Mental health services for children and adolescents in the UK are beset by “serious and deeply ingrained problems”, according to a new report from the Health Select Committee. Referral rates are increasing year on year against a background of funding cuts and efficiency savings. This has resulted in severe difficulties around accessibility, waiting times and highly restrictive criteria for accepting referrals. Some 263 children sectioned under the Mental Health Act in 2012-13 were held in police cells, according to the report.
MPs have made a range of important recommendations, including to give teachers more and better training on child mental health.
The most recent general population figures from 2004 show that 10% of children and young people will experience a mental health issue in any given year. By contrast, more than three-quarters of the children in the same survey who identified difficulties received no input from specialist mental health services.
More recent research suggests that prevalence rates are rising. Yet as the MPs’ report highlights, new population research into the prevalence of child mental health difficulties in the UK is long overdue. We should not be basing our commissioning and models of service delivery on information that is ten years out of date.
While previous surveys have used a validated mental health screening tool (the Strengths and Difficulties Questionnaire), simply categorising mental health difficulties into broad groups such as anxiety, depression and behaviour problems may not show a true picture of the scale of the problem.
General screening tools need to be supplemented by other methods that look at contextual factors – the impact of poverty, racism, family breakdown or parental mental health – and look at a wider range of difficulties such as the prevalence of self-harm or eating disorders. Only this way will we get a more accurate picture of children within our society – and the mental health needs we should be addressing.
Investment across the board
Further investment is needed in order to make adequate provision for young people and their families experiencing mental health difficulties, whatever the severity or complexity of the problems. The report makes clear recommendations about increasing funding for specialist out-patient and in-patient mental health services. Yet, providing investment to increase services at the specialist level alone is unlikely to solve the current difficulties around demand and accessibility.
Investment is needed across the spectrum, particularly at an early intervention stage, to both identify and manage difficulties earlier and to reduce the load on specialist child mental health providers. “Upstream” investments that are aimed at preventing difficulties developing or worsening to a stage that require specialist intervention are likely to be most cost-efficient in the long term. Yet government policy has been mainly aimed at investing “downstream” when problems have already developed or become entrenched. The report highlights how many preventative services, especially in the voluntary sector, have been cut as a consequence of reduced local government funding.
Importance of schools
The committee highlights schools as key settings in which many of their recommendations can be implemented. Their findings support a body of research demonstrating that teachers often do not feel skilled or well-enough equipped to understand or manage children’s mental health difficulties.
Recent initiatives such as the MindEd E-learning portal aimed at providing mental health information are steps in the right direction. So too are the recommendations from MPs in the report around child mental health training for new teachers and continuing training for qualified teachers.
Give teachers support
Yet it is unclear whether increasing teachers’ knowledge about mental health issues alone would result in changes in practice in schools. Training alone does not address common structural and systemic barriers in schools around prioritising staff time to deliver support.
Further recommendations are needed around how training is delivered and implemented in schools. This could be by providing time for supervision or reflective discussion for staff, having nominated “champions” in schools as part of senior leadership teams and schools having direct access to appropriately qualified specialists for advice and consultation.
Teaching has long been recognised as one of the most stressful UK occupations, with burn-out and career change frequent consequences. Among the most common causes of teacher stress are children’s behaviour in school and feeling ill-equipped for the role. Further training around child mental health is needed to help school staff feel better skilled and prepared for the diverse range of issues that children bring with them into school.