Mental health issues – in England at least – were well articulated in 2015’s Future in Mind report. Two years on, and with a green paper on children and young people’s mental health on the horizon, there has never been a more urgent need for solutions.
We see early intervention at the heart of this complex debate. Our whitepaper draws together evidence making the case for early intervention, giving digital services a major role in this journey.
To this end, we convened a roundtable discussion with the Guardian. Our aim was for a solutions-based conversation with a broad range of leaders in mental health, covering a range of perspectives, from government, international best practice, lived experience, and academia, to psychiatry, paediatrics, commissioning and children’s rights.
The outcome of the roundtable – published in the Guardian – is fascinating and underlines our belief in providing easy access to early intervention solutions. All of us have a role to play: CAMHS, schools, mental health organisations, charities, parents, ambassadors and policy-makers.
This is how we can start helping – where we are now failing – to meet the needs of thousands of children, young people and adults in this country who desperately need support.
Digital counselling is in the right place at the right time. Though established for over a decade, it now seems to have ‘come of age’ at a time when a lot is being asked of the NHS and as mental health has taken political centre stage. Given the evidence for early intervention, and progress towards transformation, it is time to acknowledge the role online counselling and emotional wellbeing services must play in achieving universal service delivery at a time and place to suit the child or young person in need.
XenZone met with Tim Tod who has worked in mental health, focusing on young people, for over twenty years. Tim shares his thoughts on the support schools can offer children and young people with mental health problems, and the stigma that can be attached to asking for help.
A few years ago, waiting lists for Children and Adolescent Mental Health Services (CAMHS) in Halton were high and the system of referrals was not working as it should. Both issues appeared to warrant immediate attention, but taking a broader view, Halton Clinical Commissioning Group (HCCG) and the Borough Council decided to start at the beginning with early intervention.
Instead of increasing investment in the tier three crisis services that were so much in demand, HCCG and the Borough Council looked to tier two early intervention services. Their strategy was to address mental health issues before they had time to escalate. They would focus on reaching out to children rather than waiting for crises to emerge.
And that’s where the partnership approach between the 5 Boroughs NHS Trust and XenZone came in – to the point where the XenZone and CAMHS teams are now co-located.
XenZone has been working closely with 5 Boroughs NHS Trust in Halton for more than two years now. Children and young people today have a central point of contact for all mental health services. Those from age 11 are using Kooth, our digital and face-to-face counselling services, for free.
Through Kooth, we offer access to professional online counselling, access to self-help materials and live forums, the opportunity to read or contribute to our online magazine and the ability to leave messages for counsellors at any time. The service is available up to 10pm every day of the year.
Read about how XenZone and HCCG and the Borough Council worked together on a transformative approach that is supporting children and young people with their emotional health and wellbeing at the earliest opportunity.
As we said in our 2016 white paper: ‘Service Without Thresholds‘, written in partnership with The Children’s Society, early intervention and ease of access in a transformed system are essential.
Young people, children and families need a simple way in. The individuals and institutions that support them in everyday life – midwives, health practitioners, primary and secondary school teachers, pastoral support staff and carers – need a simple route in too.
This is, in essence, what the 2015 ‘Future in Mind report’ argued for. It acknowledged that we need to move away from a system defined by “organisational boundaries” or in terms of the services organisations provide, to one built around the needs of children, young people and their families.
It maintained that support could be delivered by “joining up services locally through collaborative commissioning approaches between CCGs, local authorities and other partners, enabling all areas to accelerate service transformation.”
Digital services are scalable and access to help is immediate. Digital is the first step in such a transformed system and becomes the hub for young people first seeking help. All the elements we need to achieve this shift exist already. Visionary CCGs are already transforming their mental health services in this way – and can demonstrate better outcomes as a result.
“A space to talk about life and real feelings.”
Every year around 200,000 young people aged 10-17 in England are referred to specialist mental health services due to serious concerns about their mental health but around 30,000 (15%) of them are turned away without any support¹. As the numbers and the proportions of children affected by mental health problems such as self-harm and eating disorders are rising², ³it is important that all children have easy and quick access to mental health support.
