Transcript The challenges facing Children’s mental health provision

The challenges facing Children’s
mental health provision in the UK.
The case for a schools based model of
integrated mental health support for
children, their families and educational
providers.
• The workshop will explore the national and
local challenges to accessing mental health
provision for Children and Young people.
• A presentation of an alternative provision
model for mental health support in Schools
for Children, Families and Staff.
• Mental Health in Children and Young People
National Context
• 1 in 10 children and young people aged 5 - 16
suffer from a diagnosable mental health disorder
- that is around three children in every class (1).
• Between 1 in every 12 and 1 in 15 children and
young people deliberately self-harm (2).
• There has been a big increase in the number of
young people being admitted to hospital because
of self harm. Over the last ten years this figure
has increased by 68% (3).
• More than half of all adults with mental health
problems were diagnosed in childhood. Less than
half were treated appropriately at the time (4).
• Nearly 80,000 children and young people suffer
from severe depression (5).
• Over 8,000 children aged under 10 years old
suffer from severe depression (6).
• 72% of children in care have behavioural or
emotional problems - these are some of the most
vulnerable people in our society (7).
• 95% of imprisoned young offenders have a
mental health disorder. Many of them are
struggling with more than one disorder (8).
• The number of young people aged 15-16 with
depression nearly doubled between the 1980s
and the 2000s (9).
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SOURCES
1 Green, H., McGinnity, A., Meltzer, H., et al. (2005). Mental health of children and
young people in Great Britain 2004. London: Palgrave.
2 Mental Health Foundation (2006). Truth hurts: report of the National Inquiry into
self-harm among young people. London: Mental Health Foundation
3 YoungMinds (2011) 100,000 children and young people could be hospitalised due
to self-harm by 2020 warns YoungMinds. London: YoungMinds.
4 Kim-Cohen, J., Caspi, A., Moffitt, TE., et al (2003): Prior juvenile diagnoses in
adults with mental disorder. Archives of general psychiatry, Vol 60, pp.709-717.
5 Green, H., McGinnity, A., Meltzer, H., et al. (2005). Mental health of children and
young people in Great Britain 2004. London: Palgrave.
6 Green, H., McGinnity, A., Meltzer, H., et al. (2005). Mental health of children and
young people in Great Britain 2004. London: Palgrave.
7 Sempik, J. et al. (2008) Emotional and behavioural difficulties of children and
young people at entry into care. Clinical Child Psychology and Psychiatry, 13 (2),
pp. 221-233.
8 Office for National Statistics (1997): Psychiatric morbidity among young offenders
in England and Wales. London: Office for National Statistics.
9 Nuffield Foundation (2013) Social trends and mental health: introducing the
main findings. London: Nuffield Foundation.
10 Collishaw, S. et al. (2004) Time trends in adolescent mental health. Journal of
Child Psychology and Psychiatry, 45:8, pp 1350–1362.
Local Context
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Challenges to CAMHS
Funding / Resources
User Engagement - Voluntary
Referral Process – criteria
Diagnostic Lead – elimination model
Current Acute Presentations - Inpatient
Tier 1 and 2 services reduced –
preventative/supportive resilience
development reduced
• The Public Health England report submitted to a health
select committee inquiry cites research indicating a
sharp worsening of the trends. In the last three to four
years, there has been a steep rise in self-harm.
• Childline reports that in 2013 it experienced a 41%
increase in reports of self-harm and a 33% increase of
children reporting suicidal thoughts over the previous
year.
• Public Health England concludes that 30% of English
adolescents have sub-clinical mental health problems
In the select committee hearing, Peter Fonagy,
made the point: "We make children very
responsible for their lives but we give them very
little control over them." later he added “The
combination of responsibility and lack of control
always creates stress in anyone at any age.”
Health Committee
Oral evidence: Children’s and
Adolescent Mental Health and CAMHS,
HC 1129
Tuesday 1 April 2014
• http://data.parliament.uk/writtenevidence/co
mmitteeevidence.svc/evidencedocument/heal
th-committee/childrens-and-adolescentmental-health-and-camhs/oral/8443.html
NHS England report on mental health
services
• The presentation says that 35% of adults with
anxiety or diagnosable depression are not in
contact with mental health services, but this
rises to 76% of those aged five to 15.
