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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Alison Critchley, Chief Executive of RSA Academies, argues that the government's plans to transform mental health services across society, with an emphasis on early intervention, are welcome, but do not go nearly far enough.