Getting it right for young people

8 March 2018

The CQC launched a report today calling for national action to ensure local services work together to better support young people's mental health, which follows the recent closure of the CAMHS green paper consultation. Combined these two pieces of policy show a way forward. 

In a world dominated by Brexit, the green paper particularly stands out as a policy statement of a genuinely far-reaching nature if it is adequately resourced and implemented effectively. For good reasons it places schools at the centre of efforts to improve young people’s mental health and mental health and wellbeing at the heart of education.

Kids on the Edge – Last Chance School - Josh in a tree

At the Tavistock and Portman, we can, with our partners in our CCG, the local authority and local schools, speak with some authority about a school based approach to mental health provision.  In Camden we have already implemented a model where dedicated CAMHS staff are linked to each of the borough’s 55 secondary and primary schools and where average waiting times for a first appointment are less than 3 weeks.  A model of embedded provision has helped us reach out to some individuals and communities who may struggle to use traditional clinic based services, with 97% of referrals accepted and 40% of appointments delivered in the community.

At the heart of this model is the idea of a virtual “team around the pupil” where senior teachers and clinicians, who know and trust each other, can work together to identify and respond to the needs of young people and families in their care.  Such an approach can ensure an integrated response to someone’s needs, avoiding the need to medicalise difficulties when that is appropriate and, conversely, allowing access to be fast tracked when more serious issues are identified.

We believe the ideas in the Green Paper could map very well onto what we are already doing locally.  There are, however, some important points which we hope will be recognised in determining how the Green Paper is implemented.

First, the Designated Senior Leads for Mental Health, envisaged by the Green Paper, mirror the roles which we have seen played by senior teachers with whom we have worked in Camden. The formalising of this function, and the investment of resources to support their training and development is to be welcomed but there are potential pitfalls.  Such individuals, to be effective, need to command authority within the school and be able to influence the educational environment in which a young person is being supported.  They need, as well, not to be isolated, to work alongside colleagues who have had some basic training in mental health awareness and to work as part of an integrated team with known CAMHS clinicians.

The mental health support teams proposed in the Green Paper also have promise and their scale, perhaps an additional 8,000 staff added to the children’s mental health workforce, is exciting.  Even in a relatively well-resourced system such as that we have in Camden there is so much one could do with that kind of additional resource, both in improving access to those whose need is already recognised but also, importantly, being able to intervene at an earlier stage with those presenting emerging difficulties.

There are, however, again some important factors to take account of in deciding how such teams are deployed.  From our experience, integration, integration, integration has to be the key approach ensuring that such teams work in a seamless way, both with schools and their colleagues in specialist CAMHS services.  While I accept that there is a case for a stepped model of provision I hope there will not be the same prescription about staffing models and interventions which has characterised the rollout of adult IAPT.  Multi-agency problem solving working with young people and families is what is required not treatment factories unable to respond to the subtlety and diversity of young people’s needs.

Finally, there is a commitment for a standard on waiting times.  What could be said against this by anyone who has worked with young people in distress and who recognises the importance of timely intervention for individuals in key stages of development and for whom access to help can make a difference, not only to their mental health symptoms, but to their wider life chances. 

There is much that can be done to create systems which improve access to help.  In Camden the implementation of the Thrive model, with its focus on a population approach to mental health and senior decision making at the outset of working with a young person has been a key part of us achieving some of the shortest waiting times for CAMHs in the country.  However, resources also matter.  Our commissioners in both our CCG and Local Authority have demonstrated a strong and sustained commitment to investing in children’s mental health.  Investment levels in some other parts of the country are a disgrace, in particular when repeated recommissioning of services has been used as an excuse to take money out of services.  It would be wrong if investment in the Green Paper model was used to plug gaps in basic levels of provision.

Children and Young People’s mental health has, in recent years, been the flagship of a new level of public interest in mental health.  Getting this right for young people remains one of the best things we can do both for the individuals affected and for the health and prosperity of this country in the future.  The Green Paper offers an opportunity to build an integrated model of support.  Let’s make sure we seize it.

-Paul Jenkins, Chief Executive 

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