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New report on the state of Children’s Mental Health Services

13 Apr

On 30 January 2020, Anne Longfield, the Children’s Commissioner for England, released a report on ‘The state of children’s mental health services’. She mentioned that the National Health Service (NHS) improved provision for children’s mental health services.  However, it is still very much the Cinderella of the NHS – meeting the needs of only 12.8% of children in England, who have mental health problems.  While Longfield welcomed the progress that the Children and Young people’s Mental Health Services (CYPMHS), she warned of the chasm between children’s needs and the availability of services.

With the extra £60 million invested in special mental health services, an additional 53,000 children began treatment.  There was an improvement in tackling eating disorders, where the number of youngsters accessing services increased by nearly 50% since 2016/17.  However, much more needed to be done.  Only 3% of children were referred to the services – which was one in four with a diagnosable mental health condition.

The headline data in Anne Longfield’s report were as follows.

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Obesity Crisis: a national problem which begins at birth

12 Aug

I        Preamble

Obesity has become a national crisis.  Increasing numbers of pregnant mothers overeat.  The expectant mother justifies doing so by kidding herself with: “Well, I am eating for two.” There is some medical evidence to suggest that the overeating impacts on the unborn child, who on arrival also tends later to overeat.  The problem often starts at birth. A tragedy.

Obesity causes diabetes, cardiovascular disease, some cancers and early death.   That apart, the obese person is impeded from living a normal life. S/he walks slower, has problems breathing, spends more on larger-sized clothes and shoes, takes up considerable seating space in public transport attracting angst from others and does not look and feel good.

Childhood obesity is linked to different health conditions such as asthma and type-2 diabetes.  It also increases cardiovascular risk factors.   Obese children suffer from mental ill-health and behavioural problems.   Worst of all, an obese child becomes and obese adult.

In 2017, a national survey revealed that 36% of the UK population was overweight and 29% obese.  In the case of men, 40% were overweight and 27% obese.  With women, 31% were overweight and 30% obese.

In 1984 fewer than 10% of five to ten-year-olds were overweight, and fewer than 2% obese. In 2017/18 more than 20% of children were overweight or obese when they began school and over 33% overweight or obese by the time they left primary school.  Obesity numbers are highest in the most deprived 10% of the population twice that of the least deprived 10%.

The poorest have become the biggest victims of obesity.  Forty years ago, a poor child was around 25% more likely to be obese than a rich one. Now, by 11 s/he is three times as likely. Marie Antoinette said of the common French person: “Let them eat cake.” Prime Minister Johnson is now saying to the manufacturers about the common man in the United Kingdom: “Let them eat sugar” – a cry that does not liberate but is a curse.

Obese children are stigmatised and bullied. This leads to low self-esteem and frequent absences.

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Is children’s welfare being undermined by the twin obsessions of academic success and social media?

18 Apr

I        Children’s Well-Being

There was a time not so long ago when young people, particularly boys of an ethnic group, hated to be told that they had mental health problems.  School leaders and teachers fuelled this loathing when they (the youngsters) behaved badly with remarks such as: “You are crazy and mad!”

The pendulum has now swung the other way.  It is now quite “cool” for a young person to aver that s/he has mental difficulties.  And it is not just the “snowflake” generation.

This apocryphal story epitomises this splendidly.  One man, in a conversation with his friend, said: “My health is being ruined because of worry.”

“What are you worrying about?” asked his friend.

“I am worrying about my health!” came the riposte.

Notwithstanding, research reveals that mental ill-health is on the rise.   People (especially in the West) live longer than ever and cures have been found for an increasing number of maladies.  But the Cinderella of the Health Service is mental health. It is, therefore, unsurprising that children’s suicide rates are up 67% since 2010.  A quarter of those referred for help were denied treatment. Despite the need, according to the Care Quality Commission, 23% of child and adolescent mental health services (CAMHS) were rated “inadequate” or “required improvement”.

Of all the causes of young people’s mental ill-health two stand out.

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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.