• It notes that only 6% of spending on mental
health goes on services aimed at children and
young people, even though 50% of lifetime
mental illness starts by the age of 14.
England's child mental health services
'failing three-quarters of kids'
'Cinderella service' hit by budget cuts
and increasing demand
Jamie Doward The Observer, Sunday 18 May 2014
• Only a quarter of all mental health conditions
are receiving the treatment they need,
according to a study produced by the body
charged with improving the health service in
England.
NHS report
• The report also provides evidence that, as a
result of a rise in young people needing
treatment for complex mental health
conditions, assessments for conditions such as
attention deficit hyperactivity disorder (ADHD)
and autism are being delayed, while others
are not being identified or treated
Jamie Doward The Observer, Sunday 18 May 2014
CAMHS Data Mapping Review Discontinued
post April 2010
Sarah Brennan, Chief Executive of YoungMinds
says,
“The last national study was done 10 years ago
and so we have no up-to-date national
information on the numbers of children and
young people with mental health problems,"
Brennan said. "Planning service provision
without current data is extremely difficult,
fraught with risks and not cost-effective."
Jamie Doward The Observer, Sunday 18 May 2014
Schools are containing increasingly
more complex mental health
presentations
Health and Education
• Different Languages / Different Agendas?
• Diagnosis, Symptoms, Treatment, Symptom
management, Aetiology, Recovery.
• Can Education support Mental Health?
• Can Mental Health be supported in schools
through the use of a psycho-educational
model (emotional mindfulness)?
• Do children need more than a cognitive
educational model to understand their own
emotional experience?
A new model
• Non Diagnostic led
• Emotional and Psychological Development
and wellbeing
• An integrated service Education and Health
• Developmental and Integrated services
replacing external referral lead model
• A new Parental engagement model.
• Evidencing progress in wellbeing
Internal Referral System
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Training – What is mental health
Treatment for Mental Health
Consent for Treatment
Engagement
Levels of participation
Confidentiality
Process diagram to access emotional and psychological support
Gathering a picture
Intervention
Report / Review
Parent meeting / External
network meeting / Health
agency – GP
Concerns
raised
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Key worker
Health
Education
TAC / AR
Referral
Form
Completed
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Multidisciplinary
Meeting
Health /
Therapy to
discuss
referral
*Consent
from
Parent /
Social
worker
Individual Consultation
with staff
Team Intervention :
Meeting / Milieu Therapy
Report to
Key worker
TAC / AR
Health
Therapy
Review
Individual work
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Observation
Assessments
Joint work with staff
Individual psychotherapy
Staff development
Training
TM
May 2014 ©
Process diagram to access emotional and psychological support
Gathering a picture
Concerns
raised
•
•
•
•
Key worker
Health
Education
TAC / AR
Referral
Form
Completed
*
*Consent
from
Parent /
Social
worker
Multidisciplinary
Meeting
Health /
Therapy to
discuss
referral
View:
Referral Form
Consent Parental engagement
Multi-Disciplinary
Meetings
Non-Stigmatising
Intervention
Parent meeting / External
network meeting / Health
agency – GP
Multidisciplinary
Meeting
Health /
Therapy to
discuss
referral
Individual Consultation
with staff
Team Intervention :
Meeting / Milieu Therapy
Individual work
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Observation
Assessments
Joint work with staff
Individual psychotherapy
Staff development
Training
Integrated therapeutic support
programme
This is both an assessment system
which identifies areas of difficulties
and a programme to monitor outcomes
through the identification and
monitoring of a range of therapeutic
interventions. The support programme
is intended to support the
development of a young person’s
capacity to grow and recover in areas
of educational, emotional, social and
psychological development.
