Crisis in mental health swells as awareness grows

4 Jan

I           National Health Service Survey

On 22 November 2018, the National Health Service (NHS) published the outcomes of a survey that showed that  one in eight – 12.8% – children aged five to 19 had mental health problems in 2017.  There was a steady increase in mental ill-health among the five-to-15-year-olds, rising from 9.7% in 1999 to 11.2% in 2017.

Emotional disorders were prominent (8.1% of young people from the ages of 5 to 19) – though there were other disorders such as those linked to behaviour and hyperactivity.

Altogether, 9,117 children and young people were surveyed.  One in 18 children (5.5%) from the ages of two to four years had at least one mental disorder.  This rose to 16.9% for those from 17 to 19 years old.

Over a third (34.9%) of the 14-to-19-year-old young people who identified themselves as lesbian, gay, bisexual or with another sexual identity had mental disorders against 13.2% who identified themselves as heterosexual.

About 25% of the 11-to-16-year-olds with mental disorders self-harmed or attempted suicide, compared to 3% of those without them.

If we exclude eating disorders, most mental health conditions were prevalent in children whose families were on low income or receiving benefits.  Over a third of children with mental health disorders had special educational needs and 50% with special needs had Educational Health and Care Plans (EHCPs).

What are we doing to help these young people? Not much, it seems.  The number of referrals to Child and Adolescent Mental Health Services (CAMHS) in England increased by 26% during the last five years, according to the Education Policy Institute (EPI). CAMHS rejected 25% of referrals deeming them inappropriate for treatment according to BBC Radio 5 Live, whose researchers compiled the returns under the Freedom of Information (FoI) Act.

Altogether, 54 CAMHS outfits out of 60 in England provided returns.  In 33 – which provided full data – the referrals for the under 18s rose from 157,000 in 2013/14 to 198,280 in 2017/18.   When the figures of another 17 CAMHS – which provided part data – were added, the mental health referrals topped 264,000.

Many cases were sad if not tragic.  George Hodgson (22) experienced problems getting CAMHS to take him seriously and assess him when he struggled several years ago with anxiety and panic attacks.   He decided he could not wait and sought help from the private sector.   “I don’t know whether I would have coped if private support wasn’t there,” he said.

Jo Hutchinson, director of social mobility and vulnerable learners at the EPI, said, “While we have seen a reduction in some of the longest waiting times, many children still face a lengthy period before they can receive any specialist treatment and the number of referrals into these stretched services is rising.”

According to the EPI report 55,800 (circa) children under-18 did not meet the criteria for specialist treatment after being referred in 2017-18.

The main reasons for excluding them from treatment were as follows.

  • Self-harm referrals were accepted only if accompanied by another mental health condition.
  • A weight loss of less than 15% from the young person’s ideal weight for an eating disorder did not justify treatment (although this is against National Institute for Health and Care Excellence guidelines).
  • Young people had not already engaged with early intervention services and waited specified lengths of time.

II          Gaps in youth services

Some local authorities – 27 out of the 111-  who responded to the FoI request, said they had scrapped services related to the mental health and wellbeing of children over the last eight years.  These included community-based early intervention services, family counselling and mental health support for looked-after children, as well as school-based programmes to support children with mild to moderate mental health difficulties.

A Department of Health and Social Care spokesperson said: “We are transforming mental health services for children and young people with an additional £1.4bn and are on track to ensure that 70,000 more children a year have specialist mental health care by 2020-21.

“We are improving access to mental health services through schools with a brand new dedicated workforce, as well as piloting a four-week waiting time standard in some areas, so we can better understand how to reduce waiting times.

“We are completely committed to achieving parity between physical and mental health as part of our long-term plan for the NHS, backed by an additional £20.5bn of funding per year by 2023-24.”

Many, however, are of the view that this is too little too late.

Meanwhile, the NHS survey revealed that teachers were the most frequent professionals contacted by young people in 2017 about mental health.  Overall, 48.5% of those with mental health disorders did so. Altogether, 22.6% of those with such disorders accessed education support services.  Sadly, 25% of young people with disorders reported no contact with professionals vis-à-vis their mental health, which is why it is vital for every school/academy to have a mental health lead.

