Transforming children and young people’s mental health provision? A response to the government’s green paper - RSA

Transforming children and young people’s mental health provision?

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  • Picture of Tom Harrison
    Tom Harrison
    Assistant Researcher, Public Services and Communities
  • Health & wellbeing

The Government's Green Paper ‘Transforming children and young people’s mental health provision’ is a sensible move to lay out policy options in advance of a new national child and adolescent mental health survey to be published later in 2018. However, in the absence of up-to-date data on prevalence, I outline 4 principles that should inform the response to the consultation.

1)      Put schools first

The RSA Academies, supported by the RSA’s Action and Research Centre, have been working on a ‘Comprehensive Approach to Mental Health in Schools’ providing mental health awareness training to over 500 adults that come into contact with children across the family of academies. Our preliminary research results reflect the mood across the sector, with the twin issues of lack of capacity (related to time and training) and recruitment and retention for specialist staff as key concerns.

The lack of capacity in both Child and Adolescent Mental Health Services (CAMHS) and local voluntary sector services has been a focal point, and Young Minds charity calculates that £85m was cut from children’s mental health services from 2010 to 2015 , undermining efforts from schools to upskill their workforce adequately.

Across the RSA Academy schools, 37% of 472 staff surveyed highlighted the capacity of CAMHS as a ‘very significant barrier’ to effective mental health support. 30% also considered capacity issues with other local mental health services to be ‘very significant’. 

With these services being stretched, they are less able to upskill the schools workforce in their locality, and teachers remain, in most cases, on the frontline in realising the government’s own ambition to provide “earlier intervention and prevention” and “better, faster access to NHS services”. Thus a ‘schools first’ approach is critical to success.

2)      Have clear accountability measures for the proposed “Designated Senior Lead” for mental health in schools

Our survey data shows that much more needs to be done to improve resourcing in schools in tandem with NHS services. Only 50% of staff agreed with the statement “support for mental health issues is adequately resourced within my school, in terms of staff time and specialist support”.

The government seems to prefer a staggered and more cautious approach, with plans to roll out Designated Senior Leads (DSL) in just 20% of schools over 5 years, making it acutely vulnerable to accusations of diffidence and a lack of ambition.

Whilst policy priority areas such as child safety have benefited enormously from beefed up statutory responsibility and strong local and central accountability mechanisms, it seems unclear as yet how the DSL role would complement the existing role of Safeguard leads or Special Educational Needs Coordinator (SENCO), who are often mid- to senior-level members of staff. It is worth testing the effectiveness of bringing DSL’s within local authority's Joint Strategic Needs Assessments, accountable to Health and Wellbeing Boards.

3)      Build on the potential of devolved powers

The Green Paper seeks to investigate the creation of “New Care Models for Mental Health”, mirroring the current ‘vanguard’ sites that NHS England has set up to achieve its Five Year Forward View.

The paper advocates the creation of regional ‘trailblazer’ that correspond to the New Care Models. Whilst this could be a brilliant opportunity to scale up good work already underway, there is a risk of replicating work and developing services alongside - rather than in conjunction with - existing provision.

Indeed, the ambition to establish regionally-based Mental Health Support Teams shouldn’t miss the opportunity created by devolution. As the RSA has advocated for in the Inclusive Growth Commission, accelerated devolution in metro-areas particularly can be a vehicle for a ‘hearts and minds’ approach to mental health, where local leadership can knock heads together around shared goals. You can look to the West Midlands Mental Health Commission, Greater Manchester and London enthusiastically adopting the ‘Thrive’ approach developed in New York City for evidence of success.

4)      Learn lessons from the past

The last comprehensive national survey of the mental health of children and young people (UK wide) was 14 years ago. It found that 8% of 5 to 10 year olds and 12% of 11 to 16 year olds had a clinically diagnosed mental health condition, a far higher proportion than had previously been estimated.

The response to this was greater investment, and one key programme that emerged was Improving Access to Psychological Therapies (IAPT), which launched in 2008. 

As previous RSA research into the IAPT programme has uncovered, there is evidence that large scale service transformation, without care and attention to recruitment and retention and sufficient resourcing, can lead to poor outcomes and wide disparity. We found that areas in England and Wales have dropout rates for completing treatment as high as 90%.

The intentions behind the Green Paper are admirable, but the extent to which it is reflective of shifts in policy within education as well as devolution remains to be seen.

The Children and Young People's Mental Health Coalition amongst others are working hard to lobby the government to implement workable policy. Their approach complements what we have learnt by putting schools first in providing the mental health provison all young people deserve.

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  • These are all really good points Tom. However I believe that before real progress can be made we need to develop structures, a vocabulary and an agreed set of values between each stakeholder. Currently parents, Pre-schools, primary schools, secondary schools, Universities and health professionals all have differing systems and protocols for support, referrals, expectations and criteria. 

    No one should come first except the young person.

    Its time to start talking, flatten the hierarchy and agree that good mental health matters for us all.

    • Hi Penny,

      Great to hear your thoughts. This consultation hasn't had as wide a reach as I think the topic deserves so the discussion here is really welcome.

      Your point about different stakeholders and providers is an important one and reflects my experience working both with government agencies as well as universities and colleges. In the past I have advocated for a student focused IAPT programme for the very reason that there is an unclear relationship between statutory and non-statutory services like counselling for plus 16 students and limited accountability.

      Absolutely agree that the young person comes first. I refer to a 'schools first' approach because that what the evidence suggests really works. Unfortunately, government policy is risking developing another 'ask more of' approach to schools, which risks overburdening rather than supporting them.

      • The lack of impact on childhood obesity of schools based programmes announced last week is evidence that schools cannot impact alone. 

        My assertion, which it is evident you also support,  is that only a unified approach will succeed. 

  • Working with schools over the last year, I have focused on delivering positive change with pupils, staff, GBs and families and the wider community. The key drivers of which I have highlighted in Hope this gives a practical approach to help make a positive difference in very difficult circumstances.

  • The groups that I am involved with who are actively debating the Green Paper on Children's Mental Health are extremely concerned by many aspects of this paper. amongst the concerns are:

    a. lack of diagnosis by elimination of mental health;

    b. lack of an agreed approach to mental health shared by all stakeholders;

    c. a belief that schools do not have the capacity to deal with mental health problems; and examples where schools are themselves making the situation worse/creating it - therefore there needs to be a safe space where children can turn.

    • Re your third point Charlotte, we at provide a safe (and free) space with counselling support for children and young people, away from the school or home environment, too often a part of the problem. Overal, I think the Green paper is positive though I too share your concerns about the willingness and abilities of schools to step-up to the new demands placed upon them. I suspect charities such as the lowdown will be called upon to bridge the gaps.

      • Whilst I in no way doubt the efficacy of your services Brendan talk therapy is only one tool in the box. Many children are not yet ready to talk and need to go through a range of other processes before they do talk. For children in trauma revisiting the trauma can make the situation worse. There needs to be a variety of resources and strategies available that suit the individual's needs on a timely basis. Mental health can also be inter-generational and work needs to be done with several family members in order to resolve the problems of the initial client.  

        • I absolutely agree Charlotte and in no way want to infer 'talk therapy' is the only or the best therapy. It is only one in a range of possible therapies.

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