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Children’s mental health problems cry out for solutions

17 Aug

Data published by The Times on 6 August 2018 revealed that the number of girls who have self-harmed, based on hospital admissions, doubled in the last 20 years in Britain.   Among teenagers, the number of both, boys and girls, who admitted self-poisoning with easily available and prescription drugs rose more sharply.

According to the National Health Service 7,327 girls were admitted to hospital in 1997 for self-harm.   This jumped to 13,463 in 2017.  Altogether, 249 girls were treated for attempting to overdose themselves. This rose to 2,736 – over tenfold – in 2017.     However, boys who self-harmed stayed constant (2,236 in 1997 and 2,332 last year). Notwithstanding, boys who overdosed themselves increased over five and a half times from 152 in 1997 to 839 in 2017.

Denis Campbell wrote in The Guardian on 23 June 2018 that teachers said that Britain’s school children were suffering from an epidemic of anxiety, depression and suicidal thoughts but barely received the NHS treatment they needed. Altogether, 78% of teachers encountered at least one pupil struggling with mental health problems over the last year and 14% of cases were allied to suicidal thoughts and behaviour.  Two-thirds of 300 teachers surveyed by the health charity, Stem4, said that they had to help pupils suffering from anxiety. A little under half (45%) of teachers supported at least one pupil suffering with depression, 30% with eating disorders, 28% with self-harm and 10% with addiction.

Dr Nihara Krause, the Chief Executive of Stem4, said: “Schools face huge challenges in dealing with mental health issues of their students, and teachers are on the front line. They witness first-hand the devastating impact of pressures such as exam anxiety, bullying, and family problems. The consequences of these problems are serious, often life-threatening, and teachers are desperate to help,” said Krause.

“Yet at a time when the need for preventative, early intervention and specialist services are soaring, schools are finding it increasingly difficult to provide the help their pupils need. There’s an urgent requirement for better support mechanisms in schools, as well as decent funding for the range of mental health services children and young people need.”

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Green Paper on mental health provision in schools and academies

31 Dec

I        Proposals

On 4 December 2017, the government published a Green Paper and an open consultation around “transforming children and young people’s mental health provision”.[1] Jointly issued by the Secretary of State for Education Justine Greening and Secretary of State for Health Jeremy Hunt, the Green Paper sets out plans which could have implications for how schools deal with mental ill-health amongst children and young people. The Paper proposes that every school/academy appoint an individual as a “designated lead in mental health”, with a national training programme fully in place by 2025. This individual will take the lead to help young people with mental health issues, provide support and advice to them and staff, and teach students about the warning signs associated with poor mental health.

The mental health lead will also have the power to make referrals to “specialist services” for the victims of mental ill-health.

The proposals recommend that each school mental health lead be linked to wider support teams, forming a bridge between the school/academy/college and the NHS which will mean that every school/academic and college will find it much easier to contact and work with mental health services.

As part of the initiative, the government wants to carry out further research around

  • the impact of the internet, particularly social media, on mental health;
  • how families can provide support to those suffering with mental health issues; and
  • how mental health problems can be avoided in the future.

Further work will also be carried out to see how mental health for 16-25 year olds can be improved.

In the Executive Summary, the government trumpeted what it had already achieved.  It mentioned the following.

“We have:

(i)         legislated for parity of esteem between physical and mental health;

(ii)        promised to ensure that an additional 70,000 children and young people per year will obtain support from mental health services by 2020/21;

(iii)       improved services for eating disorders, with an additional £30 million of investment, established 70 new or enhanced Community Eating Disorder Teams, and set the first-ever waiting times for eating disorders and psychosis;

(iv)       funded eight areas to test different crisis approaches for children and young people’s mental health and tested New Care Models for Mental Health; and

(v)        published cross-agency Local Transformation Plans for children and young people’s mental health for every area of the country.”