Amid all this, governors need to bear in mind that staff who are consistently trying to mitigate the mental suffering of young people, sometimes succumb to the problem itself.  Altogether, 1.3 million days were taken off by teachers in the academic year 2016/17 for reasons linked to mental health and/or stress.

III        Initiative at RSA Academies

Many schools and academies rely on their own initiatives and resources.  A good example of this are the six academies under the aegis of the Royal Society of Arts (RSA).  The RSA’s programme is based on their research, which shows that it is not just teachers who support young people but also support staff and peers.  This calls for a whole school/academy approach toward dealing with mental ill-health.

Between July 2017 and September 2018, the RSA provided a programme of mental health awareness for their six academies and a non-RSA junior school based in the West Midlands, where the institutions serve communities with multiple disadvantages.

Its findings from the project signal that support staff members are assets for the school/academy community when they work in concert with the teachers.  With the help of the Anna Freud Centre, the RSA measured the impact of the mental health training in the academies and schools.  There was an increase in

  • staff confidence in talking about and dealing with mental ill-health;
  • staff mental health awareness and literacy;
  • staff perceptions of the academy/school as a supportive environment; and
  • “supportive behaviours” among staff.

Positive changes were discovered in all four areas among the academy/school leaders, pastoral and teaching staff and the rest of the support staff.  Staff members reported a 52% increase in supportive behaviours, encompassing talking and listening to pupils, giving practical support and signposting and making referrals to services.   Most staff members signalled that the positive changes were because of the training they received.   Altogether, 13% of staff members grew in confidence, awareness and mental health literacy and they perceived their academies/schools establishing supportive environments.

IV        The Green Paper

In December 2017, the government Green Paper, Transforming Young People’s Mental Health Provision, described a bold and ambitious approach to tackling mental health in schools and academies, which included a commitment to mental health awareness training for teachers matched with £95 million from 2019. Practical advice on promoting the mental health of young people was to be made compulsory by 2020 with changes to the Personal, Social and Health Education (PSHE) curriculum.

The National Children’s Bureau (NCB) has published a package of resources, A whole school framework for emotional well-being and mental health. In the documentation, the NCB stressed the importance of developing “a supportive school and classroom climate and ethos which builds a sense of connectedness, focus and purpose, the acceptance of emotional vulnerability, warm relationships and the celebration of difference”.

The RSA’s report, A whole school approach to mental health, mirrors NCB’s advice.  The RSA avers that establishing senior leads in 20% of schools/academies by 2022 will be insufficient if institutions are to confront five key issues:

  • a lack of specialist support services;
  • a more pressured school/academy environment linked to high-stakes examinations;
  • the impact of social media and cyberbullying;
  • violence and risk of violence outside of school/academy, and
  • self-harm.

Henry Ford was supposed to have said, “Chop your own wood and it will warm you twice.”  He had this saying on his mantelpiece.   Perhaps, schools and academies can learn from him.  If they are to tackle the malaise of mental ill-health, they must find the wherewithal (according to the RSA) within themselves to

  • train teaching and support staff alike to develop a whole-school/academy approach to mental health through establishing policies with practices to sit alongside;
  • develop staff literacy and confidence in tackling mental ill-health; and
  • ensure that there is good leadership built on collaboration with other schools/academies.

V         Sources of Mental Illness

The Mental Health and Behaviour in Schools guidance from the Department for Education identifies risks militating against children’s good mental health from a number of sources, which are set out below.

