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Spotting a mental health problem in a child is a job for a specialist, isn't it? Well, yes and no. For mental health problems to be identified at an early stage when they are easier to work with, professionals who have contact with children need to know the signs to look for. Yet according to a survey by children's mental health charity YoungMinds,¹ while almost 90 per cent of social workers, teachers, health visitors and other front-line staff have had contact with children with mental health problems, 80 per cent have received no relevant training.


In the survey - an analysis of training needs carried out in one part of England at the end of 2000 - three-quarters of staff identified recognition of mental health problems, promotion of mental well-being, managing emotional and behavioural difficulties, and knowledge of local services as key areas of learning.

So why isn't this happening?

The Diploma in Social Work is a generic qualification and there is nothing specific in its curriculum outlining exactly what should be taught about child mental health. Although students are introduced to common mental health problems in adults and children, it is up to the university or college to decide how much or how little training is given on child development and the way in which adverse conditions impact on development, health and well-being.

Most social workers specialise after qualifying, and child mental health is an aspect of the Child Care Award qualification for social workers. Whether the new social work degree will put a greater emphasis on child mental health than the DipSW is still unknown.

YoungMinds and other agencies offer training and there are a number of post-graduate qualifications appearing. YoungMinds and London's City University launched a masters degree in child and adolescent mental health this month, as has Leicester University.

But with a dearth of general training, it is unsurprising that most front-line staff do not have the skills or tools at their fingertips to assess a child's mental health. Dinah Morley, deputy director of YoungMinds, says: "This stems from a lack of understanding of mental health problems. They think of the florid, psychotic symptoms, which are rarely seen in children. But what we do see are the other problems like depression, eating disorders and conduct disorders."

About 10 per cent of the general child population have mental health problems, but this leaps to up to 90 per cent among children who are in contact with social services. Conduct disorders, in particular, are extremely common, says Morley, and need to be identified early otherwise they can lead the child on a downward spiral from truanting, to crime, to prison.

Social workers are understandably reluctant to label children as mentally ill because of the stigma attached. But the reality is that the problems that social workers spend most of their time grappling with are largely outcomes of poor mental health, says Morley.

The reason behind the findings of the YoungMinds survey dates back to the change in the social worker's role, Morley argues. About 20 years ago, training was focused on interpersonal relationships - something that is now the role of the family therapist in a child and adolescent mental health team. The jobbing social worker is more focused on a tickbox approach of carrying out prescribed tasks and the child has become an object rather than a person, she says.

"It means that mental health is not considered in the depth that is necessary to assess the sort of support that a child needs in a particular circumstance," adds Morley.

Judy Shuttleworth, former chairperson of the Association of Child Psycho-therapists, agrees: "Something has gradually happened to social work training following 'genericisation'. Before, you felt that there was a greater level of understanding about children's needs, but that seems to be disappearing as these people have left the profession."

This depletion of experience results in social workers spending more money on commissioning services or using the private sector. The knock-on effect is that they then lose control over what happens to a child, says Shuttleworth, since children rarely return to a CAMHS team.


"Then they end up buying back training from these services, which doesn't necessarily tie in well with what it means to be a local authority social worker working with children with mental health problems," she adds. "A lot of money that could go into training and support for social workers goes into this parallel world of services."

And how can someone commission services if they don't properly understand the problem in the first place? In order to act as filters for other services, they need a good understanding of what other people do.

Appropriate mental health training will help them function as social workers, says Shuttleworth. It will help them use specialist staff more effectively and give them a common language. It is difficult to work productively without these in place.

The problems don't just lie with social work training. There is a severe shortage of specialist staff. Child psychiatrists, child psychotherapists and child clinical psychologists, the staff who work at the heavy end of child mental health and take a long time to train, are all pretty thin on the ground. And there is a particular lack of people trained in child mental health combined with learning difficulties or drug and alcohol problems.

One explanation is that adult mental health is seen as the more prestigious field, while child mental health is seen as the soft option.

Funding issues are the historical reason behind the lack of child psychotherapists. Now that the NHS funds training, there has been an expansion in the numbers trained, but as this takes six years it will be some time before this increase is felt on the ground. Happily, unlike social work, once trained there is generally no retention problem.

It doesn't help that some child psychiatrists see this as their medical domain, says Morley. "There is a split view, with some thinking that children's mental illness is their business and that social workers deal with social problems. Whereas others think of a comprehensive CAMHS team with them at the sharp end and other professionals like social workers and teachers at the front end where they will see the early manifestation of mental health problems."

Sue Bailey, chairperson of the Royal College of Psychiatrists' faculty of child and adolescent psychiatry, in London, says it's something that she wouldn't be precious about. "It's not realistic that psychiatrists can do it all, social workers have an important part to play."

But to play this part properly, there needs to be a stronger developmental underpinning to training across all professions, particularly social work, so that they understand normal and abnormal development. "If you don't have any understanding about how children and families function and develop mentally, your risk assessments are flawed from the beginning," says Bailey.

Children often have mental health problems because their ordinary needs were not met from the beginning. It takes a well trained social worker to recognise the impact that situations in their life could have on their mental health and to know whom to turn to if they can't deal with it. Without this training, any children they come into contact with could already be at a disadvantage.

Unfortunately, a large proportion of the current workforce has a gap in their training around child mental health, and it will take time to repair. CC

¹ YoungMinds, press release, 12 March 2001. For more information go to www.youngminds.org.uk