On the 9th January, Theresa May made a good(ish) speech. She talked about injustice, and about how peoples’ opportunities are too conditioned by their position in life. She then turned to children’s mental health and talked about the train-wreck that is current provision.
What did she suggest?:
- A review by the CQC
- Teachers to be trained in mental health first aid.
- An end to out of area transfers (but only for ‘general mental health’ so won’t mean anything)
Now, for the issue to get prime ministerial attention is a good thing, no doubt. But how much difference will it make, really?
Let’s look at the situation. 850,000 children have a diagnosable mental health problem in the UK, of which only 25% receive a service from specialist CAMHS. The plan from NHS England is for the recent cash injection to increase this figure to…. 33% by 2020. This assumes that the money is getting through, which it pretty clearly is not. It also raises the question- even if you do manage this increase, what about the other 67%?
This is where Mental Health First Aid comes in. The idea is that teachers pick up the early signs of emotional distress and put in place simple measures, thus stemming the flow of referrals to specialist services. There are two problems with this: one is that there is no evidence that it does any such thing, and the second is that it’s only dealing with what I call socially acceptable mental health.
What is the most common mental health problem among the 850,000? Anxiety? Depression? No, it’s conduct disorder, broadly, a pattern of disruptive behaviour leading to significant impairment. These kids often have complex social, biological, psychological and educational aspects to their stories, and need complex, multi-agency intervention to get better. But the point is they CAN, but they are too tricky, and not good at advocating for themselves, and are much easier to shunt into the youth justice system. And they are HALF of the 850,000 with diagnosable problems. People talk about universal parenting course access, but anyone who works on the front-line knows that these are no panacea.
The rest of the 67% will be kids who don’t have straightforward mental health presentations- those with autism, ADHD, learning disability, or traumatised children who are too angry and fearful to look sad.
So what is needed? What should we say when CQC comes to call? Apart from handing them copies of the other three CAMHS reviews completed in the last 2 years?
You’re never going to get 100% of eligible children into specialist care, and actually you may not want to- what a lot of them need is broader, more complex and more long-lasting than a block of therapy with CAMHS. So firstly, we need to expand what we mean by mental health help, and embed it into local systems.
This will require:
- clear commissioning of a ‘local offer’ for mental health
- Support from local specialists for the rest of the sector, in terms of consultation, training and joint work.
- A children’s workforce who understand mental health and the many ways of helping.
- Inspection of what the local area provides for children’s mental health and wellbeing.
- Training and guidance in best practice across the sector.
Second, we need to ‘shift the curve’ on mental health- by improving overall mental health we can decrease the number of children requiring care. The government are still, officially, committed to a ‘life chances’ strategy, and that sounds a lot like what Theresa May was talking about- the problem is that she was talking about adult employment, and income, rather than what really matters, which is getting the best start by:
- ensuring adequate incomes
- improving early education and care
- improving homes and environments
- creating a truly inclusive education system that cares about more than exam results.
Is this ambitious? Sure. Is it possible? With the right political will, both nationally and locally, and engagement from professionals, yes, at least in part.
And the alternative is just leaving the 67% to fester into the next decade’s ‘problem families’.