Speech to the Association of Directors of Children’s Services- 7th July
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Thank you for having me. My name is Rachel de Souza. I am the Children’s Commissioner, which means it is my job to champion the voices of children and young people, and make sure that those making decisions listen to what children have to say.
It is an inspiration to be surrounded by people who care so deeply about the welfare and health of England’s children, and by the very people who have the power to improve care for children at such a challenging time. I am delighted to be here with you to discuss what children are telling me about their mental health, and what I am seeing on the ground.
Over the past few years, I have spoken to thousands of children, who consistently tell me that having good mental health and wellbeing is a top priority for them. In my 2021 Big Ask survey of over half a million children, 1 in 5 said that they are not happy with their mental health – a figure that is even higher among particular groups of children, such as older teenage girls and children in care.
Since then, my team and I have visited schools, hospitals, children’s homes, mental health inpatient settings, and community care settings to better understand what is working well for children, what is not working, and how things can be made better.
I am really pleased that ADCS has chosen to focus in on this important issue. Children’s Social Care is at the frontline of children’s mental health – with the children you support, day in, day out among the most in-need. Local authorities must be supported to work hand in glove with health providers to ensure that children get the help they want and need.
Today I want to focus on three of the biggest challenges I am seeing in relation to children’s mental health, and three key solutions that I think children’s social care can help to pave the way on. I’m sure that I will be underlining what you are already hearing from children too: that the system is overwhelmed, but that children have not lost faith – with the right reform, children are willing to put their trust in us, and take positive steps to lead healthy and happy lives.
The first key challenge I want to talk about is children not getting help early enough.
If we want to prevent children’s mental health from deteriorating, we need to go start at the beginning – and look at the foundations for a happy life. For me, it is clear that this means starting with family.
Last year, I was commissioned by Government to conduct an independent review into contemporary family life. This comprehensive review, which involved hearing from over 8000 children and parents, highlighted that having a supportive family is the foundation for children’s happiness, healthy relationships and success later in life. However, families face challenges and pressures which they need support to cope with. My review found that financial struggles, housing issues, childcare, familial conflict, abuse, and parental mental ill-health or substance use can all reduce the protective effect of families for children. One little girl said: ‘I’m worried about my mum and her mental health, and to be honest, I’m worried about mine.’ Equally, children being taken into care, and regularly changing placements, can be disruptive and traumatic.
That is why I believe family support and children’s mental health can’t really be separated out. Children exist within families, and improving a child’s relationships with parents, carers and families is the lynchpin to improving their mental health. This is perhaps most obvious when it comes to infant mental health and wellbeing, which is often given too little attention despite the evidence that early years are a crucial time for a child’s social, emotional and cognitive development. The need for early intervention was a strong theme that came out of the Care Review. The reforms to children’s social care must be implemented as a matter of urgency.
Because we are not focusing enough on prevention and early intervention, this leads to the second challenge – that we cannot currently meet the demand for children’s mental health services.
Every year, I publish our Children’s Mental Health Services briefing, which tracks waiting times for key services. My most recent report, published in March this year, reveals that while we are seeing a really positive increased investment in children’s mental health services, this investment has not been able to keep pace with demand. There is a growing gap between children’s need and the availability of support, and waiting times vary hugely from area to area – meaning children face a postcode lottery of support, as you can see in this map.
Children are left in the lurch, which is affecting their ability to attend school and have happy childhoods. One 17-year-old girl told me: ‘The lack of help with mental health has been the biggest thing that has stopped me and my friends from achieving what we want. It is difficult to access as we are not taken seriously, and when we are, waiting lists are so long.’
Help for eating disorders, a mental health condition that disproportionately affects children and young people, is just one example. My office recently conducted some analysis of the latest NHS data on eating disorders and found that only 78% of urgent cases and 81% of non-urgent cases were seen within the target time frame (falling short of the Government’s 95% target). And concerningly, these proportions have been falling over the past few years, which coincides with a post-pandemic increase in the number of young people needing eating disorder treatment. We are talking about some of the most unwell children in the country, whose lives are being put at risk.
And finally, because children are waiting so long to be seen, their needs are becoming more severe and complex. However, there is currently not enough appropriate, specialist provision for children with acute needs.
My team and I have visited children living in mental health wards, sometimes for months at a time and miles away from home. Often these are re-traumatising rather than therapeutic environments, with children experiencing and witnessing restraint, loud alarms going off, feeding through nasogastric tubes, and living in dirty and soiled segregation rooms. Children describe these settings as frightening and distressing. I think of the child in a mental health ward who told my team that the four members of staff who accompanied her at all times only referred to her by her initials, not her name. She said she felt like she was treated like an animal. Another girl living in a mental health ward, quoted here, said she has “been in the system for so long that getting let down has become normal.’ We are not only taking away children’s childhoods, we are dehumanising them.
