Talking therapies for children with mental health problems: the obstacles

Few would argue with actor Bob Hoskins’ claim in the 1980s British Telecom advert that “it’s good to talk”. But when it comes to tackling children’s mental health problems, it appears we don’t always recognise the importance of this.

There has been a growing tendency to reach for drugs when young people present with mental health problems. The European Medicines Agency reacted to this last year by saying that any prescribing of Prozac – the only approved drug for children aged eight and above – must be coupled with a referral for psychological or talking therapy.

The National Institute for Health and Clinical Excellence (Nice), meanwhile, has produced guidelines for the treatment of children with depression, which say that talking therapies should be the “first line” of action to help children with moderate to severe depressive symptoms.

Recognising the potential of talking therapies, the government commissioned two trials last year and 11 pilots in July this year to look at their use primarily in adult care, although Bury Primary Care Trust is looking at their effectiveness when used with children and young people with common mental health problems such as depression or anxiety disorders.

The pilots are being run over 12 months under the Department of Health’s Improving Access to Psychological Therapies programme. Each one is focused on a specific group of vulnerable people. Care pathways for adults with anxiety and depression are being developed first, and will be followed by similar packages for black and ethnic minority groups, older people, people with long term conditions, offenders, new mothers, and children and young people.

But what makes these sorts of services both useful and suitable for children? A new report published last month by the Mental Health Foundation contains a set of recommendations from young people themselves.

The key words to emerge from interviews with young people about what kind of support they need are “friendly”, “flexible”, “safe”, “non-judgemental” and “respectful”. They criticise professionals who clock-watch, and stress that the approach of staff is vital.

“Young people commented that something as simple as being offered a cup of tea and biscuits by a member of staff might seem like a small gesture, butcreates a sense of ‘personal approach’ and encourages engagement with staff,” the report says.

The MHF study features eight case studies of projects from different parts of the UK that offer the kind of services children and young people see as fulfilling their needs of a support service (see case study).

Counsellors at these projects can relate to young people well and are able to offer a relaxed approach, with time limits kept as flexible as possible.

Recommendations contained in the report include changing the basic service model offered at present, and making access to services possible from any entry point. A lead agency and person should be chosen in each area to convene a partnership board and co-ordinate commissioning of services.

But services that meet young people’s needs, such as talking therapies, are not available everywhere, and the government has admitted that. A Department of Health spokesperson told Community Care: “Currently, the availability and quality of talking therapies for children and young people varies around the country.”

So what can be done to address this situation? Kathryn Pugh, head of policy and innovation at YoungMinds, says child and adolescent mental health services have received an injection of funds in recent years, but that most of that money has been diverted to services treating young people with the most severe problems.

She adds that lack of funding is not the only issue restricting the use of talking therapies: “You need to have people who are trained and can deliver it.” She says that these professionals – whether they be psychotherapists, community mental health nurses, or even social workers – also need the time available to offer the therapy.

Another report from the Mental Health Foundation and other mental health charities published in October last year calls on the NHS to introduce waiting time measures for mental health services. It also says that this year’s comprehensive spending review must include new cash for improved access to talking therapies, and that the Nice guidance should be followed.

In Scotland, there are problems accessing training courses, according to Jamie Patterson, health and social care manager at the Aberdeen Foyer. He says only two locations in Scotland offer training in cognitive behavioural therapy, for example. Although access times to services have improved, in many areas young people have few options of where they can go to get help, he adds.

Commissioning of services is an issue that has been looked at by Youth Access, a representative body for organisations offering information and support services to young people. It has produced guidance for commissioners in children’s trusts and primary care trusts, which urges them to consider using counselling services.

In the past, there has been some reluctance to invest in talking therapies because of a perceived lack of evidence of the benefits. But with the DH and Nice both recognising the value for children and young people, the challenge now is to ensure every young person who needs this kind of care can receive it.

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This article appeared in the 11 October issue under the headline “Spread the word!”