A shared language of leadership
Laura Wilkes, The MJ, 4 February, 2015

Child and adolescent mental health is a topic that has been rapidly rising up the New Local Government Network (NLGN) agenda over the past year.

Time and again our conversations around a broad range of policy areas link back to one thing: mental health. There is growing recognition amongst the policy community, particularly in local government, of the connections between mental health problems and a range of negative outcomes which councils spend a vast amount of time and money trying to remedy.

While we are starting to understand the benefits of early intervention across some areas of public policy and are channelling funding towards this, there is a sense amongst the mental health community that their services, particularly child and adolescent mental health services (CAMHS) have become marginalised.

We know that approximately half of all mental illnesses begin before the age of 14 and one in four people will experience mental health problems at some point in their life.

As we are starting to understand much more about the links between mental health problems and key public policy challenges such as unemployment, family breakdown, acute health problems, drug and alcohol dependency, anti-social behaviour and poor educational attainment, the issue of tackling mental health problems in children and young people becomes stark.

Despite this, 75% of children and young people with mental health problems are not diagnosed or treated by the time they reach the age of 21.

Local government should have a significant role to play in this, but research suggests that 60% of upper tier authorities have cut or frozen their CAMHS budgets since 2010/2011 and in some areas of the UK, CAMHS provision has been cut by 25% since 2011. These figures paint a worrying picture.

In a recent event NLGN held in partnership with the Royal College of Paediatrics and Child Health, we heard that these cuts are creating real concern about a rise in demand for downstream and more acute (and costly) mental health services.

For example, one council spoke of providing fewer counselling sessions per referral, and reducing the length of counselling available per young person from two years to just 16 weeks. Whilst on an individual basis this might be the right decision, the overall picture is one of reduced upstream support, alongside fewer resources to manage downstream demand.

In this context of reducing resources, this puts enormous pressure on local authorities to fund services which are ‘all things to all people’: both universal and specialist, emergency and preventative and for children and adolescents of all ages.

Coupled with fragmented commissioning processes, silo mentalities across different partners and separate budgets for mental health services this is clearly exacerbating the problem of reduced resources and leading to complicated care pathways for young people. Professionals are acutely aware of the need to deliver ‘whole-person’ care, with services wrapped around the individual, but getting these structures and processes agreed at a strategic level and right on the ground is not easy.

Driving the difficulties in joining together partners around a shared agenda appears to be the lack of clarity around ‘who leads’ on this agenda, and ‘who are the experts’.

In absence of a shared language around mental health in children and adolescents, and where language has clinical connotations, it is often assumed that this falls within the remit of health professionals, yet we know, for example, schools and parents themselves could take a greater role in mental health support.

The ‘expert’ isn’t one individual or organisation but the range of people and agencies that a young person themselves interacts with. Mental health professionals, social workers, clinical psychologists, teachers, parents and peers should all be part of a support pathway for young people.

Understandably though, there can be real anxiety about approaching a child or adolescent with suspected mental health problems for fear that you are wrong or that you do not have the expertise to address the issues adequately. Too often this can lead to problems being missed or not acted upon.

The key issue here is the need to build confidence in individuals and throughout the system by sharing expertise in child and adolescent mental health so that a range of professionals and non-professionals are able to make interventions.

Equipping professionals, parents, teachers and children themselves with the ability to spot problems and handle conversations about mental health is central to doing this. Free tools and educational platforms, such as MindEd give accessible and bite-sized learning sessions to help build confidence and knowledge in areas like detecting problems, first help and providing care – this can go a long way in ensuring knowledge is shared.

But in order to get all these things right, we need to address the issue of ‘who leads’ on child and adolescent mental health. No one local agency has responsibility on this agenda and in central government too, there is no one department or minister with responsibility for children and adolescent mental health services. In this context of fragmentation, political leadership becomes vital.

Experience from the professionals we have spoken to suggests that securing political buy-in is a huge challenge, particularly in producing the sort of high quality and robust evidence that demonstrates the benefits of investment in mental health services which can persuade politicians to act.

The Children and Young People’s Mental Health and Well-being Taskforce, which is looking at how to improve outcomes in this area, ought to provide some of the solutions to these problems and provide the leadership centrally that is needed in giving real priority to this agenda.

Ultimately though, tackling these issues will be about much closer local collaboration between stakeholders and shared plans to achieve joint outcomes.

This will require local politicians to stick their head above the parapet on this issue and lead the way in prioritising it. Pooling and aligning resources across different tiers of CAMHS will be a step forward in maximising the little resources available, but the challenge is to continue to build the strong partnerships and trust that will enable this to happen.

Laura Wilkes is head of policy and research for the New Local Government Network