Public concern around child and adolescent mental health is at an all-time high. The prime minister, Theresa May announced in January her intention to better identify and help the growing number of young people in schools who are at risk of developing mental health issues. Prince Harry and the Duke and Duchess of Cambridge, meanwhile, are using their profiles to convince the public that “shattering stigma on mental health starts with simple conversations”.
And yet, despite growing awareness of the issue, child and adolescent mental health services (Camhs) are under an increasing amount of pressure. Healthcare professionals bemoan a lack of resources and staff while the health secretary, Jeremy Hunt, has described Camhs as the “biggest single area of weakness of NHS provision”.
What are some of the issues facing children and young people today? What problems are services confronted with? What examples of best practice are there and how can the health, education and social care sectors provide better mental healthcare for children and young people? These were some of the questions addressed by experts in mental health at a roundtable discussion, chaired by the Guardian’s health policy editor Denis Campbell and supported by online counselling service XenZone.
“For children, there are so many messages about what to be, what to look like, how you should present yourself to the world. It’s 24/7 and social media judges most things,” said Anne Longfield OBE, children’s commissioner for England. “There’s anxiety around exams, schools and increasingly linear expectations. That all builds up.”
Sarah Hulyer, an activist from YoungMinds, the young people’s mental health charity, agreed that exams and stress are part of the problem. She also talked about the considerable effect of social media on young people’s mental health. “I think social media is negative in several ways in that your public life never ends. You’re always being watched,” she said.
Hulyer pointed out that social media can glamorise mental health problems and emphasised how important it is to start a conversation about mental health at a young age. “A lot of young people learn about mental health in the media, but often the only things talked about are anxiety and depression,” she said. “Young people don’t know [the range of] problems there are until they’ve had them explained to them.”
Attendees also discussed the problems facing services. Norman Lamb, Liberal Democrat MP and former mental health minister, said: “We’re faced with a dysfunctional system with awful access, which leads to people taking their own lives. We’re not going to solve the whole problem if we focus on the system giving treatment. It has to be about prevention and a fundamental shift of emphasis.”
Most agreed that there were significant problems facing the Camhs workforce. “We do not have an available workforce with sufficient morale to deal with the problem,” said Dr Bernadka Dubicka, consultant child and adolescent psychiatrist and chair-elect of the child and adolescent faculty, Royal College of Psychiatrists. She believes there are vast numbers of children and adolescents who could have been helped before they were referred to Camhs.
Sean Duggan, chief executive of the Mental Health Network at the NHS Confederation, claimed that the importance of child and adolescent mental health has not been properly recognised in the sustainability and transformation plans (STPs) that have been drafted to improve health and care in England. “STPs are here to stay and are a vehicle for setting priorities,” he said, adding that child and adolescent mental health is an urgent priority that needs to be addressed.
Although many around the table underlined the role that schools can play in reducing mental health problems among pupils, Malcolm Trobe CBE, general secretary for the Association of School and College Leaders, pointed out that there is a gap between what schools can deal with and their access to external support.
“Teachers have workload pressures – they just don’t have the time [to offer additional support],” he said. But he also asked where children with mental health problems were going to get that extra support: “We’ve got to move from talking about it to actually doing something. Health and education departments have got to work together so we have a strategic view of this.”
While the majority of those in attendance bemoaned the state of child and adolescent mental health services in the UK, Dr Matt Muijen, adviser in international mental health, painted a different picture. “There’s an unusual publicity about poor mental health in England. That creates demand,” he said.
“When you look at the supply side, you have remarkably good standards. There is no separate budget for child mental health but you’re the second highest funder of mental health services after the Netherlands. As a proportion of the health budget, you are by far the highest.” He went on to criticise local authorities for their inability to commission services, adding: “I always feel like health services in England are constantly changing, with a total lack of stability with no one quite knowing what they’re expected to do.”
Given the huge demand on services, attendees agreed that action was needed and floated possible solutions and examples of best practice. Elaine Bousfield, founder and chair of XenZone, suggested a digital approach could help, as long as it is tied into the wider health and social care system.
Bousfield spoke about XenZone’s online counselling and emotional wellbeing platform for children and young people. It’s used by them to talk to someone – generally for one to three sessions. “The beauty is they’re not then ruminating and adding to their anxiety,” she said. “Quite often young people don’t know what’s going on. They just feel terrible and they might not know why. They need a space where they can talk about that.”
Hulyer said a large part of the solution lies in the digital world, as that is how young people communicate. She said young people have a despondent view of Camhs and don’t believe that services will ever be there for them. She stressed the importance of learning about mental health at school and how it should be part of the curriculum. “You learn about physical health, so you should learn about resilience; how to deal with stress.” Hulyer also said that parents need support and talked about a helpline set up by YoungMinds that they can call for information and advice.
Dr Emma Blake, paediatric mental health consultant and chair of the Child Mental Health Committee at the Royal College of Paediatrics and Child Health, also highlighted MindEd, an online service for adults designed to provide help with, and information on, child and adolescent mental health.
Lamb and Duggan, meanwhile, cited some areas of the country where services are working well to tackle child and adolescent mental health. In Oxfordshire, mental health professionals go into schools every week and work with teachers to increase their understanding. Lamb said they had seen a drop in referrals to Camhs because they are intervening much earlier.
In Northamptonshire, a referral management centre was developed in 2015, which includes a consultation line open to young people and families, a texting service offered by school nurses, online chat for young people to talk to a mental health professional, self-referral, a children’s crisis home treatment team and two adolescent in-patient wards. Duggan also highlighted a new programme at Sussex Partnership NHS foundation trust – the Discovery College.
The concept is based on the existing recovery college, which involves free courses developed and delivered by health professionals. The discovery college applies the same principles for children and young people. It involves free courses for 13- to 20-year-olds, providing knowledge and skills to maintain and manage mental health.
Despite these positive schemes, there is still frustration over the lack of action relative to the tone of the conversation around child mental health.
During his time in government, Lamb produced a blueprint for mental health services, Future in Mind, which brought together a number of key proposals. Two years on, the government is now producing a green paper on the same subject. “This is an excuse to carry on talking rather than doing,” he said. “I’ve said to the health secretary to create incentives around the country to make urgent progress. The green paper can provide some value, but we need to do what we said we were going to do.”
At the table
Denis Campbell (Chair)
Health policy editor, the Guardian
Anne Longfield OBE
Children’s commissioner for England
Noman Lamb MP
Liberal Democrat health spokesman
Prof Miranda Wolpert MBE
Director, Evidence Based Practice Unit, UCL and Anna Freud Centre
Dr Emma Blake
Chair, Child Mental Health Committee, Royal College of Paediatrics and Child Health
Dr Bernadka Dubicka
Chair-elect, Child and Adolescent Faculty, Royal College of Psychiatrists
Chief executive, Mental Health Network, NHS Confederation
Founder and chair, XenZone
Chief executive, Social Care Institute for Excellence
Dr Matt Muijen
Adviser in international mental health
Chair, Health, Care and Additional Needs Policy Committee, ADCS
Prof Helen Stokes-Lampard
Chair, Royal College of General Practitioners
Malcolm Trobe CBE
General secretary (interim), Association of School and College Leaders