Campaign to improve young people’s mental health develops steam

13 Apr

(1)       Campaign of The Times

Children’s health and well-being have become national issues.   Schools are finding it increasingly difficult to promote them as they have to countenance a rise in the incidence of mental ill-health among their pupils.   In fact, mental ill-health has become such a big issue that The Times has been running a campaign Time to Mind to draw its readers’ attention to the inadequacy of provision and prompt the government to take action to do something about redressing the balance for our young folk.  It appears that provision for children’s mental health is being seriously denied.  The NHS allocates only 6% of its budget to mental health overall and 0.6% to the Child and Adolescent Mental Health Service (CAMHS).

An investigation by The Times revealed that vulnerable children with mental health problems are being forced to wait for up to three-and-a-half years for assessments and almost two years for treatment.

The paper enquired about the longest waiting times since 2012 between being referred for support and being seen for an initial assessment.  In Kent, which comes under the Sussex Partnership NHS Foundation Trust, it was between 169 and 176 weeks — almost three and a half years. When enquiring about the longest waiting times between being assessed and first receiving treatment, the South London and Maudsley Trust mentioned one case where a child waited 657 days, or almost two years, while the Northumberland Tyne and Wear NHS Foundation Trust said one child had to wait 493 days.

Mental health provision is creaking at the seams and referrals are rising.  The 26 trusts each dealt with an average of 6,415 young people referred in 2014 year — a total of more than 150,000 — compared with an average of 6,009 in 2013.

The 26 trusts each saw an average of 6,415 referrals in 2014 — a total of more than 150,000 children — compared with an average of 6,009 the year before.

The Times’s campaign is being spearheaded by Professor Tanya Byron and has 10 objectives.

(i)         Getting the facts right with the government commissioning a study of child and adolescent mental health immediately and repeating it once every five years.

(ii)        Providing evidence-based treatment for all young people who need it, so that this service is on a par with the provision for physical ill-health.

(iii)       Ensuring early intervention and prevention by detecting and treating problems before they become severe, life-threatening or chronic.  Fifty per cent of all adult mental health problems become manifest by the time these people reach the age of 14, according to the research, yet, little is done for them when they were young.

(iv)       Address the scandal of young people in police cells.  Several young people suffering from mental health crises are held in police cells as “places of safety” under section 136 of the Mental Health Act.  The Times’s campaign wants this to end as also admitting youngsters into adult wards or sending them miles away from their homes.   More hospital beds are not the answer.   Rather, priority has to be given to funding sufficient inpatient places for children and young people who need them and step-down support in the community to reduce costly, long stays in in-patient care.  Priority also has to be given to funding outpatient and community outreach services with access to early intervention.

(v)        Young people should have easier and swifter access to treatment.  Front-line support services for parents and young people must be made available face-to-face, online and on the phone 24 hours a day, seven days a week.

(vi)       Local agencies of the NHS must take responsibility.   They should assess the needs of all children and adolescents.   Two-thirds of these agencies have insufficient data for commissioning.   Clinical Commissioning Groups, largely responsible for paying for CAMHS services, are commissioning without knowledge of what is needed.

(vii)      Children must not be thrown off a cliff. The transition from CAMHS to adult mental health services has been described by NHS England as a “cliff edge”. Good transitions require local coordination of services across the system.

(viii)     Professionals need and deserve better training.  Many GPs report that their training does not prepare them for the assessment and management of mental health problems.   A telephone access system to a senior mental health clinician should be considered and piloted.

(ix)       The Department for Education (DfE) should include a mandatory module on mental health in initial teacher training (ITT) with mental health part of continuing professional development (CPD) in schools for all staff.   Ofsted can then be charged with assessing the emotional support and mental health provision given to the pupils as part of the inspection process.   Many children today are falling victims to cyber-bullying, engaging in self-harm and other damaging practices.  Staff members – particularly teachers – would benefit from being trained in how to deal with these problems.

