The mental health of the nation is built on foundations laid in the early years of our lives. Yet our mental health system is designed and funded to pay the price of our failure to act on the evidence and invest in the right family support in those childhood years.
We go through many life changes and transitions in our childhood and teenage years. It’s why the age of 18 is the wrong time for child and adolescent mental health services (Camhs) to “hand over” to adult services. A joint report by the health and education select committees has turned the spotlight on the role schools can play.
According to a study [pdf] by Martin Knapp at the London School of Economics, the costs of poor mental health land disproportionately in our schools. Over half of the mean cost of addressing emotional and behavioural problems is incurred in frontline education.
Little more than 6p in every pound the NHS spends on mental health is spent on children and young people. Yet as the health and education select committees acknowledge in their report [pdf] on the role of schools in mental health, “50% of adult mental illness starts before age 15 and 75% has started before age 18”.
The select committees have put down important markers for any incoming government. The critical importance of whole-school working to promote the wellbeing of young people and the value of a joined-up approach to delivering mental health support are key recommendations.
When members of the select committees visited Regent High School in Camden to learn about the schools-based work of the Tavistock and Portman NHS foundation trust (of which I am chair), they heard for themselves the value of a joined-up approach. Equipping teachers with knowledge of mental health and making this part of their professional development is a step in the right direction. But a good grounding in child development should be at the heart of teacher training.
The presence in every school in Camden of an experienced clinician who is part of the wider Camhs team makes for a seamless response when there is a need to escalate. This whole-school approach means the clinician is there to see pupils and support staff. This pays dividends in staff resilience and help-seeking among young people who might otherwise go unseen by mental health services.
With the snap general election, the select committees did not have time to look for lessons from overseas. However, earlier this year I took part in an international study visit on mental health leadership to learn about the approach being taken by the education system in Australia. What was striking was the close collaboration [pdf] in New South Wales between the education and health departments.
Hallmarks of the approach are: acting on the best available international and domestic evidence; testing proof of concept; evaluating to ensure robust implementation; and sustained investment at scale. The principle underpinning the schools-based work I learned about could best be summed up as proportionate universalism: using the results of the Australian early development census of children in their first year of full-time schooling to identify the schools where support should be targeted, then offering support to the whole school.
So what should this mean for a green paper and future policy?
First, it’s time to make Camhs services up to age 25 the norm.
Second, mental health and wellbeing should be integral to the life and work of schools, not a bolt on.
Third, a proactive approach to identifying and meeting need could do much to prevent mental distress entrenching into lifelong mental illness, offering timely support to parents to strengthen parenting and reduce parental conflict.
Fourth, embedding mental health expertise in every school as part of a richer Camhs offer ensures there is no wrong door for young people when it comes to getting the right help at the right time.
Fifth, we need to build on the progress already made with the Children and Young People’s Improving Access to Psychological Therapies programme; deliver Camhs services that focus on outcomes; make a reality of shared decision-making; and deliver evidence-based interventions and support.
The mental wealth of the nation is critical to our future, the mental health and wellbeing of children, young people and parents should be a priority. As the select committees rightly say: “Schools and colleges have a frontline role in promoting and protecting children and young people’s mental health and wellbeing.”
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