(a)        Within the Child

  • Genetic influences
  • Low IQ and learning disabilities
  • Specific development delay or neuro-diversity
  • Communication difficulties
  • Difficult temperament
  • Physical illness
  • Academic failure
  • Low self-esteem

(b)       In the Family

  • Overt parental conflict including domestic violence
  • Family breakdown (including where children are taken into care or adopted)
  • Inconsistent or unclear discipline
  • Hostile and rejecting relationships
  • Failure to adapt to a child’s changing needs
  • Physical, sexual, neglect or emotional abuse
  • Parental psychiatric illness
  • Parental criminality, alcoholism or personality disorder
  • Death and loss – including loss of friendship

(c)        In the School/Academy

  • Bullying
  • Discrimination
  • Breakdown in or lack of positive friendships
  • Deviant peer influences
  • Peer pressure
  • Poor pupil-to-teacher relationships

(d)       In the Community

  • Socio-economic disadvantage
  • Homelessness
  • Disaster, accidents, war or other overwhelming events
  • Discrimination
  • Other significant life events

Organisations that can help people of all ages deal with mental ill-health are as follows.

VI        National Initiative for all citizens

Paul Farmer, chief executive of Mind, the mental health charity, and Lord Stevenson of Coddenham issued a report, Thriving at Work, at the end of October 2017, which had been commissioned by Prime Minister Theresa May. It reveals that Britain faces a bigger challenge on mental health at work than experts thought.  Many believe that effectively tackling the scourge of mental illness will secure improvements for human welfare and the economy.   About 15% of working people have symptoms of a mental health condition. Annually, 300,000 (circa) with long-term mental health conditions lose their jobs, a much higher rate than those with physical illness. The economic cost of poor mental health, through output forgone, is estimated at between £74 and £99 billion a year. The human cost in misery is incalculable.

The goals, in themselves, are not spectacular.  However, if adopted nationally, they will help many who are struggling at work and will signal the nation’s desire to help a growing number of vulnerable people whose illnesses are not easily manifest.  Broken limbs are visible and attract sympathy. Mental illness isn’t.  And when victims of mental illness declare their frailties, they are stigmatised, ignored or ridiculed.

People who suffer from mental ill-health find their performance compromised and their productivity declines.   Cognitive-behavioural and compassion-focused therapies – among other measures – work very well and are highly cost-effective.

The Stevenson-Farmer report set out the cost of mental illness to the country:

  • 300,000people with a mental health condition lose their job each year
  • 15%of people at work have symptoms of a mental health condition
  • £74-99bncost of poor mental health to the economy
  • £33-43bndirect cost to employers, mostly from “presenteeism”
  • £4.20 average return on each pound invested in improving mental health at workSource: Stevenson-Farmer report

VII       Closing Thought

The last year closed with the world in a state of turmoil.  One does not have to become political to recognise the unrest prevalent in Greece, Italy, France, Brazil, Venezuela, the United States of America and, of course, the United Kingdom.  Across the Atlantic and on these shores, we have the MeToo campaign to deal with predators.  The campaign, according to some, is now in danger of taking a step too far and drawing in victims without justification.

We are fixated with social media.   Travel in London by the underground or in a bus and one cannot help noticing people glued to their mobile phones.  Social media, like water and fire, is a good servant but bad master (or mistress).

Is spending more time securing our own welfare and promoting our own happiness leading to greater mental health problems?  Should we not begin to throw ourselves more into looking after others than caring for ourselves?  It could be so much more rewarding.

We live at three levels – the physical, mental and spiritual.

If you have a pound and I have a pound, we each have a pound and together, we have two.     If I give you my pound and you give me yours, we still each have one pound and together we have two.  That’s the physical level.

If you have an idea and I have an idea, we each have one idea and together we have two.   If I give you my idea and you give me yours, we each now have two ideas, but together, we have only two.    In other words, at a mental level, when we give we increase the knowledge of the other/s but do not lose what we have.  However, collectively, we have the same knowledge.

On the other hand, if I am happy and you are miserable, one of the two of us is happy and the other miserable.   If I take the trouble to make you happy – in other words – ‘give’ my happiness to you and you become happy, I end of feeling happier than I was in the first place.   By giving I don’t lose my happiness.  Rather, I am left with more than I had in the first place!  That’s the spiritual level.

One cure for people suffering from mental health problems is teaching them to climb out of their skin to throw themselves into making the lives of other better and more worthwhile to live.   Could we pass on this message to our pupils and students?  If we do, this would be one mechanism for dealing with mental ill-health.

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