(x)        Child health must be a national priority.  The campaign wants CAMHS to be directed by a national policy and given adequate funding to promote children’s and young people’s mental health.

II          The Minister of Health takes the lead

As we are on the cusp of going into the next election, the coalition, thanks to Norman Lamb, the health minister, has pledged £1.5 billion over five years for mental health services to young people.  The money will be used to achieve three objectives.

(i)         Train teachers to spot problems at an early stage.

(ii)        Ensure that every child at risk is seen by a specialist within two weeks.

(iii)       Every pupil will have access to a counsellor who can liaise with the appropriate mental health services.

Lamb, a mild-mannered man, has struggled to lift mental health up the agenda.   He set up a children-and-young people’s mental health and wellbeing taskforce to examine services. It is likely to say that the services for children are very fragmented with too little focus on prevention and very few links with schools.  “The way we organise and commission children’s mental health services is broken,” said Lamb. “The majority of those suffering don’t get access to support. That is a situation which would never be tolerated in physical health……. If you have suspected cancer, you have the right to an appointment with a consultant within two weeks, and to evidence-based treatment,” he says. “That is not the same in mental health.”

Within the NHS there is no parity of esteem between physical and mental health.   The NHS constitution guarantees patients’ right to consultant-led treatment for physical illnesses within 18 weeks.  Mental health treatment is excluded.

Lamb is angry about Labour’s criticisms that the coalition cut mental health spending.   “No we haven’t,” he retorted.  “When the system which Labour helped develop has payment for activity in acute hospitals, waiting-time standards and A & E targets, those things drive where the money goes.  We need an equilibrium of rights.”  Consequently, there is now a target of a fortnight’s waiting time for treatment after a first episode of psychosis and a six-week target for access to psychology therapies is planned.

Lamb’s taskforce found a “massive gap” between schools and mental health services.   He wishes to see every school have a contact to enable teachers to train with local professionals and school visits by those professionals.   In his hometown of Norwich, the Mancroft Advice Project (MAP) welcomes teenagers to talk about any kind of angst.   “It takes the fear, anxiety and stigma out of it.  It helps build resilience and prevent deterioration.”  MAP runs sessions at schools.  “Youngsters often don’t want to talk to a teacher about alcohol problems or sexual health, but they flock to these sessions,” he said.  Lamb wants to see more of such projects across the country.

The Big White Wall is an online community discussing emotional issues and a confidential online helpline for the 11-to-25-year olds.   Lamb wants schools and the health services to capitalise on the support they give to young people to complement what they have to offer.

The taskforce is going to recommend that mental health services use technology more and better to broadcast information, given that young people are extremely savvy with their mobile phones and tablets.

Lamb has managed to secure £150 million over five years to help young people specifically with eating disorders.  We have to wait and see what happens following the general elections.

III        School Staff

In our desire to support pupils deal with and overcome their mental health problems, there is an onus on local authorities, trusts and the government to support our principals and headteachers of academies and schools who are subjected to incredible pressures to deliver a world-class education, excellent tests and examination results and ensure that they are top of the league tables.  That the last target is a daft one as everyone cannot be top apparently does not carry much weight.

Recently, the educational press reported that the number of chaplains in Church of England schools more than doubled in the last 10 years.  Not only do they support the pupils but also the staff.  The Times Educational Supplement mentioned that Reverend John Seymour, Chaplain of Twyford C of E High School in Acton, West London, said that he made a point to talk to teachers who seemed troubled.   “You can see on their faces when they’re stressed, whether it’s about work or their personal life.  I go into the classroom at a quiet time and say: ‘How are you at the moment?’ I think the fact that they can articulate what’s going on helps them to make decisions about what they want to do, rather than feeling trapped in it,” he said.

However, staff of schools working in many inner city areas could do more than just receive spiritual support.   Heads and staff require supervision from expert counsellors to assist with offloading their burdens and bounce off ideas to help them help their pupils, many of whom have mental health problems.

