Charity YoungMinds has consulted young mental health service users on a new approach to provision. Emma Parsons reports
Three children in every class of 30 have a mental health problem and one in 12 young people self-harms. These are the kinds of statistics which charity YoungMinds quotes when explaining why it has just launched its children’s and young people’s manifesto calling for changes to mental health services.
There’s more: nearly 80,000 children and young people suffer from severe depression, and more than half of adults with mental health problems were diagnosed in childhood but never received the right treatment. Not only does this cost health services more in the long term, but it causes severe distress to the children themselves.
Changes in attitude and policy
YoungMinds, which is committed to improving the mental and emotional well-being of young people, says changes in attitude and policy are desperately needed if these statistics are to be addressed.
To draw up its manifesto, the charity worked with its Very Important Kids group, a national panel of young people with mental health problems, and Healthy Heads, a virtual group of 250 young people who influence the charity’s policymaking. The children’s own words and stories flag up 11 areas where change is needed.
One area is the transition to adulthood when many service users in their late teens report falling into the gap between child and adolescent mental health services and adult mental health services.
The extent of this problem is acknowledged in New Horizons, a 10-year strategy for mental health services launched for consultation last month. It proposes the establishment of a youth mental health service for 14- to 25-year-olds offering a range of interventions and easing transition.
Other areas for action in the manifesto include tackling unhelpful attitudes among GPs and hospital staff, and increasing training for teachers to help them spot mental health problems in the classroom. It also calls for shorter assessment times, dedicated workers, and for the worst psychiatric units to learn from the best. Above all, the manifesto urges all practitioners to listen to the young people themselves and consult them in the design and delivery of services.
“One of the things we’ve learned over the past few years is how crucial it is for us to be listening to young people about services, and what it’s like to be a young person receiving mental health services,” says Roger Catchpole, YoungMinds’ head of training and consultancy.
“I think [the manifesto’s] so powerful because it’s coming from them. One of the things that struck me was that, of the 11 points, about seven or eight have implications for training.
“They’re talking about a real change in the delivery of services. Practitioners can be critical of theory, but young people’s experiences are valid.”
1 Help us to talk about how we feel without being judged.
2 Train primary school staff to deal with our problems when we are young, not ignore them.
3 Growing up is difficult – support us when change happens in our lives.
4 Ensure everyone who works with young people, including teachers, school nurses and youth workers, have better training in emotional well-being.
5 Make waiting lists and assessments shorter and provide us with one worker for all our care.
6 Give us better access to advocates whenever we need them.
7 Improve GP training in mental health and in talking to young people about their problems.
8 Better train hospital staff on the issues that often underline our mental health problems, such as sexual abuse and violence, and in understanding our needs.
9 Some psychiatric units feel like prisons; learn from the best ones.
10 Don’t forget about us when we turn 16 – we want continuing high quality care.
11 We’re the experts – start listening to us and involving us in planning and delivering mental health services.
Case study: Warrington unit shows wishlist can be delivered
At least two of the YoungMinds children’s manifesto demands (9 and 10) are being met by a new in-patient unit in the North West to treat young people in a more suitable setting.
At Fairhaven Young People’s Unit in Warrington, a specialist team treats 14- to 18-year-olds who might have otherwise found themselves on an adult mental health ward if they were older than 16 or taking up a paediatric bed while assessments were carried out.
“A main driver [for opening the facility] was the changes in legislation due next year on not admitting over-16s to adult wards,” says Linda Kellie, assistant director of operations, Camhs, for Five Boroughs Partnership NHS Trust.
Highest rate of referrals
The North West has the highest rate of referrals for in-patient facilities in England and the lowest number of beds, so services were strained before the unit opened in June. The unit will have eight beds when it is expected to be running at full capacity this month.
One of Fairhaven’s targets is to see people quickly. Where possible, patients are admitted the same day they are referred, and referrals are accepted any time of the day or night.
Fairhaven is a short-stay assessment and treatment unit where the young person receives all the services they need under one roof and in their community.
As soon as a young person is admitted, staff work with the community team to plan their discharge and the educational services they will receive during their stay. Stays of between two and four weeks are expected, but the average is six days. Most residents return home, but some go on to a more specialist unit. Feedback from young people who have used the centre is positive: it is friendly and homely, they say.
A key theme in the YoungMinds manifesto concerns listening to young people, and Fairhaven does exactly that. It consults a children’s panel, which has so far advised on the unit’s décor and name. “Anything we do, we run by them,” says Kellie.
In-school support in Kent
A scheme to train primary school staff to spot and deal with problems at an early age – as demanded in point 2 of the YoungMinds children’s and young people’s manifesto – is already under way in Kent.
The Spark project, which is being rolled out across nine primaries and one secondary school in the district of Swale in Kent, is one of 25 pathfinders taking part in the government’s Targeting Mental Health in Schools programme.
The core of the work in Kent involves delivering projects to develop emotional intelligence and emotional literacy over a long period to support children who would traditionally have ended up in the care of child and adolescent mental health services (Camhs).
As well as running traditional sessions, the team is trialling pet therapy, an approach more commonly used with older people. “The initial response has been excellent,” says Spark project manager Mark Bowles. “It’s very effective dealing with self-esteem and confidence issues because training obedience in an animal reinforces positive behaviour management.
“It builds up a narrative, which is what we’d see in a normal emotional literacy session. The evidence also suggests the ‘stickability’ is better – the children remember it for longer. It is low- level intervention, so it’s safe.”
Speech and language support
The team also provides speech and language support, having found that anger can be the result of being unable to communicate. “We’re trying to look beyond the behaviour,” Bowles says.
A screening tool is used to identify children in need of the help, and a referral pathway enables children to be treated as young as six.
The project, which has been running since January and continues for a further 18 months, builds on work already carried out as part of Kent Safe Schools, a county wide initiative to ensure the physical and emotional well-being of children and young people through services in school and in the wider community.
Taking pressure off Camhs
“We didn’t really have anything in schools, so the Spark project has provided more targeted support,” says Bowles. “It saves money in the long term and takes the pressure off Camhs.”
The work is being evaluated by Canterbury Christ Church University and the team measures progress by using an online tracking tool called Me and My School from the Anna Freud Centre, which specialises in helping children’s mental health.
Spark is also building a manual of best practice to be shared with other schools, and aims to secure funding from local providers to continue the project after the pathfinder money runs out.
This article is published in the 13 August 2009 edition of Community Care under the headline “”A manifesto for change”