At The Children’s Society’s, we work directly with teenagers affected by domestic abuse, neglect, sexual exploitation and missing children. Many of them need therapeutic support to help them overcome earlier traumatic experiences. Many find it difficult to access support due to the high thresholds for specialist services and often long waiting times.
To help tackle the barriers young people face when accessing child and adolescent mental health services (CAMHS), we have developed an exciting and innovative new service in Birmingham City Centre, as part of our Forward Thinking Birmingham partnership, called Pause.
‘Felt safe, like I have somewhere to go. Feel better after getting everything off my chest.’ – Young Person
Pause, a walk in service open seven days a week, is for anyone aged 25 or under. It is staffed by counsellors, youth workers and volunteers, who provide a safe space for young people, parents and professionals to discuss their emotional needs and well-being. The service has been designed to both increase the availability of help and to reduce demand on specialist services through early engagement.
In the year since Pause opened, we have supported over 5,000 young people and their parents and carers and provided one to one support to over 1100 children and young people to help address issues such as anxiety and depression.
Young people shouldn’t have to wait for an assessment and then wait for weeks for some support or reach crisis point to get help for their mental health and that’s why it’s important to trial new approaches that offer early access and flexibility based around the needs of children and young people. Pause is part of the answer to help children and young people get mental health without waiting.
¹The Children’s Society. 2015., Access Denied: http://www.childrenssociety.org.uk/sites/default/files/AccessDenied_final.pdf
² Health and Social Care Information Centre. Statistics released from the Health Behaviour in School-Aged Children Surveys. December 2014. http://www.bbc.co.uk/news/health-30414589
³ HSCIC. Hospital Admissions for an Eating Disorder. 2014. http://www.hscic.gov.uk/article/3880/Eating-disorders-Hospitaladmissions-up-by-8-per-cent-in-a-year 2014.
During a recent Guardian roundtable, where we were part of a group of experts talking through solutions to the growing problem of mental health in this country, it struck me, not for the first time, how much we expect of our schools. Teachers could very well be spending more time over a year with children and young people than their parents do: the influence of our education system cannot and should not be underestimated.
One of the participants – a leader in the field of education – began a thought-provoking discussion about education and the role it plays in children’s lives. He said he felt that the UK does not have a philosophy of education anymore – that somehow we needed to redefine what this is in Britain. Is education for attainment alone – or do we have a moral responsibility to gear our young people up for the challenges they may face as young adults – especially in relation to their mental health?
There was agreement around the table that if we are committed to early intervention, education is one place to start, and that essentially, emotional wellbeing has to become as important as academic achievement. This means making it part of the curriculum, the culture and, importantly, providing teachers with the right support to make it happen.
According to the Young Minds activist – also at the roundtable – young people need educating on mental health problems so they can identify them. This lack of awareness, she said, often leads to anxiety, which can escalate.
There is a lot of work to do to get education right, but we need to begin with an agreed statement of its purpose.
There is, however, hope on the horizon.
The fact that the Education and Health Committees recently published a joint report is a sign that the departments acknowledge that they are intrinsically linked.
The report stated: “Achieving a balance between promoting academic attainment and well-being should not be regarded as a zero-sum activity”. It acknowledged that if pupils have greater well-being, then their academic performance is positively affected. We now need them to put their money where their mouth is.
Future in Mind spoke about investing in training teachers to identify emerging mental health issues. It also identified the need to provide each school with a single point of contact for mental health services, and to include keeping safe online and cyber bullying in the curriculum. Again, this is something the Young Minds activist said added to the pressures felt by pupils and students, saying, “With social media, the bullying comes home with you…your public life never ends.”
So while we have articulated the issues and talked of the urgency, what we now need to see is action. I hope that the joint report is a sign of joined-up thinking when it comes to health and education. I also hope that an articulation of a philosophy for education in this country – which should include a commitment to reducing inequalities and taking into account the importance of mental health – is at least a step closer.
Elaine Bousfield, founder and chair, XenZone