Written evidence submitted by The Association of Directors of Children’s Services Ltd. (ADCS) (CYP0062)
- The Association of Directors of Children’s Services Ltd. (ADCS) is the national leadership organisation in England for directors of children’s services (DCSs) appointed under the provisions of the Children Act (2004). The DCS acts as a single point of professional leadership and accountability for services for children and young people in a local area, including children’s social care and education. ADCS welcomes the opportunity to respond to the Health and Social Care Select Committee call for evidence as part of the inquiry into children and young people’s mental health.
- The Mental Health of Children and Young People in England 2020 survey found that one in six (16%) children aged 5 to 16 years were identified as having a probable mental disorder. This is an increase from one in nine (10.8%) found by the same survey undertaken in 2017. It is estimated that around 75% of young people experiencing mental health problems are not receiving the support or treatment that they need, this is deeply worrying.
- Poor mental health and wellbeing can have a lasting impact on children’s life chances. The Princes Trust Youth Index 2021 found that more young people are feeling anxious than ever in the 12-year history of the Index. Further, it found that one in four young people feel "unable to cope with life" since the start of the pandemic, this increased amongst those not in work, education or training (NEETs). Half of 16 to 25-year-olds said their mental health has worsened since the start of the pandemic.
- Although Covid-19 appears to pose a lower risk of infection to children and young people, the detrimental secondary impacts of the pandemic on their mental health and emotional wellbeing are emerging. Multiple surveys undertaken in lockdowns have highlighted increased fear, anxiety and loneliness amongst children and young people at a far higher rate than the general population. ADCS members report that due to lockdown and ensuing social distancing measures, there has been an increase in the number of children and young people presenting in crisis, some of whom are not previously known to children’s services and their needs have escalated quickly without the usual opportunities for services to intervene early. It is questionable as to whether the mental health system has the capacity to respond to a significant surge in demand due to the impact of the pandemic.
- In our response to the 2017 Green Paper, ADCS welcomed the focus on improving children and young people’s mental health, the emphasis on early help and prevention and the additional investment being made available. The pace and scale of implementation outlined in the Green Paper was disappointing. The ambition did not go far enough for children and young people given the prevalence of need and the significant barriers experienced in accessing services. To limit implementation of the Green Paper’s central proposals, mental health support teams (MHST), designated senior leads, and four week waiting times to a fifth to a quarter of the country by 2022/23 did not go far enough to acknowledge and address the challenges that our children and young people are experiencing and reinforces the postcode lottery so often noted in accessing mental health support.
- There remains a need for a sustainable, long term funding strategy for children and young people’s mental health services. It is understandable, given the pandemic, that the government chose to announce a 1-year spending review for 2021/22 rather than a multi-year settlement. However, this lack of long-term funding significantly hampers efforts to achieve meaningful and significant change over the longer term.
- While the Green Paper reaffirmed the government’s commitment to implementing the recommendations in Future in Mind and the £1.4 billion funding to achieve this, there continues to be a vacuum in terms of transparency and accountability as to how resources are being used to improve outcomes for children and young people. ADCS members remain concerned that funding intended for children and young people’s mental health provision is being used to alleviate wider pressures within the NHS. Following previous reports, the lack of transparency and accountability within the system has again been highlighted by the Children’s Commissioner in her publication ‘The state of children’s mental health services 2020/21’. There are significant variations across CCGs with regard to spend, waiting times, percentage of children accessing treatment, and the percentage whose referrals are closed before accessing treatment. More needs to be done to bring greater clarity on how funding is being utilised to support the mental health and wellbeing of children and young people and improve outcomes.
- The Green Paper was a missed opportunity to take account of the wider determinants of mental health. This is a complex and multi-faceted issue but as a system, we need to be open and honest about the drivers of demand or we will never effectively tackle them. It was disappointing that schools judged to be ‘inadequate’ by Ofsted were initially excluded from taking part in the arrangements for MHSTs. ADCS raised concerns that these were exactly the schools with the pupil demographics that would benefit from the additional support available. The criteria has since been revisited to allow schools to participate irrespective of Ofsted judgement, this is welcome.
- The Green Paper rightly acknowledged the vital role of schools in the early identification and support of pupils with mental health problems. Schools are well placed to understand the mental health and wellbeing challenges facing their pupils. As we start to plan for the return to schools following the third national lockdown, children and young people will need support to successfully reintegrate back into school and overcome the impact of the pandemic. Whilst Covid-19 has impacted all children and young people, its impact has not been evenly spread; health, social, educational, racial, geographical and generational inequalities have become more and more visible as the pandemic has progressed.
