There is nothing controversial in the reflection that children’s mental health services are at crisis point. The controversy comes when we try to agree the ‘solution’; with a huge variety of ideas vying for attention in a very crowded ‘market place’. Every service and profession will justifiably argue that they need more resources; and of course more resources would help. A bit. However, I would argue that the scale of the problem is so enormous that investing in pre-existing models will not provide ‘the answer’. Indeed, more concerning, this approach may even perpetuate the problem; especially if we invest in ‘specialist services’ that carve off mental health difficulties from every day life. We need a ‘whole school’, ‘systems wide’ approach, with a range of safety nets if we are to be sure that children don’t fall through the cracks.
I will use the ‘net’ analogy to illustrate the point. Currently Specialist Child and Adolescent Mental Health Services (SCAMHS) could be described, for the most part, as a basket ball net, and one that is located far outside of the schools and communities where children live their lives. Teachers and other child care professionals have to put a huge effort in if they stand any chance of ‘scoring’ help for a particular young person. Often it’s a miss – either because the person doesn’t meet the tight referral criteria, or because they don’t fit neatly with the help that is on offer at a specific moment in time. Miss your chance and it’s gone. Indeed, the basket ball net maps very neatly with the way in which SCAMHS works. Children and young people pass through, and rarely does the service stay involved for an extended period. There is huge pressure from within specialist services to ‘let go’, essential if capacity and demand models (for example the Choice and Partnership Approach), and target waiting times are to be achieved. This is not a criticism. It is inappropriate for ‘specialists’ to remain in a child’s life for prolonged periods of time, especially when there is not active intervention focused on change, and it is not helpful for specialists to drift into more supportive roles. Far better that this support is facilitated through the every day relationships in a child’s life. However, it is no doubt a huge source of frustration for all concerned when the ‘specialists’ withdraw, especially when there are not other support systems in place to ‘catch’ the young people at the other end. Mental health ebbs and flows in all of ours lives, and is rarely, if ever, ‘cured’ once and for all.
In recognition of this frustration, there have been calls for more specialists to work within schools and other community settings. It certainly would address the perceived distance and inaccessibility of the current system, and I appreciate that it is very appealing for overstretched teachers and child care professionals. However, my concern, especially if this is seen as THE solution, is the risk that it replicates one of the biggest disadvantages of the ‘specialist’ services model. By this I mean perpetuating the commonly held notion that mental health can somehow be seperated off, and is the business of only those with ‘special’ training. If it were a net I would argue that this is a fishing net approach – a specialist on site scooping up the children and young people who present in a certain way that rings alarm bells. Again, ‘referral criteria’ would be required, and some would fit, whilst others, often our most vulnerable who act out their distress behaviourally, or who don’t show up to school, would not. It would also, inevitably, be dominated by a ‘within child’ model of therapeutic support (e.g. counselling, CBT), failing to recognise the hugely important contextual factors that impact on a child’s mental health, including poverty, adversity and ongoing exposure to trauma. I have written about this risk in a number of my blog posts. Far better that those specialists share their fishing knowledge, and hand out smaller nets to core staff, supporting them from the sidelines – empowering and up-skilling them all the while.
However, the net I would like to see if we are truly to turn children’s mental health concerns around, is the safety net. A ‘catch all’ whole system approach, where we apply what we know helps children to flourish to all our children in all our child care institutions. A set of values that nurture and celebrate our young people should be at the heart of all child care practice. This would focus on relationships, and facilitate safety, connection, warmth, celebration of the unique individual, inclusion, and a recognition that not all children are starting from the same baseline – whether that is developmentally, temperamentally, emotionally or socially. Again, I have written extensively about this and how it might work in practice. The beauty of it is that simple changes can make all the difference; often requiring no additional time but rather a redirection of focus. Most importantly, the outcome of children flourishing means the academic targets so prized in our culture would follow. Indeed, it could be argued that even our brightest, most secure and privileged children survive rather than thrive in the current system. With this approach they would continue to shine, and those who get lost in the pressure to achieve,or in the chaos of their disruptive home lives would also find their place. Children cannot learn if they don’t feel valued and safe.
So, in summary, we need to think more creatively about the nets to catch our children to prevent them falling through the cracks. Specialist CAMHS has it’s place, as does more accessible and targeted support. However, if we are to really tackle the enormous problems with mental health we are facing as a society, both for our children and the adults of the future, then we need a safety net for all. A whole systems approach that embeds emotional well-being and mental health in every aspect of our children’s, and those who work with them’s lives. Where schools become a place of safety and security for our most vulnerable young people; where inclusion for all becomes a focus, and a celebration of the uniqueness of the individual becomes the norm. It is not that ambitious, and as I have written about recently, just changing the first five minutes of the school day can make a huge difference. The price of not doing this is, on the other hand, is enormous, and we know from the Adverse Childhood Experiences research that the impact of not taking serious action is alarming not only for mental health but for physical health too. To put it bluntly, it is like asking a trapeze artist to perform with only a basket ball net to catch them if they fall. Instead, we need to empower everyone in a child’s life to recognise that if we all hold on to the safety net no one need fall through. Indeed, these everyday relationships with those most proximal to the young person have the most therapeutic power. With this in place as our baseline, the children and young people who need to be fished out for specialist help would become obvious – always keeping in mind that they are coming back and will need to be held by us all.