Process diagram to access emotional and psychological support
Report / Review
Report to
Key worker
TAC / AR
Health
Therapy
Parents
GP
Review
Process diagram to access emotional and psychological support
Gathering a picture
Intervention
Report / Review
Parent meeting / External
network meeting / Health
agency – GP
Concerns
raised
•
•
•
•
Key worker
Health
Education
TAC / AR
Referral
Form
Completed
*
Multidisciplinary
Meeting
Health /
Therapy to
discuss
referral
*Consent
from
Parent /
Social
worker
Individual Consultation
with staff
Team Intervention :
Meeting / Milieu Therapy
Report to
Key worker
TAC / AR
Health
Therapy
Review
Individual work
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•
•
•
Observation
Assessments
Joint work with staff
Individual psychotherapy
Staff development
Training
TM
May 2014 ©
www.psfs.org.uk
Film: Dawn House School
What is Mental Health
• Task: Discuss in pairs
“What is Mental Health, and what causes
mental illness?”
• Similarly discuss “What is Emotional
Wellbeing?”
How might these be different and similar?
How might we support them within Schools?
Factors Contributing to Mental Health and Emotional Wellbeing
Environmental /
Social
Psychological
Biological / Diagnostic
Developmental/ Life Experiences/ Life
events (past and present)
http://www.nhsinform.co.uk/mentalhealth
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Mental health and wellbeing is an important part of overall health and wellbeing
and can be affected by different factors, including life events such as relationship
breakdowns, bereavement and work stress as well as mental health conditions
such as depression or anxiety. Health Scotland has two definitions which are
helpful in understanding what we mean by mental wellbeing and mental illness:
Mental wellbeing: There are many different definitions of mental wellbeing but
they generally include areas such as: life satisfaction, optimism, self esteem,
mastery and feeling in control, having a purpose in life, and a sense of belonging
and support.
Mental illness: Mental illness refers to a diagnosable condition that significantly
interferes with an individual's cognitive, emotional or social abilities e.g.
depression, anxiety, schizophrenia.
It is also important to remember that it is natural to feel happy when
something positive happens to you, to feel sad or angry when a bad event
occurs, or scared and anxious if you are dealing with something
worrying. Part of ensuring good mental health and wellbeing is recognising
that it is natural to feel different emotions, but also knowing when you
perhaps need some help in dealing with life events and mental health
conditions.
Mental Health
Emotional Wellbeing
Barriers to communication /
understanding
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Factors Influencing both
Internal Psychological model
Environmental
Developmental
Systemic
Biological
Trauma / PTSD / Developmental Trauma
Factors Contributing to Mental Health and Emotional Wellbeing
Environmental
Psychological
House move
Anxiety in the home – anxious parent
School Leaver – loss of stability last year
9 years at school – long period of
relative stability
Biological / Diagnostic
ASC
Self Harm , Suicide
Social Anxiety
Agoraphobia
OCD type behaviour
Concrete sense of emotional experience
Over Identification with others – early phase
Developmental/ Life Experiences/ Life
events (past and present)
Fearful of change, fear of being
alone. Concern about future
living arrangements – possible
residential college explored
Psychological Services for Schools copyright
2013 Module KN1 Introduction to Mental
Health and Emotional Wellbeing
http://www.nhsinform.co.uk/mentalhealth
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•
•
Mental health and wellbeing is an important part of overall health and wellbeing
and can be affected by different factors, including life events such as relationship
breakdowns, bereavement and work stress as well as mental health conditions
such as depression or anxiety. Health Scotland has two definitions which are
helpful in understanding what we mean by mental wellbeing and mental illness:
Mental wellbeing: There are many different definitions of mental wellbeing but
they generally include areas such as: life satisfaction, optimism, self esteem,
mastery and feeling in control, having a purpose in life, and a sense of belonging
and support.
Mental illness: Mental illness refers to a diagnosable condition that significantly
interferes with an individual's cognitive, emotional or social abilities e.g.
depression, anxiety, schizophrenia.
It is also important to remember that it is natural to feel happy when
something positive happens to you, to feel sad or angry when a bad event
occurs, or scared and anxious if you are dealing with something
worrying. Part of ensuring good mental health and wellbeing is recognising
that it is natural to feel different emotions, but also knowing when you
perhaps need some help in dealing with life events and mental health
conditions.
