Last week, the Mental Health Task Force published its long-awaited report Future in Mind: Promoting, protecting and improving children and young people’s mental health and wellbeing.
It set out a strong health-economics platform for improving the emotional health and wellbeing of children – 75% of adult mental health problems start by the age of 18.
It highlighted what we already know – significant problems remain relating to accurate data; treatment gaps; access; commissioning; out of hours assessment and the specific issues of vulnerable groups of children and young people and the role schools can play in early recognition and responding.
So far, so similar: Together we Stand (1995); National Service Framework (2003); CAMHS Review (2008); NHSE Tier 4 (2014) and Chief Medical Officer’s Annual Report (2014) set out similar pictures.
So what’s new? Children’s lives have changed, that’s what’s new.
They still have the same developmental, relationship and resilience challenges, but the world around them has changed. The pressures of learning, poverty, inequality, bullying, social media, unemployment, gangs and sexual exploitation exert impossible pressures on them – especially the most vulnerable – and often they are invisible to us.
It is essential that local commissioners, schools and providers get ahead of the curve and anticipate what types of responses are needed. Children and young people are already telling us – we need to listen, and do something different.
Moving away from a Tiered approach is helpful, but if future provision is no longer mapped out within a schematic Tiered model, what will take its place?
Ditching the acronym CAMHS might provide more leverage and encourage greater ownership across the piece. We will always need specialist mental health provision for the most troubled children but health visitors, school teachers and youth workers are all CAMHS workers when push comes to shove. They just call it something else.
At the Office of the Children’s Commissioner, we have a right of entry to every setting where children are, except their own homes. We visit schools, prisons, youth groups, pupil referral units, police cells, and secure and forensic settings. We champion children’s right to a childhood: to protection; to a voice; to health, to education; to dignity; to choice.
So often, and in so many settings, children and young people tell us about fantastic workers, sensitive therapists, psychiatrists who are lifesavers; social workers who are life-changers; nurses who are consistent; teachers and school nurses who are the only people they turn to and talk to. We would like commissioners to listen to those children and young people and hear what they have to say about what and who makes a difference to them at the most sensitive times in their lives. Their stories could shift mountains of hyperbole.
For too long, children and young people’s emotional wellbeing and mental health has been hostage to fortune – to politics, policy, priorities, data, funding and capacity. And whilst local systems reel from funding cuts and a diminishing workforce, they are again being asked to ‘transform’ and for local stakeholders to build Local Transformation Plans.
We welcome the unequivocal statements from Department for Education (DfE) and the Department of Health about the need to work together and we ask them to model in government what it expects to see happening in local organisations. Only when we have a genuine golden thread that extends from top down policy to a service children might receive will a Local Transformation Plan be good enough.
Transformation must be joined up for it to work. The notion of ‘a clear joined-up approach’ is not a new one. It has been the leitmotif of most major reports about child and adolescent mental health for the past 20 years. However, a joined up approach is dependent upon stakeholders understanding the concept of emotional health and wellbeing and how it manifests itself across a whole spectrum of need. Incorporating a head of wellbeing in every secondary school as the Nuffield Health report proposed, would be a start.
Joining up includes perinatal health, early years, wellbeing in schools, access to provision in community based settings, NEETS, considering the needs of homeless children, LGBT and other vulnerable groups – alongside PSHE in schools, mental health in the workplace and a commitment to reducing stigma. It requires clear leadership, the ability of local systems to understand its data, agree an approach to and then to sustain priorities. And a workforce development plan – a rare sight nowadays in systems that can hardly afford a workforce adequate to the need it is required to cover, and which is reeling from the when examining the bottom line reveals the number of losses of experienced staff with wisdom and the ability to manage risk.
£1.2 billion sounds a lot of money. It is. The intention is that it should reach 110,000 more children over the next five years, which isn’t a high aspiration when we know that only 30% of children who have mental health problems actually receive a mental health service.
That money£1.2bn is not all going to children and young people, it is also going toward improving perinatal mental health, training for teachers and GPs, CBT for people who claim Employment and Support Aallowance due to illness and £8.4million to provide mental health services to veterans.
So, is this the end of it? Can we finally say that things will get better?
Of course not. This is yet another stage of the journey. We welcome the additional funding, the plans for better access to IAPT and the intended reach. However it is sad (although we knew it already) that this announcement was so quickly followed by reports that mental health service budgets have been cut by 8% over the past five5 years. The reality of our lives mirrors those who need our services. It is indeed, a test of our resilience.
Future in Mind offers another opportunity to take account of what has already been learned, to take the best of the best practice already out there (in commissioning and provision), to further develop IAPT and MindEd in non- clinical settings, and to place the right of children to experience optimum health as the highest priority., through the focus and the priorities of Local Transformation Plans.
The messages from Future in Mind must now be translated downward from policy rhetoric into the challenging reality of local service planning and delivery.
So here’s a final challenge: Ask a child or a young person. They’ll tell you what to do! Dare you?