Pupil mental health: crisis, what crisis?
With the government's recent pledge to provide training and support for mental health services, is there renewed hope that funding woes will at last be addressed?
'An ounce of prevention is worth a pound of cure.' (Benjamin Franklin)
Earlier this week the government announced that mental health reforms were to focus on young people. In her speech at the Charity Commission the prime minister, Theresa May announced:
- that every secondary school will be offered mental health first aid training - which teaches staff how to identify symptoms and help those who may be developing a mental health issue
- trials on strengthening links between schools and NHS specialist staff, including a review of children and adolescent services across the country
- that by 2021, no child will be sent away from their local area to receive treatment for mental health issues
- the appointment of mental health campaigner Lord Stevenson and Paul Farmer, chief executive of the charity Mind, to carry out a review on improving support in the workplace
- that employers and organisations will be given additional training in supporting staff who need to take time off
- a greater emphasis on community care such as crisis cafes and local clinics, with an extra £15m towards this, and less emphasis on patients visiting GPs and A&E
- the reallocation of £67.7m (mostly from the existing NHS digitisation fund) to online services, such as allowing symptom checks before getting a face-to-face appointment
- a review of the ‘health debt form’, under which patients are charged up to £300 by a GP for documentation to prove to debt collectors they have mental health issues.
This announcement comes hot on the heels of the ‘Children’s and Young People’s Mental Health: Time to Deliver’ report, from November 2016. This report called for a mental health lead in every school, and while everyone who works with young people would surely agree that there is much more needed regarding access to services, early intervention, education and training, this isn’t a new issue. The Health and Social Care Act (2012) legislated new responsibility for the NHS to deliver ‘parity of esteem’ between mental and physical health in 2012.
'Parity of esteem’ involves ensuring that there is as much focus on improving mental as physical health, and that people with mental health problems receive an equal standard of care.
While the renewed focus on parity of esteem is clearly welcomed, along with the increased attention now being placed on mental health, the fact that there appears (from a SENCO’s perspective) to be a significant gap between rhetoric and reality, continues to frustrate families and schools and store up difficulties for young people into adulthood. Quite simply, more needs to be done.
The profile of children and young people’s mental health has never been higher. In 1990 there was not a single mention of mental health in UK newspapers and only 9 in 1995; compared with 996 in 2015 (Source: Lexis Nexis via Professor Peter Fonagy).
As mentioned earlier, this fresh announcement is welcomed. However, we cannot assume renewed focus will have any tangible impact without appropriate funding.
Although it has been reported that the additional training will make school staff better at identifying mental health problems in pupils, should appropriate provision not be available afterwards there will be limited direct, long-term improvements for young people and their families.
If schools and teachers are to take a role in mental health, they need to be able to make a referral to mental health services quickly.
It seems clear to me that additional funding will need to be allocated to help local areas support parity of esteem. Developing existing approaches to mental health and (potentially) commissioning new pathways will ensure that services are connected more clearly with physical health care and other service provision.
Shortages in specialist workforce areas will also need to be addressed. In addition, there is a need for investment in training and education aimed at GPs, nurses and other (school) staff to help people with mental health problems to access the same care and outcomes as anyone presenting physical symptoms.
Figures compiled for the BBC by NHS Digital showed that between 2011-12 and 2015-16 the number of patients attending A&E units with psychiatric problems rose by nearly 50% to 165,000, and for the under 18s alone the numbers almost doubled to nearly 22,000.
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What are some of the facts?
Changes in thinking, mood and/or behaviour that impair functioning (Murphey, Barry & Vaughn, 2013) is a concise way of considering what we mean by mental health.
It is also important to be aware of prevalence and long-term impact; there are 20% of children and young people affected [with mental health issues] worldwide (Belfer, 2008) and 50% of adult cases originate in childhood or adolescence, 75% by the age of 24 (NIMH, 2005).
There is evidence of a significant increase in the prevalence of mental health difficulties between childhood and adolescence (Green et al, 2005) along with reduced quality of life, a loss of economic productivity, destabilisation of communities, and higher rates of health, education and social care utilisation (Belfer, 2008).
By 2030, depression alone will yield the highest disease burden in high-income countries, accounting for nearly 10% of disability-adjusted-life-years (Mathers & Loncar, 2006).
While the recording of admissions to A&E is an area for a separate debate, there is clear evidence of a substantial increase in hospital admission episodes in under 17s where self-harm is recorded as the cause (Burt, 2016):
Simply attempting to refocus existing service provision and retrain school staff will have very limited impact in an already over-stretched system
Whether we believe in a mental health ‘crisis’ or not, Google trends are revealing: the UK is second only to Australia in searches for ‘mental health’ and first for ‘self-harm’. This week’s announcement highlights the need for more to be done, but any words must be backed with action and this can only be achieved with additional funding and direct support. Simply attempting to refocus existing service provision and retrain school staff will have very limited impact in an already over-stretched system.
I watch this space with the hope that the increased ‘open’ discussion and debate on mental health will see realised that more appropriate pathways require proper resourcing.
I always live in hope.
Supporting older pupils
'More than third of teenage girls in England suffer depression and anxiety.' (Open Door, September 2016).
Our Safeguarding Teenagers: Supporting Mental Health & Protecting Young People Online conference will be the perfect opportunity to:
- network with leading practitioners and experts
- attend a variety of keynotes and in-depth workshops
- take away proven strategies to successfully support the mental health of your older pupils.
Register now to secure your place!
- Belfer, M. L. (2008), Child and adolescent mental disorders: the magnitude of the problem across the globe. Journal of Child Psychology and Psychiatry, 49: 226–236. doi:10.1111/j.1469-7610.2007.01855.x
- Burt (2016), Self-Harm: Children: Written question – 22945, Parliament.
- Green, H., McGinnity, A., Meltzer, H., et al. (2005), Mental health of children and young people in Great Britain 2004. London: Palgrave.
- Mathers CD, Loncar D (2006) Projections of Global Mortality and Burden of Disease from 2002 to 2030. PLoS Med 3(11): e442. doi:10.1371/journal.pmed.0030442
- Murphey, D, Barry, M, & Vaughn, B, (2013) Positive Mental Health: Resilience. Child Trends, publication #2013-3.
- NIMHE (2005), Guiding statement on Recovery, Department of Health