Put early intervention front and centre of mental healthcare

The week commencing 14 May 2018 was National Mental Health Awareness Week. Among the many events organised to mark this, the All-Party Parliamentary Health Group and CLOSER (a research centre bringing together the UK’s leading longitudinal studies) held a joint seminar on “Tackling mental health problems in children and young people: the importance of early intervention”; bringing together MPs, charity leads, academics and the health and social care workforce.

Listening to the attendees, it was heart breaking to reflect upon how far we have still to go in this area.

Central to the discussions was a recently released and uncompromising parliamentary paper.

On 9 May 2018, the Health and Social Care Committee published their response to the government’s green paper on Transforming Children and Young People’s Mental Health. From a committee made up of a majority of government (rather than opposition) MPs, the conclusions could not be more blunt.

Lack of ambition

The committee’s assessment is evident from the title: “The Government’s Green Paper on mental health: failing a generation”. This is further underlined by a headline introduction which concludes that the committee considers that the green paper “lacks any ambition and fails to consider how to prevent child and adolescent mental ill health in the first place”.

This is not a response which holds back for the sake of political sensitivity and, given the importance of the subject matter, this is to be welcomed.

The criticisms are wide ranging:

• The government limited the scope of the green paper too early by restricting the terms of the evidence review
• The proposals put more pressure on the teaching workforce without sufficient resources, and the timetable for implementation ignores hundreds of thousands of children over the next 12 years
• The green paper does not adequately connect to other relevant policies and misses opportunities to address fragmented and, in places, poor services
• There is a lack of evidence that the changes the green paper proposes will join up services in a way which places children and young people at its hear
• The government should have placed a greater emphasis on, and provided a strategy for, prevention, early intervention and dealing with some of the root causes of child mental health problems
• The green paper says little about mental health of the 0-5 year age group. Opportunities are being missed to promote emotional resilience and prevent mental health and well being problems later in life.
• Young people are falling through the gaps and not receiving the services they need as they enter adulthood

The accompanying “social story” document (published online alongside the committee’s response) outlines why, among other areas of concern, the lack of emphasis on early – rather than crisis – intervention matters so much:

• Half of all mental health conditions first occur by age 14, and three quarters by age 24
• At least one in 10 children are living with some form of diagnosable mental health condition
• One third of 18 year olds drop out of mental health support rather than transfer to adult services

These will not be surprising statistics for those working with young people. Whether working within the NHS, with looked after children, with those in the youth criminal justice system, or in schools, the needs have long been known.

What adds context to the current state of affairs is that these needs are finally coming to the attention of the wider media and general public alike. In March 2018, Southern Health Foundation Trust was fined a record £2m, after pleading guilty to breaching health and safety laws.

With thousands of young people on waiting lists to access our currently overburdened and underresourced mental health services, we can only hope that the government reflects on and reacts to the committee’s criticisms

As much as £1m of this fine was in recognition of the failings that led to the death of 18 year old Connor Sparrowhawk. During an investigation which only came about after the vociferous campaigning of Connor Sparrowhawk’s mother, the trust was found to have failed to properly investigate the deaths of more than 1,000 other patients with learning disabilities and mental health problems over a four year period.

It is incumbent upon those of us working within or for providers within the sector to consider why, despite the front page headlines, there still seems to be a reticence to place the emphasis on early prevention strategies. Perhaps it is because those who work with or for young people often rely so strongly on the moral argument, assuming it to be a no brainer.

We should help these young people, they say, because it is the correct thing to do, because they are vulnerable and because we have a moral obligation to be proactive to prevent pain where we can.

But what if we were looking for an alternative language to persuade governments of the efficacy of allocating greater funding to early intervention? If so, it may be the age old argument of allocation of resources that could win out.

If we could make substantive differences to, for example, the 0-5 age group (a group not satisfactorily addressed within the green paper), we could minimise or even prevent mental health issues persisting into adulthood. This is a straight forward economic argument. Short term, early intervention which could have a measurable impact on reducing the significant financial resources required to address long term and/ or crisis interventions in adults.

This is evidently not the sole solution, nor is it suggested that early intervention would rid our adult population of the current mental health crisis. It does, however, seem like a false step for this green paper not to have put early intervention front and centre.

The government has two months to respond to the committee. With thousands of young people on waiting lists to access our currently overburdened and underresourced mental health services (and with the knowledge that, if not properly treated, these mental health issues will affect these young people into later life), we can only hope that the government reflects on and reacts to the committee’s criticisms. For the sake of current and future generations, it cannot do so soon enough.