Five priorities for improving children"s mental health | Paul Burstow

The mental health of the nation is built on foundations laid in the early years of our lives. Yet our mental health system is designed and funded to pay the price of our failure to act on the evidence and invest in the right family support in those childhood years.

We go through many life changes and transitions in our childhood and teenage years. It’s why the age of 18 is the wrong time for child and adolescent mental health services (Camhs) to “hand over” to adult services. A joint report by the health and education select committees has turned the spotlight on the role schools can play.

According to a study [pdf] by Martin Knapp at the London School of Economics, the costs of poor mental health land disproportionately in our schools. Over half of the mean cost of addressing emotional and behavioural problems is incurred in frontline education.

Little more than 6p in every pound the NHS spends on mental health is spent on children and young people. Yet as the health and education select committees acknowledge in their report [pdf] on the role of schools in mental health, “50% of adult mental illness starts before age 15 and 75% has started before age 18”.

The select committees have put down important markers for any incoming government. The critical importance of whole-school working to promote the wellbeing of young people and the value of a joined-up approach to delivering mental health support are key recommendations.

When members of the select committees visited Regent High School in Camden to learn about the schools-based work of the Tavistock and Portman NHS foundation trust (of which I am chair), they heard for themselves the value of a joined-up approach. Equipping teachers with knowledge of mental health and making this part of their professional development is a step in the right direction. But a good grounding in child development should be at the heart of teacher training.

The presence in every school in Camden of an experienced clinician who is part of the wider Camhs team makes for a seamless response when there is a need to escalate. This whole-school approach means the clinician is there to see pupils and support staff. This pays dividends in staff resilience and help-seeking among young people who might otherwise go unseen by mental health services.

With the snap general election, the select committees did not have time to look for lessons from overseas. However, earlier this year I took part in an international study visit on mental health leadership to learn about the approach being taken by the education system in Australia. What was striking was the close collaboration [pdf] in New South Wales between the education and health departments.

Hallmarks of the approach are: acting on the best available international and domestic evidence; testing proof of concept; evaluating to ensure robust implementation; and sustained investment at scale. The principle underpinning the schools-based work I learned about could best be summed up as proportionate universalism: using the results of the Australian early development census of children in their first year of full-time schooling to identify the schools where support should be targeted, then offering support to the whole school.

So what should this mean for a green paper and future policy?

First, it’s time to make Camhs services up to age 25 the norm.

Second, mental health and wellbeing should be integral to the life and work of schools, not a bolt on.

Third, a proactive approach to identifying and meeting need could do much to prevent mental distress entrenching into lifelong mental illness, offering timely support to parents to strengthen parenting and reduce parental conflict.

Fourth, embedding mental health expertise in every school as part of a richer Camhs offer ensures there is no wrong door for young people when it comes to getting the right help at the right time.

Fifth, we need to build on the progress already made with the Children and Young People’s Improving Access to Psychological Therapies programme; deliver Camhs services that focus on outcomes; make a reality of shared decision-making; and deliver evidence-based interventions and support.

The mental wealth of the nation is critical to our future, the mental health and wellbeing of children, young people and parents should be a priority. As the select committees rightly say: “Schools and colleges have a frontline role in promoting and protecting children and young people’s mental health and wellbeing.”

Join the Social Care Network to read more pieces like this. Follow us on Twitter (@GdnSocialCare) and like us on Facebook to keep up with the latest social care news and views.

Five priorities for improving children"s mental health | Paul Burstow

What can be done to tackle the youth mental health treatment gap? | Paul Burstow

By 2020 one in three teenagers will have access to cancer treatment in England. Think about that: only one in three. There would be an outcry. It would be scandalous, horrifying, unacceptable.

It is not true, however. Unless you delete the word “cancer” and insert “mental health”, and then it is.

In medical terms, there is a treatment gap. The number of children and young people living with a diagnosable mental illness far exceeds the number who get any help. One in 10 children suffer a diagnosable mental illness, yet just one in four of them receive treatment. By 2020 the gap may close, a little, if plans in NHS England’s Five Year Forward View for Mental Health [pdf] are realised, but only a little.

