The government’s recent proposal to improve children and young people’s mental health services is a very positive step. The Green Paper emphasises the importance of early intervention and ease of access to prompt care. This provides a very welcome and essential emphasis. However, there needs to be inclusion of a robust prevention programme to ensure all children and young people have access to ways of experiencing positive mental health. This should include prevention from perinatal level and above and include children presenting with differing degrees of mental ill health.
The Green Paper aspires to establish parity between physical health and mental health. This is commendable. However, it is important that the allocation of funding to support mental health at all levels, is ring-fenced.
Whilst the emphasis the Green Paper makes on the provision of mental health support and intervention in schools is crucial, this should not be at the cost of existing child and adolescent mental health services. The Green Paper puts forward the opportunity for ‘innovative’ service development. This must not be established by disregarding evidence-based services and should be subject to detailed evaluation.
The Green Paper proposes having a designated senior lead for mental health in every school. This is a positive move. However, the training programme for such leads must be considered carefully and should be in collaboration with mental health specialists who are familiar with both schools and children and young people’s mental health, work within a developmental context and follow national guidelines. It is important that teachers are not expected to act outside their teaching role. They are not mental health therapists or specialists and cannot be expected to work as such. Whilst health economics are important, the input of specialist mental health professionals should not be devalued for cheaper alternatives since the lack of specialism to provide accurate assessment and proven intervention will prove more costly in the long term. The senior lead for mental health in schools should provide a signposting service and should not be involved in mental health assessment or the delivery of interventions. It is essential that these mental health leads have training and supervision on an on-going basis and have an annual appraisal by a specialist mental health provider.
The Green Paper proposes the development of mental health support teams to work in and with schools. These teams will provide a more accessible mental health service and facilitate better links with tertiary specialist services. There needs to be a coherent plan, based on existing research, on how these teams should work. There is no doubt that inclusion and collaboration of a number of professionals including educational psychologists, school nurses, social workers, counsellors, school doctors, clinical psychologists and child and adolescent psychiatrists in partnership will provide effective support and intervention. Resources should be ring-fenced to avoid poor quality interventions that are not evidence based or skilfully delivered. To ensure support and intervention is at a high level, teams must include specialist mental health professionals with a range of seniority and be managed by an experienced clinician. This will enable intervention to be suitably targeted. For example, support for children experiencing life events, adjustments issues, friendship issues can be provided by non directive supportive counselling and play therapy. Brief, evidence based interventions can be delivered by specially trained staff including Psychological Wellbeing Practitioners and accredited Cognitive Behavioural therapists whilst on-going support services for vulnerable children and those presenting with complex mental ill health problems, family interventions will be best delivered by social workers and clinical psychologists.
There are strong and consistent associations between adverse life circumstances, deprivation and emotional and behavioural problems in children and young people. Educational psychologists can provide consultation, assessment and brief evidence based interventions in schools. School nurses are well placed to support children and young people presenting with on-going physical problems, which also have impact on their mental health.
Smooth transition between school mental health teams and specialist NHS services should be developed for children with complex mental health needs or those not suitable for treatment in school.
The Green paper makes the welcome suggestion of a four-week waiting time target for NHS CAMHS. However, the NHS CAMHS services are currently hugely under resourced and it is unlikely that this target is achievable. Concerns include the threshold for acceptance to such service criteria becoming even more stringent, some services being forced to offer substandard non-evidence based short-term intervention and increased stress of staff working in such challenging environments. It is therefore proposed that more investment is made in funding the training of mental health specialists including clinical psychologists, specialist mental health nurses, social workers and psychiatrists who make up NHS CAMHS teams.
The main initiatives of the Green Paper will be offered to 20% of the country over a 5-year time scale. The full roll out of the designated mental health lead will not happen until 2025. In the meanwhile there are on-going cuts that are being imposed on CAMHS, school nurses, educational psychologists and a variety of children’s centres. It is recommended that schools are informed early of these initiatives so that they can start to prepare themselves to be ready to implement the proposals as soon as it becomes possible.
The Green Paper proposes compulsory PHSE. This is a positive step. However, not only will schools need guidance and support on how to implement this within the curriculum but the content and how children and young people are taught PHSE topics has to be informed by existing research and clinical experience and it is proposed that clinicians, educators and researchers are all involved in the putting together of an effective PHSE programme.
In summary there are many welcome changes proposed by the Green Paper but implementing these recommendations in the most effective way will need considerable investigation, research, planning and training.