As part of our series of think pieces on children and young people's mental health, Andy Smith Vice President for the Association of Directors of Children's Service (ADCS) explores the current mental health system for children and young people and what more could be done to develop it.
Poor mental health and wellbeing can have a lasting impact on children and young people’s life chances, but they face multiple pressures in their lives that adversely affect their mental health. We have made progress over recent years to acknowledge and understand better the importance of good mental health for children and young people, yet there is much more to do before we achieve real parity of esteem. Accessing the right support early can make a huge difference, yet too many children are waiting months for an assessment and over a year for treatment. The current system is not working for children and needs change, the consequence of failing to act could threaten to overwhelm the children’s social care system.
Children with more complex needs or who have experienced some form of adversity are more likely to have poor mental health. Factors such as living in poverty, financial crisis or where parents already have poor mental health can increase the chances of children suffering with their mental health, whilst children in care are four times more likely to experience mental health issues than their peers. The cost of living crisis and the pressure this has put on struggling families across the country will have had a further impact on the emotional wellbeing of children and their families.
Accessing the right support early can make a huge difference, yet too many children are waiting months for an assessment and over a year for treatment whilst access to more specialist services for mental ill-health, such as Tier 4 beds, is either taking too long or is not available at all with no alternative.
Children and young people face multiple pressures, both online and in the classroom and these have only been exacerbated by the pandemic. They sacrificed months of their learning during partial school closures during the pandemic and we are now seeing some of the impact of this, however, many teachers are reporting being unable to access CAMHS or other relevant support. In 2022, ADCS published a special thematic report on children’s mental health as part of its safeguarding pressures research which outlines some of growing pressures in the system that are directly linked to children’s mental health. For example, the research found that the proportion of children’s social care assessments where children’s mental health is a factor has increased from 9.1 per cent in 2017/18 to 13.6 per cent in 2021/22 whilst parental mental health increased from 20.5 per cent to 24.5 per cent over the same period.
The report, along with many others before it, concludes that services are overstretched with children facing long waits to access the right support, particularly CAMHS. These services are not always able to meet the emotional wellbeing and mental health needs of children today who face new and unique pressures. Services are too rooted in clinical diagnosis, and for children in care access is often dependent on them being ‘stable’ even though many children will not be ‘stable’ until they receive therapy. For children in extreme distress, crisis care responses vary, there can be mismatch between available services and actual needs and risks, with some children being told they’re too ill for local services, or not ill enough.
We need to think differently about how we integrate services across place so that children’s outcomes are at the heart of every decision made by all partners. This goes beyond structures but focuses on how we can meet all children’s needs, with local services better connected. The role of local authorities as leaders of place would be key here.
We must look differently at ways to build emotional resilience, support good wellbeing and treat mental ill health. Future in Mind didn’t prove a turning point for CAMHS and the NHS’s Long Term Plan was neither comprehensive nor sufficiently ambitious for children and young people’s mental health; the distinct needs of children must be drawn out.
The need for a shift away from focusing on diagnosing mental health problems towards early help and prevention for those who need it is clear, as is the need for flexible services that are available when and where children and young people need them. This requires joined-up national action from central government departments, mental health commissioners and providers. Whilst there have been some positive developments here, they are not ambitious enough, as illustrated by the roll out of mental health support teams in schools which have a target of covering 50 per cent on schools by 2025. Many local authorities are investing to expand this offer across as many schools as possible in their local area, but this is not sustainable as a long-term solution.
Since April 2021, local areas in England moved towards Integrated Care Systems (ICS), new partnerships set up to meet people’s health and care needs better and it is hoped that through improved co-ordination and join-up between local authorities, NHS and other partners, the population’s health will be improved and inequalities will be reduced. There can be a number of positives from greater collaboration and join-up between health and social care and this will hopefully simplify what is a very complex system. However, central to these arrangements must be a clear focus on the physical, mental and emotional needs of children. For mental health services to work effectively for children and young people, partnerships must be stronger across the country. There needs to be a clearer understanding of partner’s roles and expectations to meet children’s holistic needs. There is no doubt that greater funding is needed to meet the growing demand we are all experiencing, but this must be met with a strong commitment by all partner agencies and relevant government departments to make children and young people’s mental health needs a priority. Whilst some local areas have developed good working relationships with their NHS mental health providers, this requires urgent attention from central government departments, mental health commissioners and providers, working together at national level.
As leaders of place, local authority children’s services have a key role to play here, but all partners have a responsibility to ensure children’s needs are met. Government departments must address some of the systemic challenges that are preventing children and young people from accessing the support they need. ADCS has previously called for a review of children’s mental health services to re-think the system from top to bottom. This remains an urgent priority because the mounting pressures threaten to overwhelm the children’s social care system which was never designed to meet children’s mental health needs. Children and young people often tell us that mental health is their biggest priority, we owe it to them to act and make the system work for them and future generations.
This article and views reflected within it were provided and written by Andy Smith, ADCS Vice President.