I am sure that like me, some of the children you are most concerned about are those children with the most complex needs, who end up deprived of their liberty in inappropriate placements. We can all agree that being locked up in a caravan in the middle of winter, constantly supervised by agency staff with no training in healthcare, and no real education offer – is an inappropriate setting for any child to be in. These children are falling between the gaps of different statutory services which are under immense pressure, and working with different thresholds for support. As a whole system we haven’t worked out how we should be meeting the needs of these children.
This not only puts pressure on health services, but also on local authorities and children’s services – with many children not previously known to children’s social care presenting with more complex needs, triggering immediate care proceedings and in some instances, child protection plans.
So what can we do about it? To prevent the onset of poor mental health, I want to see early help for children and families.
Parents want to help their children and to be brilliant parents, and there shouldn’t be stigma around accessing support when needed. I want to see a Family Hub within each neighbourhood so that all children and families benefit from the support they offer, including health visiting, parenting programmes, early help and Start for Life. This must include a focus on early years, to ensure parents have the support they need to give their baby the best start to life. We need to see a greater focus on parent-infant mental health services, which can have lifelong benefits for children.
Secondly, we need to provide joined up support for children where they want to get it.
When I talk to children it becomes abundantly clear that they want help that meets them where they are. For most children, that means help in school. As one 9 year old girl told me, having a trusted adult to go and speak to in school ‘can help your mind to calm down’. She put it so simply, but those few words contain real wisdom and insight. I want to see an accelerated roll out of Mental Health Support Teams in schools and training of Senior Mental Health leads, so all children have the opportunity to access this support. I recently met with Place2Be to discuss their work with schools on this, and theirs are the kinds of support that I want all schools to be able to access.
For this to work well it requires close collaboration between schools, health and social care. I was a Headteacher for many years, and so I appreciate the challenges involved with working in a joined-up way with other agencies, not least when the footprint you are working in does not align with your multi-agency partners.
The move towards Integrated Care Systems is very welcome, and there is already tremendous progress happening at a local level to ensure greater collaboration between children’s social care, schools and health. For example, we recently spoke with leaders in Bradford doing really exciting work on developing tools to better identify autism in schools at an earlier stage. Effective strategic coordination at this regional level will help to reduce waiting times and the need for restrictive interventions later down the line.
ICBs must prioritise children’s mental health, and DHSC and DfE must work together to ensure there is join up between key strategies, such as the Children’s Social Care Strategy, the SEND & AP Improvement Plan, and the forthcoming Major Conditions Strategy. Inspection frameworks should also take a holistic view of health and social care, and special consideration for whether children’s needs are being met.
And finally, I would like to see better mental health support for children in care, children living away from home, and care-experienced children – across the spectrum of need.
Access to mental health was the biggest issue raised by children in care in ‘The Big Ask’. Children in care are incredibly brave and resilient, but many have faced significant trauma and disruption in their lives, and do not have the support network that other children have. I want children to have access to timely, tailored mental health support, signposted by trained advocates – and there should be an expectation that care leavers can access CAMHS until the age of 25.
I don’t believe any child should be in an institution – but for those children who are, I want to ensure that their settings are as safe, loving, and familial as possible. I will shortly be doing some work looking at what that group of children I spoke about earlier – those deprived of their liberty – need in terms of their care. We need better data and insight to understand who this group of children are, their needs, and their experiences of care. I would be delighted to work with any of you who have a particular interest in finding real and practical answers for these children.
Today I have outlined just some of the barriers children and young people face to living healthy and happy lives. We have some way to go, but I am confident that through working together to put support for families in place early, strategically prioritise children’s mental health, and ensure children in care get timely, high-quality services – we can ensure that every child can aspire to be their best, and contribute fully to their classrooms and their communities.
Back in 2021, I heard from over half a million children about what their top priorities are, and the biggest challenges they face. Children are the experts of their own experience, and hold many of the solutions to the problems they face. That’s why over the next year, I will be going right across the country to talk to children in more depth about their ideas for how we can overcome these challenges. We must build a society and a world that children feel is theirs – and one they feel excited to inherit as adults. I believe that is a society that cares, that puts good mental health and wellbeing at its heart. In the words of this very articulate 9-year-old boy quoted here “if adults listen, the world will be better.” Thank you.