Background
Under article 24 of the UN Convention on the Rights of the Child, every child has the right to the best possible standards of healthcare, and to access facilities for the treatment of illness and rehabilitation.
We know from our own research and the work of others, mental Health and wellbeing is one of the biggest issues children are concerned about. This is also true of parents and carers, and professionals supporting children and young people.
This page will set out the challenge facing us, and some of the specific issues relating to supporting children and young people’s mental health and wellbeing.
What do we know?
Whilst we know mental health and wellbeing is one of the biggest issues children are concerned about, there is limited data available on the prevalence of mental ill health in Wales. Here’s some of the available data which paints a picture:
- The School Health Research Network found that, from their survey of secondary school-aged young people in 2021/22, that 46% reported mental health symptoms ‘classed as at least slightly raised….with 24% reporting “very high” mental health symptoms’ (SHRN, 2023).
- In my survey of over 8,000 children and young people in autumn 2022, around two thirds of children and young people told us that they are concerned about their mental health and wellbeing. This is higher amongst children identifying as an ethnic minority, and children in the lower affluence category. Almost three-quarters of children young people in the lowest affluence category worry about their mental health.
- I also asked over 1,000 parents and carers about mental health support for their children. Over half worry about their child’s mental health and wellbeing often or a lot. One third feel that schools do not support their child/children’s mental health and wellbeing. Less than half know where to go to get mental health and wellbeing support for their children, and four fifths are not confident that they could access support quickly if they needed it.
- Senedd Ieuenctid (the Welsh Youth Parliament) published a report, Young Minds Matter, in November 2022 which reported on the findings of their consultation with thousands of young people, and contained a series of recommendations for Welsh Government. These included, amongst others, creating a ‘recognised central “one stop shop” for information, resources and support’; embedding supporting mental health and wellbeing into education; and better support for young people at an earlier stage to lower the demand on Child and Adolescent Mental Health Services (CAMHS). We have endorse these recommendations.
Casework from our independent Children’s Rights Advice and Assistance service
Our office regularly hears experiences of children feeling that they are being ‘bounced’ between services without ever getting the correct help.
Often, children and young people who are looking for help for their mental health and wellbeing are also waiting for an assessment for a neurodevelopmental condition. We explore the experiences of some of these children and young people in our 2023 report A No Wrong Door Approach to Neurodiversity.
If you are a parent or carer, or support young people in your work, and you’re worried that they aren’t getting their rights, you can contact our independent Children’s Rights Advice and Assistance service.
Our recommendations
We made a series of recommendations to Welsh Government and Regional Partnership Boards in 2020 and 2022 to try to drive improvement in the offer for children across Wales, through our No Wrong Door work. I am pleased that the Welsh Government has acted on several of our recommendations. Since our reports we’ve seen brilliant examples which go the extra mile to try to support children in the here and now. Whilst it’s pleasing to see progress, challenges remain and we expand on those in the section titled ‘conclusion’.
What is happening to support children?
Mental Health Sanctuary Models
The Welsh Government and Plaid Cymru, through the Co-operation Agreement, have made provision for new ‘mental health sanctuary models’. I was pleased to visit the first one that opened, in Carmarthen. These sanctuaries provide a safe and calm space for children experiencing a mental health crisis, who can access it by calling ahead and coming in quickly or in some cases are able to drop in. The relatively new ‘NHS 111 press 2’ telephone service, a 24/7 service for people in need of urgent mental health support, is already playing a key role in directing those who contact the line to the right support where possible.
In the Carmarthen model, staff consist of a range of professionals who can help to work on de-escalating from crisis, before working with the young person to come up with a plan for the next few hours and days, as well as longer term goals. I really welcome this model of care for children and young people which helps children and young people during their immediate crisis, but also means that they can avoid feeling they have no option to present at A&E.
Whole School Approach
All schools in Wales are required to pay regard to, and should be making plans to embed, a whole school approach to mental health and wellbeing. The whole-school approach seeks to support good emotional and mental well-being by promoting a supportive environment in schools, while ensuring that children who need extra support for their mental health and wellbeing are properly supported by the right professionals. Many schools in Wales are progressing well with their whole school approach plans. Schools need to make sure that children are involved throughout the process so that the changes made reflect the reality of the needs of the school population, and Welsh Government and Public Health Wales should make sure they monitor how schools are doing this.