Psychological Services for Schools copyright 2013
Module KN1 Introduction to Mental Health and
Emotional Wellbeing
Definitions
• Mental Health
• Emotional Wellbeing
Mental Health and Emotional Wellbeing are interlinked, but not necessarily causal. In
children with ASD or Asperger Syndrome much of their behaviour could be understood as
symptoms similar to mental health conditions such as OCD, Anxiety, Mood swings. This
type of behaviour is sometimes dismissively referred to as ‘part of being on the spectrum’.
Whilst there may be some truth to this, these symptoms could also be an indication of an
emotional disturbance indicative of a mental health condition.
Early detection and intervention is key to maintaining good emotional wellbeing and could
be seen as a preventative factor in the development of Mental Health.
Displaying concerning behaviour may be indicative of a mental health condition but it could
also be a response to abnormal life events or a response to normal developmental
experiences in childhood.
Children’s presentation must always be understood within the context of development,
maturation, family context, early developmental history, comorbid presentations such as
neurodevelopmental conditions and wider systemic understanding.
Psychological Services for Schools copyright 2013
Module KN1 Introduction to Mental Health and
Emotional Wellbeing
Mental Health
Emotional Wellbeing
Barriers to communication /
understanding
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•
•
•
•
•
Factors Influencing both
Internal Psychological model
Environmental
Developmental
Systemic
Biological
Trauma / PTSD / Developmental Trauma
Psychological Services for Schools copyright
2013 Module KN1 Introduction to Mental
Health and Emotional Wellbeing
Levels of presentation
Presenting behaviour / Observable behaviour
Anxiety, Low Mood, Self Harm
Symptom Management
Psychological, Pharmacological, Environmental
Levels of engagement in psychological work (CBT, Group, Systemic,
Psychodynamic, EMDR)
Diagnosis
Based upon current symptoms and causal groupings
Aetiology - origins/causation
• Genetic
• Biochemical
• Developmental history
• Life events – trauma / PTSD
• Current Environment – family
• Attachment Trauma
• Developmental Trauma
Psychological Services for Schools copyright 2013
Module KN1 Introduction to Mental Health and
Emotional Wellbeing
• The presentation reveals that cuts are increasingly being reported
in places such as south-west London. It says the Maudsley Child and
Adolescent Mental Health Services reports cuts across its London
boroughs ranging from 17% to 38%, and quotes the concerns of
mental health teams across the country.
• One team said that its £1m budget was to be slashed by £300,000
from next year. As a result, it was having to draw up plans to
become an urgent assessment and urgent treatment service only.
• Specialists would be unable to deliver the therapy for which they
had been trained. Another acknowledged that its specialist and
early intervention services were being dismantled.
• A third said that an increase in both routine and emergency
presentations had left it with no choice but to give priority to
clinical risk cases over routine follow-up activity, such as
assessments for ADHD and autism.
• The document quotes statistics, which reveal that in England there
is only one mental health specialist per 30,000 young people under
20, compared with one per 5,300 in Switzerland, 6,000 in Finland
and 7,500 in France.
Jamie Doward The Observer, Sunday 18 May 2014
Consent for Treatment
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What is consent
Different levels for consent
Who is consenting
Statutory provision – Mental Health Act
Voluntary engagement
Psychological Services for Schools copyright
2013 Module KN1 Introduction to Mental
Health and Emotional Wellbeing
Treatment
• Pharmacological – biochemical imbalances Depression
- Antidepressants, Anxiety – mood stabilisers, Psychotic
Illnesses – Antipsychotics
• Psychological Therapies – individual, group, systemic
models
• Applied environmental management. (Risk, Anxiety
management, emotional processing)
• Body focussed treatments – exercise, diet, lifestyle,
sensory focus, relaxation, mindfullness.
• Psycho-educational understanding of ‘flight-fright’
mechanism in PTSD. Hyper/Hypo arousal systems.
Psychological Services for Schools copyright
2013 Module KN1 Introduction to Mental
Health and Emotional Wellbeing