The government is promising “immediate action” to reduce the social exclusion of several vulnerable groups. But progress is likely to be uneven across the agenda, finds Lauren Revans
The government’s latest social exclusion action plan openly admits that it could “take years” to deliver the system changes required to tackle the most entrenched pockets of social exclusion, while results could “take decades to show”.
But, with an eye on the quick-wins that are so important in maintaining enthusiasm the action plan also promises us “more
focused and immediate action” to supplement this drive for deeper reform.
Included in this “series of immediate changes” are plans to try new ways of tackling mental health and conduct disorders in childhood, of getting adults with more severe mental health problems back into work, and of offering children with additional needs more personalised services.
But for any of these ideas to succeed, extra funding, training and support for practitioners will be needed.
Developing intensive interventions at home to tackle childhood mental health and conduct disorders
The Department of Health will launch a series of pilots next spring to test different approaches to tackling mental health
and conduct disorders. These will focus on intensive home-based interventions such as multi-systemic therapy, a short-term
treatment which focuses on the parents’ support needs rather than just the child and is generally used where problems are
According to YoungMinds director Barbara Herts, those best placed to carry out this work are mental health professionals,
counsellors, therapists and social workers, most of whom do a lot of systemic therapy already.
“Some community nurses might want to do some extra training to be able to do it as well, and youth workers in particular
settings might also be in a good position,” she says. “However, not just any professional can turn their hand to it. It requires sophisticated training.”
Likelihood of national roll out: slim
The well-documented shortage of such talking therapies is already hindering implementation of other initiatives, such as NHS
guidelines on depression. Effective national rollout will require far more investment than is likely to ever be on offer for child and adolescent mental health services, and interventions are likely to end up looking more like the standard parenting support programmes springing up across the country under plans to tackle antisocial behaviour.
Chance of long-term success: 2/10
Herts reluctantly admits that the idea of being able to offer intensive home-based help to every child with a mental health
problem or conduct disorder is “unrealistic” given the shortage of psychological services within the NHS.
She believes a better starting point might be to focus on “de-bunking” Camh services so workers are freed up to see young people at an earlier stage, and providing those working in early years with mental health awareness training so they can spot the difference between a behavioural problem and a mental health problem.
Encouraging employment for those suffering from more severe mental health problems
By next April, the Department for Work and Pensions and Department of Health will set up eight new regional teams drawn
from public, private and voluntary sector employment organisations to boost efforts to increase the number of adults with
severe mental health problems helped back into work.
Good practice is likely to focus on the Individual Placement and Support approach to vocational rehabilitation, under which employment is an integral part of an individual’s care plan and ongoing support is available on an unlimited time basis once they start work. But support could also involve the introduction of more incentives into the system, such as paying providers according to how difficult it is to find someone a work placement.
Delivering the plan will require an expansion in the number of link or employment support workers.
“Some of them will be mental health professionals or social workers,” predicts Andrew McCulloch, head of the Mental Health Foundation. “But there is also a role for unqualified workers and employment workers as long as they are trained in mental health and in understanding employers.”
He believes that much of this growth will take place in the voluntary sector, and that this will require “serious development” and “a big expansion in training”.
Chance of long-term success: 6/10
The government has a vested economic interest in getting as many people with mental health problems back into employment as possible. However, this is not a new problem and previous efforts to tackle it have been largely unsuccessful.
Employment rates among those with moderate to severe mental illness have actually fallen from 14 per cent in 2000 to 10 per cent in 2005.
There is also a concern in the sector that employment rate targets and financial incentives could result in people being pushed back into work inappropriately. But McCulloch warns against discouraging the plans, insisting there is scope to appropriately help many more people. And, after many years of talk, he is confident that there will finally be some action.
“The Treasury is doing some work for the comprehensive spending review targeted on this. I don’t think we can guarantee
funding, but it’s the best shot we’ve ever had.”
Piloting of budget-holding practitioner model for children with additional needs
Fifteen pilots were launched in June to trial the concept of the budget-holding lead professional. The aim is to test whether
budget-holding enables lead professionals to access services for children and families more easily and results in greater choice.
The budgets available for lead professionals to hold range between £100 and £2,500 per child over the 18-month trial period. What the money can be spent on also varies from pilot to pilot, from covering the cost of new school shoes or membership
of an after-school club to paying for counselling services or respite care.
Guidance on the lead professional role was published by the DfES earlier this year following an earlier round of pilots, so moving to a budget-holding lead professional model is more about evolution than revolution.
Sara Tough, Change for Children senior manager at Telford and Wrekin Council, which has been piloting the lead professional
role for the past 18 months and just begun piloting the budget-holding aspect too, said the shift was being managed locally by integrated services managers and had not required an intensive amount of additional training for staff.
A wide range of practitioners are capable of taking on the budget-holding role: over an 18-month period, more than 500
practitioners from 22 different professional backgrounds took on the lead practitioner role in Telford and Wrekin.
Likelihood of national roll out: high
An evaluation of the pilots will begin this month and run until the pilots end in April 2008. The action plan states that the pilots “could be part of a future system of delivery with much more user choice and tailoring of services to individual needs”.
And the model is certainly in keeping with the government’s wider plans for reforming the way care services are commissioned
and delivered – plans to test a similar budget-holding lead professional model in relation to looked-after children are due to be included in the imminent green paper on children in care, and recent pilots in social care have already illustrated the
potential of individual budgets to empower service users and personalise service provision.
Chance of longterm success: 7/10
Development of the budget-holding lead professional role appears intrinsically linked with the Every Child Matters: Change for Children agenda. But the action plan admits there are “formidable barriers” to overcome to implement this change successfully.
Not least of these obstacles is ensuring that the up-front investment pilots received is made available to all councils when the scheme is rolled out.
Tough says that, without this pump-priming money, it would be more difficult, and dangerous, to shift the emphasis of service delivery towards early intervention and away from the reactive and acute end of services.
Chief executive of children’s charity NCB, Paul Ennals, adds that placing individual professionals in charge of the purse
strings could also change the relationship between the practitioner and the child they are supporting, potentially creating
conflicts of interest.
“We may discover that there are some circumstances where actually it’s not right for the lead professional to hold the budget,” Ennals concedes. “But I don’t think that will happen often.”
● See Reaching Out: An Action Plan on Social Exclusion, 2006,
This article appeared in the magazine on page 28 (28/9 – 4/10 issue) under the headline: Steps to Inclusion