We need to look out for ourselves and others as Child and Adolescent Mental Health waiting times increase warn Karen Wespieser MBE & Dr Jo Taylor
As we plunge into lockdown 3.0, we're now approaching a year of living with COVID-19 and the effect on all of our mental health cannot be underestimated.
Some families are dealing with the emotional fallout of the loss of loved ones, loss of an income, or wondering how to pay for life's necessities. Even if you think you're doing okay overall, you are likely have times of feeling low, listless and lacking motivation. Children are not immune from these same feelings, but with less control over their destiny or the maturity or experience to deal with it. And that's before taking into account any special educational needs or disabilities they may be contending with.
Karen Wespieser MBE, of Teacher Tapp and Parent Ping, and Dr Jo Taylor, a child and educational psychologist based in London, have collaborated on today's article, about how users surveyed by the Parent Ping app have found the already difficult process of getting support for emotional issues has been impacted by Coronavirus.
Keep CAMH and Carry On Caring by Karen Wespieser MBE & Dr Jo Taylor
In January 2020, the British Medical Association (BMA) reported that under a third of young people with mental health problems in England are able to access the care they need and called for funding to be doubled.
As with all medical and policy issues, mental health support for children and young people was suddenly on the backburner as the NHS and the Department of Health struggled to deal with the scale of the pandemic.
But where does that leave us? At the start of November, we used Parent Ping to ask 600 parents (not just parents of children with SEND) if they had ever sought mental health support for their child. 17% had experience of this. Most had sought support via the state system - their school, their GP or the local authority (LA) / Child and Adolescent Mental Health Services (CAMHS) or an educational psychologist (EP). A small number had gone private.
Requests for mental health support
The likelihood that parents have sought mental health support for their child increases with the age of the child, and by the time they are in secondary school, nearly a third of the Parent Ping sample had reached out to ask for support.
For children with a special educational need or disability (SEND) the proportion is higher still. Of those with an Education Health and Care Plan (EHCP), 59% had been in contact with one of these services - nearly half directly with the LA / CAMHs or EP - and over 10% through private provision. For those without an EHCP, one in five had sought support via their school.
So far, this is all pretty much in line with national figures, and surveying is not necessarily the most accurate way to get a clear picture of demand for services. What we were more interested in, however, is how long parents think it would take to get support were they to need it.
It takes time.. a lot of time
We asked, ‘Imagine you needed to seek mental health support for your child. From the day you request support, how long do you think it would take for it to be put in place?’
An optimistic 3% of parents thought that it would be in place in less than a week, and a pessimistic 14% thought it would take more than a year. The most common response was that it would take up to six months.
For parents of a child with an EHCP (the group who told us they were most likely to have sought support in the first question), their responses were clustered around the top end, with 52% thinking it would take more than six months.
We live in a society that has become more ‘immediate’ and ‘on-demand’ for services. But when it comes to vitally important mental health care, the wait just seems to get longer. There are potentially serious, life-altering consequences for a child who has to wait for six months or longer to be seen by a mental health professional. The impact on the wider family being left in distress for such a long time cannot be underestimated. Unfortunately, having to wait months for support seems to be the general experience for children and families.
So how does this compare?
NHS data shows that 15% of children and young people waited less than a month between referral and their second contact for mental health services between April 2018 - March 2019. 18% waited up to three months (the official stats stop recording wait time after this point) and 34% had their referral closed before treatment. This leaves 24% still awaiting contact, and 9% who had been contacted, but not seen.
If a young person manages to "meet the criteria" for assessment, which seems to grow ever-tighter, having their case closed before receiving professional input is surprisingly common. It can happen for a number of reasons. If a family moves between local authorities (or is placed in housing in another authority) they normally join the back of a new queue. Also, if a few appointments are missed then the case can be closed. This poses a conundrum because our mental health services are stretched and so need a way to decide who to work with and prioritise. Equally, it will be the most vulnerable families who are being moved across homes and who will have the most reasons to miss appointments. So, a broader question for the world is: how can we make sure that we keep track of families who have their case closed?
Promote wellbeing to make mental health difficulties less likely
Emerging evidence suggests that COVID-19, and the response to the pandemic, could have a significant impact on the nation’s mental health. Challenges inadequately resourcing mental health support will have been compounded by the national health crisis, and it seems very unlikely that wait times will have improved. So what can we do?
The government has spent about £8 million on the Wellbeing for Education Return process - a series of training sessions to be delivered across 2020-21, with the aim of supporting mental health. The sessions draw on a range of psychological theory. A key focus is on preempting mental health difficulties by providing as many ‘protective factors’ as possible.
The structure of the training is that professionals train senior leaders in school, who then train teachers, who will be integral in supporting children. But, it is also something which families can do quite easily and there are free, easy to understand resources which can help. For example, The Resilience Framework allows people to celebrate the things which are going well and plan some areas of focus to introduce more protective processes around a person. Usefully there is also an adult version which can be used by families or professionals.
Being kind to yourself is vital
A term often used when people talk about promoting mental health is ‘self-care’, or taking time to look after yourself. While knowing what nourishes and supports us is useful, it is also important to consider community care (people helping each other). This is for a simple reason: when we are having a tough time, sometimes we don’t have the resources to do what we know we need. Imagine a hard week at work, not sleeping for some reason, and then receiving some bad news from your family. You might know that going for a run is something that helps you to feel good, but you're busy, lack energy, and feel sad and stressed. What are the chances you will think “I’ll go for a run when I have more time”?
This is even more common in parents, especially those who have disabled children, for whom taking time to sustain themselves can slip far down the priority list, leading to even greater difficulty. The Circle of Care is a free resource designed specifically to support people looking after others. It is a three-step activity that helps explore what maintains your wellbeing, how to bring other people into these routines, and how to maximise the chances that they happen.
Waiting times are unlikely to reduce in 2021. If anything, they're more likely to continue to rise. While self-care and care for those around you will rarely be the whole solution, it is an important starting point in difficult times.
Karen Wespieser is an education researcher. She was awarded an MBE in the 2020 New Years Honours for 'for services to children and young people with special educational needs and disabilities, particularly during the COVID-19 response. Karen has worked at the National Foundation for Education Research, the Centre for Education Economics and the BBC amongst others. Most recently, she was responsible for establishing the specialist curriculum for Oak National Academy. Her current role is as Chief Operating Officer at Teacher Tapp and Parent Ping. Find Karen on twitter @KarenWespieser
Dr Jo Taylor is a child and educational psychologist based in London. He has expertise in child development, cognition, learning and mental health. In addition to his work with children, families and schools, Jo supports leaders and organisations to use psychology in their social change work. In 2020, Jo received a Winston Churchill Memorial Trust Fellowship to complete research on navigating adversity with compassion. Find Jo on twitter @jgetaylor
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