NEST/NYTH
The NEST / NYTH framework is a tool for planning mental health and wellbeing services across Wales. NEST stands for Nurturing, Empowering, Safe and Trusted. It is designed to support all services, not just mental health services, work together in helping children and young people with their mental health and wellbeing needs. Together with the NEST / NYTH team in Welsh Government and Aneurin Bevan University Health Board, we have supported the development of an e-learning module on the Ty Dysgu platform, which launched in Spring 2023. The e-learning module provides an introduction to the NEST framework, children’s rights and how healthcare professionals can implement and support both.
National mental Health and wellbeing strategy
In February 2024, Welsh Government published its draft all-age mental health and wellbeing strategy, and its draft all-age suicide and self-harm prevention strategy. I would urge anyone with an interest in children’s mental health and wellbeing to have a read and consider responding to the consultations through the links above.
We hope that the new strategy will include a real focus on children and young people, with a plan for delivering an improvement of experiences of children whether they need preventative, lower level or more specialist help.
What are Health Boards doing?
From December 2023 – April 2024 I met with every health board in Wales to discuss children’s mental health and wellbeing. They told me about the pressures on services supporting children with their mental health, but they also told me about encouraging examples of practice. These include:
- Mental health professionals working with schools to upskill and provide support to staff through the CAMHS In-reach programme and other innovative practice;
- Innovative models which mean children are seen quickly when referred in to the service, and where the support is tailored to their individual needs, rather than being placed on another waiting list; and
- Plans for new ‘sanctuary’ models and crisis responses.
The Challenges
Despite these developments, the challenges are stark. Some of the things health boards told me include that:
- The current workforce is struggling to meet the demand;
- There are years-long waiting lists for neurodevelopmental assessments, and a lack of support while waiting;
- The service for children with eating disorders in inadequate;
- There are often problems encountered when a young person transitions from child to adolescent services (we support Mind Cymru’s campaign on improving the experience of transition to adult services – Sort the Switch). We also heard of times when children are kept on adult wards or in other inappropriate care because the appropriate beds aren’t available;
- There are problems accessing specialist inpatient mental health care;
- The relationships between health and education services aren’t always positive, and mean a missed opportunity to embed mental health support within schools; and
- As we found in our No Wrong Door work, there is still disagreement between health boards and local authorities when it comes to providing for children with complex needs.
What do others say
UN Concluding Observations
Every 5 or so years, the UN Committee on the Rights of the Child requires governments to report on how they are upholding children’s rights.
Working with our colleagues in Scotland and Northern Ireland, and along with children’s rights organisations across the UK, we reported to the UN Committee in November 2022.
As part of our evidence to the UN Committee, we worked with young people from Wales, Scotland and Northern Ireland to share their voices and experiences. Within their report, young people from Wales expressed the need for accessible support and advice surrounding mental health issues, with calls for preventative measures. It goes on to talk about how young people should be at the centre of all support services and there should be no barriers in place to prevent young people from receiving the support they need and deserve. So, from a young person’s perspective, we’re hearing that they want to be able to access support when they need it and not be sent away to find all the different services themselves.
After hearing our evidence and evidence of others, the UN Committee on the Rights of the Child made their recommendations to all Governments of the UK and made several on the subject of mental health. Here is a summary – that Governments should:
- Ensure the availability of community-based therapeutic mental health services and programmes for children of all ages, and for providing comprehensive mental health promotion, screening for mental health issues and early intervention services in schools;
- Urgently address the long waiting times for accessing mental health services
- Strengthen measures to address the underlying causes of poor mental health, eating disorders and other self-harming behaviours among children, and invest in preventive measures.
We expect Welsh Government to respond to these recommendations this year.
Conclusion
The scale of the challenge ahead of us is huge, and every day children and young people in Wales are quite simply not getting the service they deserve.
This challenge requires concerted, collective effort directed by meaningful and measurable actions.
Despite my office’s work to highlight many of these issues through our No Wrong Door projects, and the tireless work of other organisations including within the third sector, many of the same problems still persist, and in many cases they have been exacerbated by the impact of the pandemic and reduced living standards experienced across Wales.
That is why I am calling on Welsh Government to ensure that there is a children and young people- specific Delivery Plan which delivers the ambitions of the forthcoming mental health strategy.
Welsh Government has made progress in developing policy, and making funding available for some projects which aim to deliver a No Wrong Door approach. This needs to make a difference on the ground over the coming years. My team and I will now be working to monitor the progress in making children’s rights to the highest standard of care for their mental health and wellbeing a reality in Wales.