It’s time Cinderella came to the ball
There are few areas where the health and social care system can make a bigger difference than in supporting young people with mental health and emotional difficulties. On the latest count nearly 10% of children and young people will experience a diagnosable mental health problem and yet we only spend £0.7 billion or 6% of the NHS mental health budget on this area of care. If we get it right in providing young people the help they need we can make a difference to their immediate distress and that of their families. We can also increase the chance that they will successfully complete their education and enter adult life and the world of work with the same chances as their peers. Get it wrong, as I am afraid we in too many cases now, we can condemn some young people to a lifetime of underachievement and with 50% of adult mental health problems developing before the age of 14, trap some people into a history of using of adult mental health services.
For the last 6 months I have been involved in the Children and Young People’s Mental Health Taskforce, whose report is published today. Born in part in response to shocking stories last summer of young people in severe distress having to travel hundreds of miles to access an inpatient bed or even worse being detained in a police station when no beds were available, the Taskforce I hope marks a turning point in the fortunes of this Cinderella of Cinderella services. The news over the weekend that the Taskforce’s report would be accompanied by some financial commitment in the budget has increased my optimism that this may be the case.
Working on the Taskforce revealed a deep commitment and consensus across experts drawn from health, social care and education about what was needed to improve care, and above all outcomes for young people. That view was reinforced by the strong messages from children and young people themselves and from their families about what needed to change.
A number of points stand out.
First the compelling case for investment in an area which has been historically underfunded, has been disinvested in the years of austerity and where the case for the long term benefits of improving access and outcomes for children and young people are compelling. We have known for some time, for instance, that the costs of crime of adult with conduct problems in childhood might be as high as £60 billion per annum and yet we are failing to make the investment in the proven interventions which could make a real difference in the future in reducing that cost.
Second that this area needs the same focus on integration as we are beginning to bring to the care of frail older people. Joint commissioning, which also embraces the money which is spent by schools on supporting young people with mental health problems is crucial if we are to create a system which is up to the task of meeting the needs of children and young people. Joined up provision is also crucial. The role of schools and other universal provision for young people is central. Teachers need training and support to manage the pupils in their care with mental health problems and specialist services in CAMHS should link with schools to provide training, advice and easy routes of referral for those young people whose difficulties need more complex intervention.
Third that the old model of CAMHS, based on the four tiers of response, is no longer fit for purpose. While well intentioned, it has created a system which is over complex and baffling for young people and their families attempting to seek help. I liken it to the experience of a salmon trying to swim upstream against the curent with young people having to fight to show how ill they are to access the necessary help.
Over the last year we have been involved in working at the Tavistock and Portman, together with colleagues from the Anna Freud Centre, to develop a new approach to CAMHS, the Thrive model. Thrive looks to identify not levels of need but rather the purpose of care. By using careful assessment and shared decision making it focuses on helping to distinguish those young people who can be helped with advice and signposting towards self-help resources, those who can benefit from routine treatment and those with more complex needs who need longer term support including those for whom therapy may not deliver immediate benefits but who because of the level of risk they present with still need to be held safely in the system and supported other goals in life. I hope Thrive can play a significant role in improving access and outcomes by facilitating integrated working, working in partnership with young people and their families and making the best use of the specialist clinical resources available and the wider resources which exist in the voluntary sector and elsewhere in the community.
My final point relates to the need for us as a society to stand back and reflect on our wider aspirations for young people. There is no doubt for me that, on the whole, the stresses on young people today are greater than when I was a teenager in the 1970s. The world is less innocent and our expectations on what young people will achieve is greater. There is a need, not just to look at how we respond to the inevitable mental health and emotional difficulties which will emerge, but to focus on resilience; how we equip young people to handle the stress they face and in some cases to change the way we do things to reduce it. Attitudes towards mental health and emotional wellbeing are crucial. My work with Time to Change, and the experience of my own children, convinced me that young people are in many cases more knowledgeable about mental health issues and more sympathetic to those affected than my generation would have been. However there is much to do to build on that and, in particular, to change the attitudes of some of the adults around them whose response is key when those young people experience difficulty.
The Taskforce report and the welcome prospect of a commitment for additional funding are very important step forward but it will be crucial this area is something which any new Government, after May, also makes a priority. Society as whole is the winner if we get children and young people’s mental health right. It’s time Cinderella was invited to the ball.