions speak louder than words. The government’s response to the Green Paper consultation does not show enough action on how as a society we are going to stop sleepwalking into a children’s mental health crisis.

“The response has let down the children who gave their views about the problems with the Green Paper and if the government does not rethink its approach, it runs the risk of letting down future generations too,” he added.

‘Proposals fail to mention social workers’

Meanwhile BASW, the professional association of social workers with more than 20,000 members, pointed to “significant shortfalls” in the government’s response to the consultation, not least the near absence of the role of the social worker.

The association said it had frequently highlighted serious flaws within the context of inadequate mental health system that systematically fails children, young people and their families. These flaws hinder social workers from providing the high-quality advice, support and interventions they are trained to give.

While social workers occupy many different roles within the child and adolescent mental health services and deliver essential, skilled services in this specialist area of work across the statutory, private and voluntary sector, the government response “again fails to mention the role of social worker and the positive role they play in improving children and young people’s mental health,” the association said.

“This is incomprehensible, as social workers are coordinators, practitioners and often the point of delivery for these services,” a statement from the association added.

Furthermore, the organisation said it “remains concerned” at the total lack of planning for specialist services to refer children and young people to; particularly for those with more complex needs, including children and young people subject to immigration control, separated children seeking asylum, children in the secure estate or children with disabilities, particularly as many of these children and young people will not be in mainstream schools and often their needs are not prioritised by mainstream services.

“The government’s response seems to only consider children who are engaging with statutory services, such as a school or a GP.  However, children who are looked after, in gangs or experiencing sexual exploitation are less likely to engage with these statutory services.  This current plan does not set out how children’s needs will be met in the community or in spaces where they feel most comfortable,” said BASW’s statement.

Whole-school approach

BASW argues that for the plan to be truly transformative it needs to consider investment in local authority funding for both universal and targeted services (including for example children centres) that are evidenced to promote good mental health and wellbeing.

The association urges:

  • Greater recognition and inclusion of the role(s) of the social worker in meeting the mental health needs of children and young people.
  • The inclusion of ‘looked after children’ at every stage of the Green Paper process by registering their needs as a core part of the new training programs and implementing the recommendations of the SCIE Expert Working Group on Improving Mental Health Support for Children in Care.
  • Expanding the remit of the mental health support teams to cover early years provision and providing incentives for nursery staff to undertake tailored mental health awareness training.
  • Providing ring-fenced funding for local specialist services to ensure that once a mental health problem is identified, the services exist to refer that child or young person to. The existing postcode lottery is unsustainable and unfair.

However, Catherine Roche, Chief Executive of children’s mental health charity Place2Be said: “We welcome the government’s commitment to improving children and young people’s mental health, investment in the Mental Health workforce and recognition of the crucial role of schools.

“School leaders and school staff are uniquely placed to promote a culture of positive mental health and spot the early signs of problems. Specialist support can be truly effective when provided in schools as part of a ‘whole school approach’. This investment in the Mental Health workforce is much needed. We look forward to working with new Mental Health Practitioners to provide timely and effective school-based mental health support for more children and young people,” she concluded.

Government Response to the Consultation on Transforming Children and Young People’s Mental Health Provision: a Green Paper and Next Steps

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