The Teacher Support Network said that there had been 6% rise in the number of educational professionals seeking support from counsellors via the charity’s helpline in 2014.   Their main issues have been anxiety, stress and the “ability to say ‘No’”.

IV        What can schools and parents do?

In the United Kingdom, Nuffield Health has invited secondary schools to apply as potential candidates to receive succour and support to combat poor physical and mental health among pupils and teachers.  For the successful school, Nuffield Health will

(i)         second the nominated staff member who takes responsibility for Wellbeing;

(ii)        invest in state-of-the-art fitness facilities and equipment;

(iii)       provide a two-year personalised health-and-wellbeing programme developed in collaboration with the school;

(iv)       organise and deliver health-checks for the pupils and staff; and

(v)        carry out an independent evaluation of the programme.

Unfortunately, there is little time left because the closing date is 17 April 2015.

Meanwhile, a headteacher gave Camilla Cavendish, The Sunday Times correspondent, a piece of what the latter thought was astute advice. She told Cavendish not to send her child to “a pushy school where he would be in the bottom half of the class”.  Others had told her that she wouldn’t really wish to turn down a place at a top school.   Many parents think that their children are bright if not very bright and will be immune to the growing waves of anxiety and misery which these youngsters express through eating disorders.

Psychiatrists and psychologists are extremely concerned about the pressures privileged children face.   In a US study, children of rich parents were found to be twice as likely to suffer from depression and anxiety as the rest.   A psychiatrist, who is inundated with young clients from top schools, is of the view that the “new achievement focus” is more toxic for children than parental divorce.  Pressure is coming from parents as much as schools keen to climb up league tables.

In state schools, A Place to Be, a national counselling service whose patron is the Duchess of Cambridge, has become increasingly visible.  The service works in 235 schools.  The website provides the following (stark) information.

(i)         One in 10 children aged between 5 and 16 years – i.e. three in every class – has a mental health problem and many continue to have these problems in adulthood.   Half of those with lifetime mental health problems first experience symptoms by the age of 14.

(ii)        Among teenagers, rates of depression and anxiety increased by 70% in the past 25 years.

(iii)       One in five children has symptoms of depression and nearly a third of 16-to-25-year-olds surveyed thought about or attempted suicide.

(iv)       Ten years ago, estimates put the cost of mental health problems in England at £77 billion, including the cost of lost productivity and the wider impact on well-being.  More recent estimates suggest the costs to be closer to £105 billion.

There are too few private schools that acknowledge, leave alone tackle, mental health issues with their pupils.   One notable exception is Wellington College where the principal, Sir Anthony Seldon, who will shortly be retiring, has put a huge premium on promoting pupils’ happiness. Earlier this year, he had a book published called Beyond Happiness: The trap of happiness and how to find deeper meaning and joy. Sir Anthony is the co-founder of Action for Happiness.  He has developed innovative programmes to teach resilience and discuss mental health.

The conspiracy of silence in many of our schools militates against children’s well-being leading to an exacerbation of mental health problems.   Because mental health services have been so grossly underfunded the subject is stigmatised – especially by parents.   As a consequence, many of our young people suffer from a loss of appetite, loss of sleep, low moods, and isolation. Children at both ends of the achievement spectrum are victims.  The very bright ones are expected to win every trophy and conform to well nigh impossible expectations both, from home and school.  The less able children are also subjected to pressures for not being clever enough and can self-harm or become victims of bulimia – especially when consorting with copycat peers.

We have yet to learn much more about mental health.  However, we can make a start and do what appears to be a very difficult job – take the first step by talking about it and banging the drum to have provision for young people who suffer in silence.

Sadly, on the 23 March 2015, a catastrophe in the French Alps, where a depressive co-pilot, Andreas Lubitz, crashed the Germanwings Airbus 320 carrier flying from Barcelona to Dusseldorf killing all 144 passengers (including 16 German students who were returning from an exchange tour of Spain) and six air crew, is likely to promote the continued stigmatisation of mental ill-health.   I pray that I am wrong.

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