Policy and practice Reports and research Consultation response: Transforming children and young people’s mental health provision Children England consultation response to the government's green paper, March 2018 Children England is the infrastructure body for the children’s voluntary sector and has been supporting and representing charities delivering services for children and families since 1942. Our response to this green paper consultation is based on the views and experiences we gathered from those of our member organisations most concerned with the emotional welfare and mental health of children and young people. We don’t attempt to duplicate particular points from their areas of expertise, which will feature in their individual consultation responses; rather we have identified areas of consensus that reflect sector priorities for the children and young people’s mental health system as a whole, and the extent to which the green paper is seen to address those. In summary The green paper does not recognise the causes and complexities of children’s mental health issues, but attempts to identify and medicalise the signs that may manifest themselves in a school setting The green paper does not attempt to join up the many initiatives working to support children’s mental health, either geographically or chronologically over the development of the child, and also fails to clarify how the various professionals involved should interact with each other to ensure a consistent, holistic approach with the child at the centre It is not ambitious enough in its scope, in its timeline or its investment of resources, and will leave the majority of children who need it without the appropriate mental health support It is clear that there is a crisis in children and young people’s mental health provision, with services struggling to meet the needs of an increasing number of children and young people and mental health problems being left unaddressed for dangerously long periods of time. This green paper, even if entirely successful in its ambitions, will not significantly ameliorate that crisis. It does not go nearly far enough in appreciating the causes of those mental health issues and the necessary scale and holistic nature of changes to provision if we are to nurture all children’s mental health and respond appropriately when issues inevitably arise. In order to do this, it would need to take its starting point from the earliest and most vulnerable moments in a child’s life – in the early years well before school age, for example, and at times of trauma or transition that may be unforeseen for an individual child but for which the system can be better prepared than it is currently: for example, children coming into care or children arriving unaccompanied from overseas. It would need to make children in these vulnerable situations – and the recognition that any child could at some point experience such challenges to their mental health – the central focus of strategic efforts to improve mental health provision and multi-agency processes. The right direction of travel We welcome the recognition of the important role schools and teachers play in supporting children’s general mental health, and the need for training for a designated mental health lead in each school. Insofar as good mental health is a product of an individual’s understanding of their own wellbeing, and shaped by the environments in which they spend their time, we welcome the paper’s proposals for PSHE lessons to ensure every child learns about mental wellbeing and for schools to review policies such as behaviour and exclusion for their impact on, and contribution to, students’ mental health needs. We also welcome the recognition that children and young people are currently waiting too long for the right help, and that waiting times must be universally and significantly reduced. Our concerns Schools The proposals for equipping schools to support children and young people’s mental health neither go far enough in giving schools the resources they need to successfully do this, nor do they appreciate the much wider and deeper causes of mental ill-health that will not be addressed by the school-led system the paper proposes. Children and young people’s mental health problems can be at best revealed, and at worst exacerbated, by a school environment if it continues to promote good academic performance as the over-riding indicator of success for all children, and casts any more holistic progress in their life and development as merely a means to achieve academically. Changing a whole school’s culture is a huge undertaking, and we are doubtful that a single designated mental health lead in each school, with minimal training and support, and their mental health role being an additional responsibility to their ‘day job’ at the school, will have the kind of resources or authority needed to make the school-wide changes the paper rightly envisages as necessary to support pupils’ mental wellbeing and enable all staff to identify signs of distress. The barriers to a child’s needs being identified, referred to the appropriate member of staff, signposted to the appropriate service and supported by the wider school setting seem considerable in the context of existing pressures on teachers, a dearth of school nurses and counsellors, and the lack of clarity on how Mental Health Support Teams will function and interact with school populations. The mismatch between the huge expectation placed by these proposals on just one individual in each school, and the level of resource invested in them to do so, is only further underlined by the fact that schools will not even be required to have such designated roles, only encouraged and ‘incentivised’ to have one. While we believe that most schools will be keen to participate in efforts to improve mental health for their pupils, given that we understand the sums on offer for training designated mental health leads is under £1000 per school, it is hard to accept that this represents a real ‘incentive’ for otherwise reluctant schools to join in. For the hundreds, or maybe more than a thousand children at any one school that chooses not to appoint one, the whole model through which the green paper envisages them getting better early