In the coming weeks, the House of Commons Education and Health Select Committees will be hearing oral evidence on their inquiry into children and young people’s mental health and the role of education. Members of the Manchester Institute of Education have written three blogs expanding on some of the key issues in their submission and drawing on their research into education and mental health.
Mental health difficulties (such as anxiety and self-harm) among children and young people are increasingly prevalent. The Government has launched various strategies to combat this crisis, however the investments are yet to make a marked difference, especially with cuts to major NHS provision being made. Here, Professor Neil Humphrey examines the statistics and looks at the policy changes needed to tackle children and young people’s mental health issues.
- Various governments have launched strategies to improve mental health provision yet money still isn’t getting to the frontline
- The Government’s reliance on schools to improve mental health outcomes may be part of the problem and not the cure
- The children whose circumstances place them at the greatest levels of risk, their families, and the dedicated and caring professionals who populate the mental health care system designed to protect and support them are all being failed
- The children’s mental health crisis is one driven by brutal cuts to CAMHS and education reforms that have turned schools into exam factories
Around 10% of children and young people experience ‘clinically significant’ mental health difficulties (so severe as to warrant professional help). Half of all people who will experience such problems in their lifetime will have their first ‘onset’ by age 14. Children affected by mental health issues are less likely to attend and achieve their potential in school and more likely to be unemployed as adults. Mental health difficulties lead to significantly lower quality of life, lost economic productivity, and higher rates of health, education and social care service use. Mental health care costs us around £105 billion per year in England. By 2030, depression alone will be responsible for the most years lost as the result of a disabling condition. That’s more than heart disease, diabetes and a range of other physical conditions. Put simply, mental health difficulties can and do destroy lives.
Getting the support system right for young people who struggle with their mental health is critical. At the local level, mental health provision is funded by Clinical Commissioning Groups (CCGs), Local Authorities and schools. Providers include NHS statutory Child and Adolescent Mental Health Services (CAMHS, which can include psychologists, family therapists and others), school staff and counsellors, voluntary sector providers, educational psychology services, and independent providers. Other agencies that are often involved include social services, health, and youth offending teams. Sitting above all of them are the Government, who set policy directives and decide which areas to fund.
Erosion of provision
Talk of a crisis in children’s mental health has received significant media attention recently ( The Independent, The Guardian, The Telegraph). But how might such a crisis have been created? One useful approach is to think about the balance between need (e.g. the prevalence of mental health difficulties) and provision (e.g. availability and access to high quality, comprehensive support for children and young people). In terms of need, talk of a mental health crisis is often accompanied by reference to a rising tide of children experiencing distress (fed by increased screen time social media usage etc.). However, with the exception of anxiety among teenage girls and self-harm among both sexes, each of which has risen significantly in recent years, the evidence suggests that most mental health difficulties have remained remarkably stable since the late 1990s. So a surge in the prevalence of mental health difficulties in recent years cannot be solely responsible for the crisis. To complete the picture, we must turn to provision. Here, we see significant erosion over a period of several years.
The children’s mental health charity, Young Minds, have documented major cuts to CAMHS since 2010. They found that three quarters of Mental Health Trusts and two thirds of CCGs froze or cut their budgets from 2013-2015. The effects of such cuts run deep. They have led to significant increases in CAMHS referral thresholds and waiting times, and compromises to the quality of provision. In 2015, 28% of children referred to CAMHS were not allocated a service.
In the same year, the Government launched Future in Mind, their strategy for improving mental health provision, and promised to invest a further £1.25 billion in child mental health by 2020. In the first year, the BBC reported that the Government only allocated just £143 million of what should have been £250 million. Young Minds’ figures show that only 50% of CCGs actually spent their allocation on increasing their CAMHS budget by the equivalent amount. So where did the rest of the money go? Most likely, backfilling cuts or on other priorities (the rest of the NHS), according to Young Minds.
Schools are increasingly being seen as central to the resolution of this crisis. In January the Prime Minister announced reforms that will include Mental Health First Aid Training for all secondary schools. In late 2016, an education and mental health select committee was formed to examine the role of schools in promoting mental health. Future in Mind led to the piloting of a scheme to improve relationships and working between schools and CAMHS (a perennial issue).
The Government’s ‘turn to schools’ may at first seem laudable. School is, after all, the primary developmental context after the family. Our research at the Manchester Institute of Education has shown that school can be a highly effective setting for improving mental health outcomes among children with emergent mental health difficulties. But to the cynical eye, the renewed governmental focus on the role of schools in promoting mental health is classic distraction politics, purposeful misdirection designed to draw attention away from the cuts being made elsewhere in the system. This is, after all, the same government (albeit with help from the Liberal Democrats initially) who withdrew targets and funding for participation in the National Healthy Schools Programme, eliminated the ‘wellbeing’ component of the Ofsted inspection framework, and have continually failed to heed calls to make personal, social and health education a statutory requirement in schools. They also proposed to make the early years foundation stage profile (EYFSP) – which offers a holistic view of the learner including their personal, social, and emotional development – non-statutory. At the same time, they planned to introduce mandatory academic tests in the first year of primary school. Thankfully, that idea was quietly scrapped after a disastrous pilot and schools have been instructed to continue using EYFSP.
The proposed academic testing of 4-year-olds noted above is just one example in a series of ill-conceived education reforms designed to increase accountability through increased testing and examination preparation in schools that, ironically, actually serve to exacerbate children’s mental health difficulties. Childline reported a 200% increase in counselling sessions relating to exam stress from 2012-2014, and their most recent review saw an 11% increases in exam worries and 12% increase in children and young people reporting problems in school. The words of a primary school teacher capture the current situation well:
“I have just had a child off school for three days because he was so worried about his recent test result and didn’t want to take any more tests. In the lead up to SATs, I have had pupils in tears, feeling sick, feeling stressed because they were so worried about the results from the tests”.
It is important to remember that most young people will not experience the kinds of difficulties that I have described in this article. But for those whose circumstances place them at the greatest levels of risk, the Government is failing them, their families, and the dedicated and caring professionals who populate the mental health care system designed to protect and support them.
The children’s mental health crisis is one driven by brutal cuts to CAMHS and education reforms that have turned schools into exam factories. The fact that mental health is so firmly on the policy agenda is to be welcomed, but is reminiscent of an idiom often attributed to Albert Einstein: ‘You can’t solve a problem with the same mind that created it’. The Government certainly needs to change its mind about both education and CAMHS.