In this blogpost I summarise where Wales is at in its reform journey of children’s mental health services and present my vision for the next leg of the journey.
Read our July 2018 position paper
Wales is now in the fourth and final year of its Together for Children and Young People (T4CYP) programme which set out to improve access to clinical and community services as well as prevention and early help.
The Programme has led to some improvements such as shorter waiting times for initial assessments, but we still don’t know whether children are getting the services they need after assessment, or whether children are being sent down a clinical route unnecessarily in the absence of something else more suitable.
During that time there has also been a groundswell of agitation for more radical approaches, led by myself, the cross-party committee of Assembly Members that scrutinises the Government’s work on children (and in particular its tenacious chair Lynne Neagle AM), young people in youth and school forums throughout the country, parents and pioneering practitioners from many backgrounds, including the remarkable Liz Gregory, a clinical psychologist.
Here are some of the ‘ideal’ responses to our children’s needs that many of us have recognised as the best ways forward, and my analysis of the likelihood of them happening in Wales.
- Children are supported to develop ways of preventing mental ill-health and emotional difficulties, and get early help where and when they need it
What is the likelihood?
After some considerable pressure from myself and the National Assembly’s Committee for Children, Young People and Education, through their Mind Over Matter report, the Government has agreed to support a ‘Whole School Approach’ to mental health and wellbeing.
It has been good to see our Ministers for Health and Education personally chairing the working group for this. I expect the work of this group to set out the ‘menu’ of evidence-based provision that we would expect every child or young person in Wales to receive, including learning about mental health, school environments that support wellbeing, and early help available in schools and the community, when needed. The good news is that a number of schools in Wales are already well along the way to having this kind of environment in place, but other schools will need more support, with Government and Estyn setting out high expectations, and providing resources too.
- ‘No wrong door’ when seeking help. Children who need specialist help are supported through a multi-disciplinary service that can help with social as well as mental health needs.
What is the likelihood?
This was a recommendation in my most recent annual report. I am fed up of hearing from families about how utterly lost and exhausted they can get in the system, and from staff who are frustrated because they can’t get a suitable response from other services. The Government has responded with some new funding for regions to develop children’s mental health services across health and social care, which is good to see, but say they will not require an integrated approach. This makes me concerned that children will face a postcode lottery of services. While I have seen evidence of a new, ‘no wrong door’ approach getting underway in Gwent, and planned in Cardiff and the Vale, I am not convinced that this more joined-up approach is being planned everywhere.
My recent consultation of over 11,000 children and adults made it clear that tackling mental health is a top priority for my work as the independent children’s champion for Wales. I will be visiting every region in Wales this year to challenge them on their plans for this, and seeking reassurance that no region will be left behind. I continue to speak to Government ministers about the need for them to drive a more integrated approach also.
- We have suitable therapeutic accommodation in Wales for the small minority of children who require somewhere safe to live while they recover from trauma.
What is the likelihood?
This is a real problem for us in Wales (and the rest of the UK). We have small numbers of young people with huge needs for specialist, safe care because they have a range of mental health and behavioural difficulties, often as a result of trauma they’ve experienced. They may not meet the narrow criteria for a mental health unit but they need specialist help. I would like to see the best of our social work, education and mental health providers joining together to develop excellent places of safety for these young people, that avoids them having to go hundreds of miles from home to specialist services, often in England.
The Government has provided some new money to the regions for this, but I haven’t yet seen any firm plans for new services like these. I’ll be asking the government to do more to help with getting these developed.
- Children have safe places to go at the point of crisis
What is the likelihood?
When I ask young people about what an ideal school that supports their mental health would look like, they almost always talk about one important thing being a safe place within the school, such as a support base, ‘cwtch’ or haven where they can go if they need help. I’ve seen more and more of these develop in schools, alongside staff who are available to listen. This should hopefully become a more standard offer with the Whole School Approach.
But, what about children and young people who are not in school, or are in a state of crisis beyond what the school can help with? I would love to see walk-in services for children and their families needing immediate advice or reassurance on mental health. This wouldn’t necessarily mean on-the-spot access to a psychiatrist, but someone trained to listen well, give initial advice, and arrange a more specialist mental health assessment if needed or other help such as family support or youth services. This may sound an impossible dream, but they exist all over France (Maisons Des Adolescents). I have visited one and it was a calm and welcoming place that just about managed to keep up with demand.
I am talking about such crisis centres to public sector leaders whenever I can, in the hope we may be able to pilot one in Wales.
Conclusion
Overall, it is clear that no single service, and certainly not the NHS alone, can meet our children’s mental health needs. The new Youth Parliament and the newly developing youth health boards, parents and caring professionals will not allow this to drop. I am here to support them to encourage change, and demand it if we need to.