How can we meet children and young people’s mental health needs?

Helena recently attended ‘Transforming Mental Health Services for Children and Young Adults – Improving Accessibility & Recovery Outcomes’ at the Child and Adolescent Mental Health Services (CAMHS) National Summit.

One of the largest challenges faced by child and adolescent mental health services (CAMHS) is meeting children and teenagers’ mental health needs. With an increasing number of children requiring support, this often means long waiting times for distressed families. Children and young people’s experience of accessing support within and outside of CAMHS can also vary drastically, with many young people left feeling helpless and isolated as they wait to receive the support.

At the CAMHS National Summit, speakers and participants were invited to discuss what could be done to tackle this challenge and improve services. Speaking on behalf of young people was inspiring young mental health campaigner and healthcare activist Imogen Voysey. After her hospitalisation at age 16, she began working to improve mental health services for children and young people, and for the last two years has worked with YoungMinds on their ‘Amplified’ programme. Imogen’s recommendations for improving services were: learning from what goes wrong, putting in place early and effective interventions, and encouraging clinicians to build compassionate relationships.

The feedback wasn’t new or surprising, but while most of us aspire to adhere to these principles, the reality is that they can get lost among service pressures, processes and procedures, and budget constraints – all to the detriment of young people. However, at a practice level, Imogen’s principles tell us what we can do to help children in difficult situations, despite the challenges of the system.  

For Imogen, it was human connection that was the most important:

Children are people. Someone with a mental illness needs to be seen as a whole person. Treat them as a person, not as a symptom of what they have been diagnosed with”.  

For me, this highlighted the stigma that still surrounds mental illness, and how this can become unconsciously entrenched within systems without us realising. It can be in the language and labels that we use, even within mental healthcare settings. We need to encourage more young people like Imogen to speak out about their experiences and involve them in designing services where they do not feel stigmatised.

Imogen’s key lessons for professionals were that it can take time for children to build trust with adults who are ‘treating’ them, and that “treatment cannot happen in a vacuum”. She also emphasised the importance of clinicians and professionals coming down to the same level as the young person in helping to remove communication barriers, even if it feels uncomfortable. This made me reflect on Our Time’s interventions. For me, what makes KidsTime Workshops particularly powerful is that they deliberately remove this traditional hierarchical relationship of professional and patient. They create an equal and empowering environment where children and families are recognised as experts in their own situation, and have the freedom to express themselves without fear of judgement or stigma. This makes them more active participants (as opposed to passive recipients) in their own care, and that of their peers.

One thing Imogen said that struck me in particular was that “Complete recovery is not a realistic expectation and people in charge of the system need to recognise this”. This is a healthy challenge to the current system, which is geared towards treatment and cure, as opposed to management and prevention. The nature of mental illness is that it can fluctuate over a person’s lifetime; however, it can be managed effectively and improved with timely intervention, and this does not necessarily need to be of the ‘critical’ kind. This is why there is no ‘cut-off’ point for families taking part in our KidsTime Workshops – families are free to attend as frequently as they need to, and KidsTime is always somewhere they can return to. Many of our families are fearful of losing access to this support, (e.g. due to loss of funding), and this can be very disruptive and destabilising for them.

Following this feedback, there was a lot of discussion about the need for early intervention and collaboration across different agencies. With 50% of people accessing adult mental health services starting their journey at age 14, the case for prevention could not be more prominent. However, in the words of Dr Prathiba Chitsabsan (Associate National Clinical Director for Children and Young People’s Mental Health Teams, NHS England) the “decades of underinvestment” in mental health and the resulting pressure on services has contributed to a culture of services pulling back and retreating into their specific spheres of responsibility. What is needed is a shift in mindset towards investing in prevention at both a local and national level, and this can only be achieved at the scale required if appropriate funding is made available from the government. And more attention must be paid to the impact of mental illness on the whole family. Despite being acknowledged as an adverse childhood experience, parental mental illness is consistently overlooked in debates on childhood trauma – but confronting it is only this way we will break the intergenerational cycle of mental illness.

Local transformation sustainability plans and partnerships were highlighted as areas of opportunity with scope for influencing local mental health services, and Our Time will be exploring these as part of its development agenda. Dr Chitsabsan also signalled that longer-term, the NHS would be exploring investment in more targeted interventions for complex trauma, filling in the gaps of current provision, which was welcome news.

There was a general consensus that improvement in children’s mental health services required investment outside of CAMHS, as well as within. Certainly, with a little bit of funding, (in comparison to the cost of more critical interventions), charities such as Our Time can help to fill the gaps in services. However, this also requires cooperation and support from local decision makers and commissioners. Interestingly, when talking about her support network, none of the people Imogen listed were actually treating her for mental illness. For Imogen, “a support network is about creating an environment where a young person can feel safe; this could be a trusted adult, family member, peer, youth or voluntary group”. This is exactly what Our Time’s interventions do, and it is striking how consistently the themes of ‘knowing you are not alone’ and ‘having someone to talk to’ emerge in the feedback from our children and families.

Overall, the CAMHS Summit was an informative and thought-provoking day, which reinforced the role Our Time has to play in raising awareness of the children of parents with mental illness and offering a relatively simple, low-cost solution to this complex problem.