The sensitive but important issue of mental health provision for children and young people was today’s topic. This was in response to the government’s green paper, Transforming children and young people’s mental health provision, which was published at the end of 2017.
The evidence session was split into two, hearing first from:
- Anne Longfield OBE, Children's Commissioner for England
- Dr Pooky Knightsmith, Vice Chair, Children and Young People's Mental Health Coalition
- Rowan Munson, former member, Youth Select Committee
Welcoming the green paper
When asked by chair Robert Halfon, they were in broad agreement in welcoming the government’s green paper, with health and education coming together to address an issue, but there were some reservations. Anne Longfield suggested it isn’t ambitious enough, and needs to mirror the successful roll out of IAPT (improving access to psychological therapies) for adults. Rowan Munson felt that the 16-25 age group were not accommodated enough and cuts to local services disproportionately affected the young, while Pooky Knightsmith was concerned funding would be inadequate, and that it wouldn’t do anything to help the 3/4 young people who currently have mental health problems who aren’t able to access assistance.
Commitments backed up by resources
Anne Longfield suggested there is a big gap on what is spent on mental health provision between children and adults. Children, 20% of the population, receive only 6% of the mental health funding in England. She suggested the National Audit Office assess current spending levels.
Whole school approaches to prevention, including parental involvement
Anne Longfield said that interventions should start from birth, with support for parents, rather than waiting until the child starts school. The current system is fragmented and doesn’t identify children struggling with mental health problems early enough. Pooky Knightsmith said that prevention is hugely desirable, and criticised the green paper for missing the 0-5 year-old bracket, as well as maternal mental health, saying that teaching staff and parents with good mental health act as positive role models for children, and that the mental health of the mother is a key point being missed. Anne Longfield agreed a family approach is desirable.
Children from disadvantaged backgrounds are more likely to have poor mental health
Robert Halfon expressed the concern that more targeted support is needed, and that the focus on schools forgets the most vulnerable, because they are also the most likely to be excluded from school. Access to the current system is difficult even with parents fighting your corner.
The government’s social mobility through education paper, Unlocking Talent, Fulfilling Potential, suggested the implementation of “Opportunity Areas” to test out its proposals. The concept of “trailblazers” was raised, and Anne Longfield agreed that the places with highest levels of disadvantage are where government should move fastest. Pooky Knightsmith said the trailblazer areas should show a diversity of size and geography, to see what works well, and then roll it out quickly.
Helping home and family
Andrew Selous MP asked what more can be done to help children in difficult family situations, such as where there is damaging conflict between parents. Anne Longfield proposed a joined-up approach, having family hubs and working with children and families from birth, citing Sure Start as centres supporting families.
The problem of transition – young people falling through gaps
It was agreed that more needs to be done around transition – when young people hit 18 and are no longer eligible for children’s mental health provision and must move to the adult service. Rowan Munson made the point that it’s only possible to be registered with one GP, but many young people are away at university for half of the year.
The impact of social media
Rowan Munson said that social media can have negative consequences, but it’s unclear if, with young people with poor mental health, it's a coping mechanism or something that makes their condition worse. Pooky Knightsmith pointed out that autistic children can make more meaningful relationships with social media, but that it must form part of PSHE.
Who will provide mental health support in schools?
The issue of increased pressure on schools and teachers to deliver was raised, the reality being that additional funding would be required to ensure specialist provision accessible to all children on a large scale, with retention of clinical data to see which approaches work.
The second session heard from:
- Paul Whiteman, General Secretary, National Association of Head Teachers
- Stuart Rimmer, CEO and Principal, East Coast College
- Dr Bernadka Dubicka, Chair, Child & Adolescent Faculty at Royal College of Psychiatrists, and Professor
- Tamsin Ford, Professor of Child and Adolescent Psychiatry, University of Exeter
Reaction to the green paper
Bernadka Dubicka said that workforce recruitment and retention was the biggest barrier to delivering high quality care with child psychiatrists in place. Paul Whiteman welcomed the green paper from schools’ point of view, but expressed concerns about the pace and limited scope, the money available and the resources to implement proposals. He also raised concerns about evaluation and accountability – worrying that the provision would end up being another stick to beat school leaders and heads with. Stuart Rimmer felt that colleges had a much larger role to play, especially with a disproportionately high number of disadvantaged students. Tamsin Ford used the example of some SEND (special educational needs or disabilities) students, who may do well in class but be unable to cope at break time, where parents must choose between their child’s mental health and attainment.
Reaching out to parents
Michelle Donelan MP observed that young people can say they’re different people at home and at school. She suggested granting schools more power and ability to reach out to parents to educate them on warning signs, especially for anxiety disorders. Paul Whiteman said that the pressure at school is pervasive. He felt there are limits on what schools can do – they educate children but he didn’t want to see the education system overloaded by trying to influence beyond the school gate. On the other hand, Bernadka Dubicka felt that parenting was a big gap in the green paper, saying that there is evidence that parental engagement helps. Andrew Selous MP claimed mental health problems can be tackled early by having parents on board. Tamsin Ford suggested health visiting and support for women, especially with post-natal depression, so that parents’ needs are met at the same time as children’s.
The witnesses acknowledged the difficulty in changing from child to adult services once young people hit 18. Tamsin Ford said that information should flow between the two so that knowledge is not lost, and bridging the gap is seamless. There are tensions on role of parents, who feel blocked out of adult services, though especially when ADHD is concerned, it’s often the parents who organise the appointments with mental health specialists. Even though parents are crucial to the process, adult services are not used to working with them.
Image of Michelle Donelan MP by Chris McAndrew, via Wikimedia Commons