Improving children’s mental health

New research sets out the challenges of delivering better outcomes for children and young people – and how councils can mitigate these by acting early to resolve issues before they escalate.

Building on the success of our Bright Futures campaign, the LGA commissioned Isos Partnership to research how local government is supporting children and young people’s mental health and emotional wellbeing. Its report demonstrates what role local government can play in improving services and outcomes for youngsters and their families.

Helping children and young people to fulfil their potential is a key ambition of all councils, but too many are not receiving the support they need to have good mental health.

Despite increased investment and focus on mental health services for children and young people, the number requiring support is going up, thresholds for accessing support remain high, waiting times are long and there is significant difference in provision between different local areas.

We know that about one in eight children and young people is affected by mental health problems, which can have a damaging impact on their future life chances if not tackled quickly and effectively.

But the story of more children requiring support is not just about rising need. It is also about the pressure and strain on core universal services as a result of shrinking resources.

With reductions to pastoral support staff in schools, targeted youth services, children’s centres, health visitors, school nurses, and so on, the collective capacity for universal services to provide additional support for children, young people and their families experiencing turbulence and emotional distress has been diminished.

Despite the very challenging national context for supporting children and young people’s mental health and wellbeing, fieldwork in eight contrasting councils shows just how much local government can do.

Through working closely with key partners, councils can help mitigate the effects of some of these challenges, and deliver better outcomes for children and young people.

Nine key themes recurred in the research as critical elements in establishing an effective partnership-based approach to supporting young people’s mental health. These include leadership and vision, self-reflective partnerships, integrated commissioning, promoting good mental health for all children and young people, and developing the children’s workforce.

Embedding child and adolescent mental health services (CAMHS) in other key services and supporting families were also key.

The research highlights three areas, beyond the issue of underfunding, that were impeding the most effective use of resources and the workforce. The first is that the complexity and fragmentation of the system means it is difficult to see a clear national direction.

The second is the lack of capacity and poor wellbeing of those delivering mental health support, reflecting: staff shortages in key professions, such as educational psychology and children’s psychologists; the lack of join-up between these professions; and reduced capacity of staff in universal services, such as schools or health visiting.

The final issue is the lack of focus on early support and intervention. Arguably, the orientation of the whole system – from where funding is directed to the targets that are set – incentivises a set of behaviours that prioritises specialist and complex treatment at the expense of earlier intervention and prevention.

It is revealing that all the national targets that relate to children’s mental health revolve around access to specialist treatment rather than outcomes experienced by children and young people. Where these were securely in place, local areas felt that they were able to deliver better and timelier access to support, earlier intervention and prevention, and more efficient use of resources.

Essentially, this is about working together to improve the mental health and emotional wellbeing of all children and young people by acting early to resolve issues before they escalate, and by providing timely, accessible and joined-up care for those with more complex needs.

Those councils embracing these critical elements can – together with their partners – make sure all children and young people have the bright future they deserve.  

A whole-community approach

The Isles of Scilly, off the southwest tip of Cornwall, are constructing a different offer of support for children and young people, focused on preventing poor mental health from escalating and using the resources already available on the islands to provide help.

In 2015, there were 18 young people, out of 420 children and young people on the islands, receiving child and adolescent mental health services (CAMHS). Not only was this a high proportion of young people given the small size of the population, but – because of the islands’ location – young people had to fly to Cornwall every two weeks to attend appointments with a clinician, which was disruptive and gave little anonymity.

Lynn Plummer, the incoming Children and Family Services Manager, asked young people what would make a difference. The overwhelming reply was someone to talk to in school. With this in mind, the council decided to take a different, whole-community approach.

Staff across children’s services and the archipelago’s one school were trained in mental health first aid and emotional resilience. An experienced family support worker was also employed, and he and another member of school staff trained to become THRIVE practitioners. THRIVE is an approach to emotional and social resilience based on targeted interventions.

“You need to be in the right place at the right time

The family support worker was critical in bringing about a change of culture in the school, and in developing the mental health and emotional resilience of families. “It’s about being there every day, picking up on the little nuances that can make a difference,” he says. “By hanging around the school gate at the beginning of the day, asking people if they are OK, you can see if someone’s late or has slammed the car door. You need to make sure you’re in the right place at the right time.”

Monthly meetings champion a new, multi-agency way of working called Bloom, making better use of skills and resources. They provide an opportunity to discuss a child or young person, putting their needs and that of their family at the centre and then deciding on a course of action that best fits their challenges, with specialist advice from CAMHS.

Bloom offers a different way of thinking about a child, providing early help to prevent the escalation of problems and reduce the need for a referral for treatment.

People are more trusting of children’s services. By building a relationship with their health visitor or school nurse, they then feel supported through the referral process, rather than seeing it as something that is done to them. Today, there are only three young people accessing specialist CAMHS treatment on the Isles of Scilly.

You can find out more about the research by visiting www.local.gov.uk/supporting-good-mental-health. The eight councils that took part were Bedford Borough Council, the London Borough of Camden, Cornwall Council, Dorset Council, Hertfordshire County Council, the Council of the Isles of Scilly, Liverpool City Council, and Salford City Council.

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