With the recent announcement by the government of an increase of £20b of the NHS, some of which will be spent on children’s mental health, it’s a good time to consider how that extra money should be spent.
The social and economic cost of poor mental health is £105 Billion per year, yet the total budget for mental health is £34 billion. https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf Figures release in 2016 show than in 2012/13(latest available figures) just 11% of the total NHS budget was spent on mental health, with children’s mental health receiving £704m which is 0.7% https://centreforum.org/publications/children-young-peoples-mental-health-state-nation/
The Children and Adolescent Mental Health Service (CAHMS) is the NHS department for childhood mental health. To access CAMHS there needs to be a referral from a doctor, school nurse or school. They come under a lot of criticism from some directions, but they are under resourced and have a waiting list of up to 18 months. (https://www.theguardian.com/society/2017/oct/20/children-waiting-up-to-18-months-for-mental-health-treatment-cqc) When a child gets an assessment around a quarter (24%) do not meet the threshold for treatment and others are told they are in too much crisis for treatment. These facts and figures sound outrageous and can be devastating for parents (and teachers) who are desperate to get help for the children who are ill.
But CAHMS are correct to say some children don’t meet the threshold for counselling, and are equally correct to say for some children in crisis counselling is not the solution; for counselling to be effective the patient will need to be stable enough to embrace it. The problem does not lie in the lack of provision for these children within CAMHS, but the lack of provision outside of CAMHS. Mental Health, just like physical health is on a spectrum – some patients will require medical intervention, others won’t. The level of medical intervention will vary too from community nurse, doctor’s appointment, dentist, physio therapy to hospitalisation. In the same way CAMHS provide a service for certain children whose criteria match CAMHS expertise and other provision needs to be invested in for those whose needs fall outside this provision.
In the same way we look after our children’s physical health, regardless of symptoms, we should protect our children’s mental health, regardless of symptoms. That begins with parenting, but schools can play a huge part, and primary schools are where the focus on mental health care should begin within education.
There have been a few reports in to counsellors in schools, the ones that have been done have been in secondary schools Mick Cooper’s report School-Based counselling in UK secondary schools shows the average number of counsellors in England and Wales per school is just 2, providing between 5 and 9 sessions per week. (https://www.researchgate.net/publication/279534540_School-Based_Counselling_in_UK_Secondary_Schools_A_Review_and_Critical_Evaluation)
The report recognises that over 90% of school staff felt that in-school counselling “met the needs of their students well.”
A report in 2018 by Pro Bono Economics looked at the work of mental health charity Place 2Be and concluded that for every £1 spent on counselling there will be a benefit to the long-term economy of £6.20.
This is where a fresh approach is needed. A great example of this is social impact company Evolve: Social Impact. www.evolvesi.com they train Health Mentors, to work (mainly) in primary schools they hold 1-1 mentoring sessions with children who are showing early signs of mental health issues and using an array of recourses from child counselling. Lego-therapy. Art-therapy, CBT techniques help the child to understand and overcome their problem. Some of these children will still be referred to CAMHs but while they are on the waiting list they are getting help with their problems, by someone they know, trust and have built a rapport with. If they do not meet the CAMHs threshold, they continue to receive support.
The extra money being made available is very welcome, and used correctly will both alleviate the pressure on the NHS and provide greater, more personal support for the children who need it most