In the second chapter of the Green Paper added: “We have made our commitment clear through significant investment in services for children and young people, including:

  1. legislating for parity of esteem between physical and mental health in 2012;
  2. investing record levels in mental health services, totalling £11.6 billion in 2016/17;
  3. making an additional £1.4 billion available for children’s and young people’s mental health between 2015/16 – 2019/20 to enable an additional 70,000 children per year to be seen by children’s and young people’s mental health services by 2020/21; and
  4. committing to recruit 1,700 more therapists and supervisors, and train 3,400 existing staff to deliver evidence based treatments.”

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Chorus to support young people improve mental health swells

18 Aug

Localis, the think tank, published a report recently asking the government to make it compulsory for a mental health module to be included in initial teacher training (ITT). The report stated that mental health services for youngsters should be brought into schools/academies to prevent more than half-a-million pupils from being failed by the agencies.

Readers may recall that Prime Minister Theresa May announced recently that every secondary school in England would be provided with free mental health training.   Localis has now asked government to give school leaders more detail about what form this will take. It pointed out that in spite of the £1.4 billion recently committed to improving Child and Adolescent Mental Health Services (CAMHS), more than 555,000 primary and secondary pupils who have mental illnesses will not receive NHS care and attention by 2020-21.

The Times Educational Supplement (TES) reported in the summer of 2017 that an increasing number of pupils had become suicidal in their attempts to secure help because CAMHS had raised the threshold for triggering that help.   A pupil of a school in South West London attempted suicide with an overdose. When her headteacher asked her how she was feeling when she was saved, she replied: “Pretty awful.” And then she revealed that she had attempted to kill herself to attract the attention of CAMHS.  In her school alone, three other pupils also attempted suicide for the same reason.

According to the TES, Heather Dickinson from Papyrus, the teen-suicide prevention charity, says that helpline advisers frequently hear from pupils who have expressed suicidal tendencies to see professionals from CAMHS.  “People either can’t access CAMHS or aren’t getting enough from them,” she told the TES.  “Sometimes young people feel that they’re not taken as seriously by CAMHS as they might be….So they escalate their behaviours.” Dickinson has seen a dramatic rise in calls and text messages the charity receives from teenagers with suicidal thoughts.

Growing numbers of pupils are being driven to make what look like suicide attempts just to get help, because the thresholds for accessing CAMHS’s services have increased. While CAMHS is planning school-based approaches to mental health, only 3% propose placing counsellors in schools.

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Mental Health: a case for placing it centre-stage

18 Apr

I           The Health and Education Select Committee

In the last week of March 2017, MPs on the Health and Education Select Committee received oral evidence from experts in the final session of their joint inquiry into the role of education in preventing mental health problems in children and young people.

Baroness Tyler of Enfield, the chair of the values-based child and adolescent mental-health system commission, Lord Layard, director of the Well-Being Programme at the London School of Economics, and Natasha Devon, a former government mental health champion, among others, presented evidence.

The main points raised during the session included the following.

  1. Embedding well-being and mental health awareness across the whole school was very important. Baroness Tyler explained that well-being in the school context includes parents and teachers. She welcomed the move to place Sex and Relationships education (SRE) on a statutory footing and called for compulsory personal, social, economic and health education (PSHE) in all schools.
  2. Senior leaders should be encouraged to measure how schools were influencing the well-being of children through surveys, and their integration into school improvement plans. Lord Layard asked the committee to run a pilot with volunteer schools to re-balance the present focus on measuring academic performance only.
  3. The impact of school funding pressures on mental health should be measured. Natasha Devon highlighted the effect of cuts on access to school support services including counsellors, to the enrichment curriculum and to subjects like sports, drama and music which support positive mental health.

The cross-party group of MPs on the Committee questioned ministers on their record on education and children’s mental health. Edward Timpson MP, Minister of State for Vulnerable Children and Families, said: “There was still much to be done” to address patchy and variable access to mental health services for young people across the country.

The MPs involved recognised that governing boards are responsible for promoting the well-being of children and young people and required to ensure that they set a supportive ethos and culture.

