It's tough being a young person today. When I was a girl, you had to be a child actor to grow up in the public eye, but today, it's like living in a goldfish bowl: everyone's on YouTube or Snapchat or other social media and that can bring with it the possibility of bullying both online and in school, on top of the stress of exams, grades, how you look blah blah... And that's without having any family difficulty or existing special need or mental health problem.
It isn't hard to see how this can take a toll on even the most well adjusted young person, but if you do have emotional difficulties, finding the right help has been a complete lottery. So the launch yesterday of the new Future in Mind policy that is aimed at overhauling children's mental health services or CAMHS - The Child and Adolescent Mental Health Service, is way, way overdue.
The policy is the government's answer to the Children and Young People’s Mental Health and Wellbeing Taskforce’s findings, which detailed the difficulties families have in accessing mental health support. The taskforce reported that three-quarters of children and young people with mental health issues did not have appropriate mental health services, saying, “the human case for striving to reduce this distress and suffering is overwhelming”.
Future in Mind, aims to provide personalised, needs based support. Imagine that!
The Care Minister, Norman Lamb, said he recognised that the way in which Children's Mental Health services was organised was, "Fundamentally broken." And I think we'd all agree with that.
You may have read here on SNJ that myself and Angela both have lengthy experiences of their "help" while Debs hasn't even managed to get her child seen after a year's wait. And we know from reading your comments that we are certainly not unique.
If you have a child with ADHD, Asperger's, anxiety or any one of a long list of conditions you will most probably be familiar with CAMHS. While some have had a good experience, most find the service inflexible, poorly organised and lacking any real solutions to help children with complex mental health conditions who are often not getting the right support at school either. We were once told our son couldn't have Cognitive Behavioural Therapy (like wot it sez in the NICE guidelines) because his Asperger's would mean he wouldn't be able to apply it in real life. As it turns out, properly applied (like, not by CAMHS), he certainly could and did. (Slight pause now for deep breath to avoid swearing). And some people wonder why I can be intolerant of idiots...
So, anyway, this new policy is to be welcomed and we hope that it will be implemented in a slightly more organised fashion that the SEND reforms because mental health very often goes hand in hand with SEND difficulties and indeed is one of the four areas of need in the SEND Code of Practice: Social, Mental and Emotional Health. Or SMEH. Obviously it would have been jolly useful to have done things the other way round.. Fix CAMHS, then bring in the SEND reforms but hey... thaaaat's politics!
My problem with CAMHS
Seriously, don't get me started, we'll be here all day. But anyway, when your child is involved with CAMHS, you may often only see the Overlord psychiatrist once every five or six weeks and there is often no communication in between with the school or family. So at your update appointment you have to remember to say everything that has happened in between times, good and bad... WHILE YOUR CHILD IS IN THE ROOM. I absolutely LOATHE this aspect. While of course, the child needs to be a participant in their own treatment, sometimes it just does more harm than good to talk negatively about them and your family situation in front of them. But then, that's another argument.
The new policy has many facets to it and provides a broad set of recommendations that should enable greater access to the service and higher standards as well as promoting positive mental health and wellbeing for young people, especially those from vulnerable backgrounds.
If it's implemented.
Because we all know what's gathering pace and about to hit us like a tornado - the General Election, where all eyes are on the Westminster prize and politicians retreat to their constituencies to try to hang on to their seats. Although this may mean that the civil servants can get some work done in peace.
Future in Mind Highlights
The main themes of the policy are:
- Promoting resilience, prevention and early intervention
- Improving access to effective support – a system without tiers
- Care for the most vulnerable
- Accountability and transparency
- Developing the workforce
I'm glad about that last one, because for me, it all comes down to people and the same thing that is tripping the SEND reforms up - CULTURE CHANGE. You can change systems but if the people don't change their attitudes to go with it, you might as well not bother. We are seeing this issue up and down the country right now with the transfers to EHCPs and with new entrants. The changes have been hastily implemented with far too little understanding that you can't change people's minds as easily as you can change the heading on a policy paper.
On top of this, any new systems need to be able to fit in with schools so they can work together. Teachers, too, need to be trained how to identify a child with a potential mental health issue, work with their parents and know how to summon the right help in time to do any good.
Below are some of the key recommendations from the report. I took the ones below from Young Minds and added my own comments in places.