identification and support falls down completely. Workforce While improved training in mental health awareness for teachers will help schools to support students, there are many other professions and roles which need more training and more capacity if children’s mental health is to be supported in all settings, and they are to receive actual help as well as being identified as needing it. Social workers, foster carers, early years educators and counsellors, for example, can only fulfil their vital roles in nurturing and responding to children’s mental health if they are well prepared and resourced. The green paper doesn’t clarify how these professionals, and existing ‘designated’ roles such as the Virtual School Head, or designated safeguarding lead roles in any/all children’s services, can be trained and supported to integrate better mental health awareness and support within their important responsibilities. Resources More broadly, the green paper offers very little in terms of investment in a system that is already overstretched, and will only become more so over the period it foresees. Whilst a move away from a rather rigid tiered system of assessment and treatment is welcome, there is still an urgent need for more and better investment in CAMHS and serious investment in the infrastructure of specialist provision for children with the most acute and complex needs. The whole child In proposing rather piecemeal initiatives for parental support, further education settings and family provision, as well as focussing on schools as the main ‘service’ location for the expression of mental health issues, the paper fails to cover the full span of childhood, from infancy to adulthood, and the wide diversity of children’s pathways through statutory and voluntary services during their childhoods. This approach assumes the best of children’s mental health as a norm, waiting until a child’s behaviour triggers a warning in the ‘right’ setting (ie school) - at which point the children’s progress towards better mental health becomes a medicalised process that looks for ‘clinical’ signs, and a referral pathway towards clinical treatment. We believe that, whilst the majority of children will be mentally and emotional well most of the time, a responsible mental health system should be holistically and constantly aware of the huge challenges facing children, and the huge variety of ways in which poor mental health and signs of acute problems will often be hidden, or manifest in unobvious ways to the people closest to them (including professionals). There is much to be learned from the Adverse Childhood Experiences programme, and its implications for all professionals’ day-to-day practice relationships with children. In conclusion: not sufficiently ambitious or strategic The slow testing and roll-out through selected trailblazer areas, and the lack of strategic integration with other initiatives scattered around the country, mean that a large proportion of the children and young people in need of better responses today are likely to see no impact from this green paper within the time span of their own childhoods; and the realisation of its proposals nationwide would not be seen until at least 2022-23. (The UK Council for Psychotherapy estimates that by 2020/21, 65% of children in need of mental health services will still be denied access to them.) In a best case scenario, if the full intentions and all the mechanisms in the green paper work as hoped, a pupil in a school that has a mental health friendly culture and a great designated lead, could indeed be more rapidly noticed at school when they show signs of struggling with their mental health, could be better supported by the school and its designated lead, referred promptly for appropriate community-based support from their Trailblazer mental health support team, and could be healed and helped effectively without their distress worsening into more acute problems, avoiding their circumstances spiralling into school exclusion, offending or family breakdown that leads to care. In this sense, we can understand and support the good intention of the proposals in this green paper. In a far worse scenario, however, a child in need of additional help in a non-trailblazer area, whose school is one of the more than 50% who don’t currently have a designated mental health lead, and who has not already been identified as needing mental health support, could experience no change or improvement in the response they receive for a great many years to come. If their mental health problem is responded to with school exclusion rather than support, if they feel left on their own, suffering in silence, and their distress deepens, and they are in one of the areas where extra funding has not reached the front line of CAMHS capacity, and they are not an Emergency and Urgent Care Vanguard either, it may even be more difficult to find appropriate health and social care for them once their problems have spiralled in seriousness. It is not clear what this green paper will really offer the child living in such an area by way of any real improvement on what is there currently. Given the unconnected patchwork of optional measures and pilot initiatives in and surrounding this green paper, the chances of a child in need of help falling through all of its intended provisions is, in fact, high. In short, while the green paper includes some promising measures, it is not strategic in its system design, it is sluggish in its response to an urgent crisis, and it is under-resourced for the scale of improvement required if it is to deliver real benefit for all children, everywhere. We would encourage the government to be far more ambitious in its expectations and investment, to make sure that every single type and specialism of agency across children’s services (not just schools) can play an active role in radical improvements in professional awareness and the skills to support children’s positive emotional and mental wellbeing. And finally, we would urge government to learn critically from a long, cross-party history of expecting trailblazers and pilots to deliver a workable template for coherent subsequent system change in all areas of the country - of which we cannot think of one successful example.