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Call to raise the profile of and provision for mental health in schools and academies

1 Jan

For the well-being of a nation to be promoted, children’s mental health must be safeguarded.  They are our future.   We commit a heinous crime by neglecting children’s welfare and happiness.   However, children’s mental health is taking a backseat in the provision we make for them within our schools/academies and the wider society.  The focus, at times, is exclusively on a narrow curriculum dominated by English and Mathematics and, when in their teens, the English Baccalaureate.

In the 61st issue of Governors’ Agenda, (see here) we focused on the promotion of children’s mental health.  It is now time to revisit this important matter, especially as there have been developments.

Emily Frith of the Education Policy Institute published in November 2016 Children and Young People’s Mental Health: Time to Deliver.  The report calls for a “high profile, national government programme to ensure a stronger focus on mental health and wellbeing within schools”. The recommendations in the report – set out in three sections – are as follows.

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Boost staff morale to control expenditure in schools/academies

28 Aug

I        Staff: Human Resources v Resourceful Humans

With the financial noose tightening around the necks of schools/academies, governing bodies have to keep a close check on expenditure and find innovative ways of raising funds.   Staff costs consume the lion’s share of a school budget – anything from 80% to 85%, though one school, with which I worked a few years ago, bucked the trend by spending 102% of its budget share on staff salaries.  The governors leaned heavily on parents – through voluntary contributions – and charities to make up the shortfall in the overspend.

Spending 80% of the budget on staff is unsurprising given that staff members are the most valuable resources of a school.   For governors to keep a firm rein on this area of spending, they don’t have to operate curmudgeonly.  However, they should ensure that the ambience at the school invigorates and motivates staff.   There are sufficient pressures on teachers, in particular, to make this exercise challenging.  They are subject to myriad demands coming from disparate sources.  The mix is toxic: government wishes, parental expectations, Ofsted inspections, changes to the curriculum and assessment, league tables – to name just a few.   The over-emphasis on data has led some taking their eyes of the ball – i.e. the children, for whom the overwhelming number of teachers became teachers in the first place.

The pressures have taken the stuffing out of many, so that, come the holidays, they collapse in a heap.  However, in term time, teachers who are the victims of the hot house environments of their schools, fall ill over varying periods of time, causing their governing bodies concern as they have to find extra monies to cover for their absences.

Education data consultants, SchoolDash, analysed teacher absences for the academic year 2014/15 using the workforce census data published by the Department for Education (DfE).  They discovered that in primary schools/academies rated “Inadequate” by Ofsted, teacher absences averaged 9.97 days compared to 6.26 days for those working in “Outstanding” schools/academies.   In secondary schools/academies rated “Inadequate” the average teacher absences was 8.94 days compared to 5.72 days for the outstanding ones.

The good news is that for teachers taking sick leave, the average number of days lost was 7.6 – down from 7.9 the previous year.

Primary teachers were more likely to go off sick in the West Midlands (55%) and least likely in the north-east (48%).  At secondary level, almost two-third of teachers in the south-west (65%) took time off last year, compared to 56% in the north-east.  However, teachers in the north-east were more likely to be absent because of sickness for longer periods of time.  The lowest average number of days off by region was achieved by London’s primary teachers, i.e. 6.03 days and the capital’s secondary teachers – 5.97%.

The schools suffer in other ways, even if they have the financial wherewithal to hire supply teachers, in that the stand-ins are not that good, consequently, not welcomed by the pupils whom they have to teach.

If schools/academies are to flourish, they need to promote staff happiness. This does not mean that the atmosphere should be one described by Tennyson in his poem on the Lotos-Eaters where “slumber is more sweet than toil” and brother mariners are exhorted to rest and wander no more.

Even if our schools/academies are not haemorrhaging teachers out of the profession, ignoring their welfare is detrimental to the quality of education we are keen to promote.   Several of our school leaders, who themselves are under considerable pressures, pass these pressures onto their staff contributing to the low morale and driving them to sick beds and doctors’ surgeries.  Headteachers want the best for their schools.  However, the methods deployed are sometimes counterproductive and the outcome is plummeting staff morale leading to absences which puts pressure on school budgets.  Continue reading →

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