Improving the role of schools:
- providing a named CAMHS mental health service contact in all schools
- involving schools in the local plans devised by local Health boards
- alternative treatment venues should be made available, in particular for children from vulnerable and hard to reach backgrounds
- promotion of whole-school approach to fostering resilience within schools
- increased commissioning of home treatment and other flexible services
Early Years
- every birthing unit to have a specialist perinatal mental health clinician by 2017
- increased investment in early years health services and ensuring parents have access to evidence-based interventions and support to strengthen attachment and avoid trauma
- local authorities to invest in funding for early support initiatives and invest strategically in mental health services from 0-5 from Oct 2015
- health visitors should receive updated training in mental health
These are clearly important as they recognise the importance of giving mothers the mental health support they need at such a time of huge change in their lives. Poor attachment of children to a significant adult can lead to severe mental health issues in both childhood and as an adult.
Children and Young People from vulnerable backgrounds
This includes "Looked after" or children in care, as well as those who may be at the margins of mainstream society or, in system-speak, "vulnerable and hard to reach."
- remove the arbitrary age cut-off
- make the way they are cared for personal to the needs of the child, but using methods that are known to work from previous experience
- find different places to treat them that may be easier to get to or less intimidating in nature
- ensure that the professionals involved work together and share notes and information so everyone knows what's happening.
- Have a named professional whose job it is to liaise with everyone involved with the family to ensure that services that have been put into place complement each other and work in harmony to benefit the child in the way they need them.
Improved access
In the area of improved service provision and access, the Taskforce report recommendations include:
- developing a nationally branded web based portal for children and young people, parents and teachers to access information and support
- all GPs should have a named CAMHS contact
- improve accessibility by practically applying the Department of Health “You’re Welcome” quality criteria for young people friendly health services
- potentially extend CAMHS services to young people up to 25 years of age
- best practice guidelines to be developed for local Health bodies and GPs around student transitions
- increase in number of 'one-stop shops' with single point of access systems based in the community
- greater access to personal budgets for children and young people and their families
- development of peer-support schemes with professional support
These are just some of the recommendations and of course, Nick Clegg has announced a whopping £1.25 billion investment in CAMHS services to pay for it. But oh, tick tock there goes the election count-down clock. Will the next government, whoever it is, carry the policy forward? Will this thorough plan filter through into improved services? How long will it take?
Young Minds has called for an annual temperature check to be taken so it doesn't slide off the agenda and I agree that this is imperative if these plans are to transform the sow's ear of CAMHS into a silk purse of a mental health service that can really make a difference to every young person who needs it.
Over to you - and I know you care about child mental health a HUGE amount. What do you think?
Tania is an experienced broadcast and print journalist & author. She also runs a PR, web & social media consultancy, SocialOro Media.
Tania is a rare disease & chronic pain patient advocate with Ehlers Danlos syndrome.
- Ombudsman report says councils are “standing in the way of support” by failing to offer personal budgets during the EHCP process - November 24, 2023
- 10 reasons the Change Programme might fail, by experts from across the SEND sector - October 27, 2023
- For children with SEND and their parents, a compassionate teacher is key - October 20, 2023
Tania, what never ceases to amaze me is the amount of money or lack of money spent by commissioners of services without any academic evidence of whether the service is required, whether it is fit for purpose and does it prevent what it was commissioned to do as no real evaluation of health/social care commissioning exists in the current sphere.
Yet I read recently a piece of research on mental health (trying to source it again) which stated that academic research had shown that by the age of 18 nearly 98% of all mental health cases were already either diagnosed or children were suffering significant issues and would be later diagnosed as adults due to the process we have in this country.
Therefore only 2% of cases develop as new cases in adulthood and if my memory serves me right the majority two client groups in this 2% group were ex services and Older people with a significant illness.
Therefore if 98% of mental health issues happen in childhood and continue to affect people in adulthood then any commissioner and senior manger in the health and social care field who believes their mantra of prevention should invest their budgets in child mental health today as the savings on society are too great to deny.
Obviously this is quite a simple link as other complex factors are at play in children’s lives and not all have access to other services but Camhs should be a priority as a core service and not an after thought when situations hit extreme trigger points.
Creative therapies need to be more actively used…art, play, music, drama-areas of expression children can readily access. From my own experience of working with children with difficulties, talk therapies rarely invite children to explore their suffering-of course this depends on the therapists approach/experience ..From my own experience of working with CAMHS-I noted that-as in any line of work-there are some fantastic folk whom are highly successful in supporting children, and also, for sure some folk that shouldn’t be working in the environment.However one very important issue is the fact that so many practitioners are over worked carry up to 50 cases at the same time-trying to fit every youngster in is almost impossible-especially when there can be times when Tier 3 and Tier 4 referrals coming in on mass-which results in deemed lower risk cases being put on hold. I think before any of us starts pointing the finger and possibly casting doubt upon the success of CAMHS we need to recognise what needs to be addressed-yes funding-more ethical working conditions-as anyone who has worked in mental health, without good supervision, burnout can happen very very quickly.