At this point, everyone agrees that children and young people’s (CYP) mental health services are in crisis. So we all gave a wary cheer when a green paper was announced last year. Just before Christmas it emerged and…. well.
The challenge facing the government is, admittedly, immense. Only 25% of CYP with a mental health problem receive treatment from specialist services, suicide is the 2nd biggest killer of adolescents, and the mental health problems in adulthood that represent our single biggest health problem (more than cancer, heart disease et al) mainly start in these years.
There are two ways it could have gone. The DH could faced up to the crisis, and the fact that you’re not going to quadruple the size of specialist services (even if you had the money, you don’t have the people). They could have looked beyond a simplistic, linear view of mental health as a line from ‘OK’ to ‘a bit sad’ to ‘really sad’ to ‘ill’, and realised that mental health is complex in ways that cuts across organisational boundaries, that usually doesn’t fit into neat treatment categories, and is more likely to present with anger and disruption that sadness or worry.
They could have paid proper attention to the various reports over the last decade which have pointed out the fragmentation of the system (CQC 2017) the need for meaningful collaboration between agencies locally and nationally (Lenehan 2017, Future in Mind 2015), and that CYP mental health needs to be actually, properly, everyone’s business (Basically every report ever). They could have injected resources into the system while creating the legislative structure to pull agencies together into the kind of collaboration we need.
But they took the other approach, that of the PR professional, who asks ‘who are the loudest voices, and how can we get them onside?’. From this point of view, the fact that the linear view of mental health as ‘sadness and worry’ is so wrong doesn’t matter, because it’s the media view. The fact that the most common condition in mental health, conduct disorder, is barely discussed is quite convenient because it’s complicated to treat and mainly happens to poor people. And the fact that schools are loudly banging the mental health drum becomes an opportunity.
What the DH need is to be seen to do something- they need a headline, and they need visible services that will please schools. So they will embed mental health workers in schools who will pick up the low-level sad/worried pupils, and give them a brief psychological intervention. No matter that we don’t know if this model works, how many of these cases would be self-limiting anyway, how on earth schools will ensure quality or governance, or how it will connect to the wider system. It will allow the government to claim huge figures of young people ‘treated’ and allow everyone to feel better about themselves.
But I’m being slightly unfair. These teams will also, it seems, run parenting course. I’m all for that, but it doesn’t really help unless you also have a service that can assess children’s behaviour and see what underlies it. And there are no extra resources for this, so what happens if the parenting course doesn’t help? “The parents aren’t doing it right”.
This is a disappointingly narrow, shallow, and headline-chasing response. There is no mention of wider child health services which provide support for autistic children, those with ADHD, children with special needs, looked after children etc, there is scant reference to wider vulnerable groups, and the connections between physical and mental health are ignored. Above all, there is zero attention to reversing the fragmentation of local systems. It’s not even as if the model suggested it that cheap- estimates are circulating that they will need to employ 8000 people, more than currently work in specialist CYP mental health services now!
The frustrating thing is that the green paper could be much better with just a bit more attention to the system as a whole– better guidance for commissioners, money in the system as a whole and a duty for all local agencies to spell out their contribution to a ‘local offer’ for mental health, which the local population can interrogate and influence, will do so much more than the sticking plaster on offer.
But it’s still just a green paper. It can change, right? Well, yes, but so far the DH have been amazingly bad at engaging with the sector about this, and time is running out. Pressure is required to get them out in the open- more pressure is needed to see that a good headline and some happy headteachers isn’t going to make the problem go away.