Over half of lifelong mental illness and distress shows its first signs in adolescence. We have an opportunity to do something to change people’s lives for the better and dramatically reduce the number of adults living with entrenched mental health problems. This is a great prize.

In her first major speech of 2017, Theresa May stressed the importance of prevention. Green papers on social justice, family and the role of schools in monitoring mental health and wellbeing are in the pipeline.

But can the treatment gap be closed by scaling up access to treatment and providing more digital options alone? Where will the workforce come from to provide the extra services and sessions required?

What if we could reduce the number of people getting ill in the first place? What are the underlying causes of rising levels of mental distress in children and can we put in place measures that increase resilience and reduce risk? If so, what are the most promising approaches?

Our ambition is to look beyond treatment and containment towards prevention and early intervention.

These are some of the questions Birmingham University is setting out to explore in its new policy commission. I will be chairing the commission, working with a range of experts, and together we are calling for evidence from non-governmental organisations, academics, public agencies, thinktanks, and people with lived experience of mental health issues across the UK and internationally.

I first outlined the ambitions of the university’s mental health commission in my inaugural lecture last autumn. Our ambition is to put together a new approach that looks beyond treatment and containment towards prevention and early intervention.

There is already some good evidence of what works in mental health promotion and illness prevention. As minister for mental health I commissioned the London School of Economics to review the evidence [pdf] and rates of return on investment. Among the findings was that school-based social and emotional learning programmes return £84 for every £1 invested. However, often the “saving” does not land in the budget of those who must make the investment. Siloed budgets and misaligned institutional objectives get in the way.

Last year I wrote about my visit to New York to learn about Mayor Blasio’s mental health programme: NYC Thrive. Thrive is a city-wide action plan devised from a population health perspective. It is trying to break down some of the silos. It involves schools and colleges, housing providers, the police and businesses. Prevention and early intervention are at its heart.

The West Midlands has set out its ambitions in its own Thrive strategy and the mayor of London is also working on plans.

Over the next 12 months the commission will be taking evidence, looking at the most promising ideas and setting out the actions that government and other agencies can take to make the shift to an ethos of prevention.

Join the Social Care Network to read more pieces like this. Follow us on Twitter (@GdnSocialCare) and like us on Facebook to keep up with the latest social care news and views.

What can be done to tackle the youth mental health treatment gap? | Paul Burstow

Paul Burstow: The Human Rights Act need to apply to all pensioners in care homes

So, for example, a individual living in a care house has no safety of tenure, and a resident can be evicted quite simply. It is properly acknowledged that the shock of getting forced to move out of a care home can contribute to someone’s death, and so the Human Rights Act is rightly a backstop in this kind of instances, but only if the Council organized the care.

Worse even now, if you are cared for in your own home by a personal or third sector company, even if the Council arranged it, human rights safety does not apply.

Final yr I was delighted when a cross celebration vote in the Property of Lords defeated the Government to amend the Care Bill to end this anomaly. But that Bill is not but law, and the Justice division is digging its heels in and now would like MPs to overturn that vote.

On ideological grounds the Justice Division would have MPs vote so that the Human Rights Act does not apply to older people who correct up their very own care. It believes that the Act ought to not apply to personal care arrangements.

But this is just not great adequate. How can it be acceptable that if men and women rob a bank and go to prison, then their dignity and care are covered by the Act – but not an elderly person with dementia living in a care home?

So as an alternative of making an attempt to unravel the alterations the Property of Lords manufactured, the Government should embrace it. Respect for a person’s human rights must be at the heart of very good care, it ought to be engrained in the culture of each organisation that supplies care, regardless of whether they are private, charity or publically run. Clarifying the law in this way would be a spur to every care supplier to develop a human rights method into the way they deliver care, assisting to drive up specifications across the entire social care sector.

The Care Bill will be a landmark reform of care in England, extensively welcomed by charities representing older and disabled folks. It is anything the Coalition can be proud of. I am as a result respectfully calling on the Justice Secretary to get rid of his ideological blinkers, and believe about the message he is sending out. I can only hope he reconsiders – for the sake of households and folks needing care everywhere.

Paul Burstow: The Human Rights Act need to apply to all pensioners in care homes