- DfE has invested £8m in the Wellbeing for Education Return Programme and while this is a welcome acknowledgement that wellbeing needs to be prioritised, this programme is intended to help education staff support and build their own, children and young people’s, and parents’ and carers’ mental wellbeing, on top of their existing roles. We have rightly looked to schools to address the universal health and wellbeing needs of pupils as part of their day to day offer, but they are under significant and sustained pressure as they continue to grapple with Covid safe arrangements, bubbles, self-isolation, developing a hybrid learning offer and planning for exams. This is workforce under significant pressure and we need to be careful about asking too much of them without also providing the necessary resources.
- ADCS members continue to support the LGA’s call for central government funding to be used to ensure access to on-site school counselling services for every pupil in secondary and alternative education provision is mandatory. DfE is aware of the benefits of school based counselling, Counselling in Schools: a blueprint for the future, states: “counselling within secondary schools has been shown to bring about significant reductions in psychological distress in the short-term, and helps young people move closer towards their personal goals”. This is something that is also supported by the Children’s Commissioner, whilst encouraging greater collaboration with the voluntary sector to build capacity and ensure this is rolled out to the benefit of all children and young people as quickly as possible.
- Although the development of school based early help and prevention models is welcome, there remains a large cohort of children and young people who do not attend registered education settings. The ADCS Elective Home Education Survey 2020 estimated that over 75,600 children and young people were being electively home educated on 1 October 2020. Findings showed that ‘health/emotional health’ was the third most common reason provided by parents or carers in choosing to electively home educate, yet these young people won’t benefit from the school-based support that is being developed.
- The needs of young people with a learning disability who require access to specific mental health support must also be given further attention. This area of provision is often more poorly resourced than other specialist mental health services and it is unclear how such children and young people will benefit from this approach.
- As the roll out of MHSTs continues, there is limited information available as to the impact of implementation to date. The system would benefit from more information on progress with roll out, future roll out plans and impact, including data around the need for onward referral to more specialist services.
- Available data on the spectrum of emotional health and wellbeing services, including referrals and access to specialist children and young people’s mental health services remains limited. In her recent report, the Children’s Commissioner identifies that in 2020, only one in four children who needed mental health services were able to access them and although the Green Paper set out an ambition for a 4-week waiting target, only 20% of children referred to services started treatment within 4 weeks.
- ADCS members report continued challenges in accessing tier 4 provision for those with severe and/or complex needs who require in-patient services. This is two-fold; partly a result of health partners drawing distinctions between children and young people’s emotional and behavioural needs and their diagnosable mental health condition in order to gatekeep access to rationed CAMHS services, and the NHS policy drive to reduce the number of children in tier 4 mental health placements. This has resulted in these children very often being referred for secure welfare placements or being placed in unregulated provision with significant levels of wrap around support because there is a lack of appropriate provision in the community. Secure welfare placements remain in acute shortage and the government has recently confirmed plans to reform unregulated provision. Where children have accessed a secure or tier 4 placement, there is a desperate need for more bespoke step-down provision that will support their successful reintegration into the community. Those children who do not meet tier 4 criteria but exhibit the same levels of distress would also benefit from such provision, however, a whole system approach is needed; health and social care partners have a joint responsibility to develop this provision. There are clear synergies with secure youth justice provision too.
- ADCS members continue to be concerned that the current system does not have the capacity to meet both current and future need; the full impact of the pandemic is not yet known at an individual or societal level. The recruitment and retention challenges within the CAMHS workforce have been widely reported and cannot be underestimated. There is a lack of oversight and ownership at the national level in the development of the whole spectrum of the children’s services workforce. The absence of national data on the wider children’s services workforce further exacerbates this problem. ADCS members suggest there is a need for a national holistic workforce strategy, informed by timely and accurate data, covering the breath of professionals working with children and young people. There are shortages in many areas of the workforce, from social workers, teachers and educational psychologists, to speech and language therapists to child psychiatrists, which must be addressed.
- The contribution of health and its poor prioritisation of the needs of vulnerable children, not limited to the role of CAMHS, continues to be a longstanding concern for ADCS members. The health system has joint responsibility with children’s social care, for ensuring that the needs of young people with complex health and mental health needs are met, with suitable provision which is jointly funded. Where this is not happening, the right accountability measures need to be in place, currently they are missing from the system. The new Health and Care White Paper, along with the further development of Integrated Care Systems placing them on a statutory footing, provides an opportunity for all partners to prioritise children and their mental health.
- The principles of early intervention and prevention are wholeheartedly supported, it is absolutely the right thing to do to work with children, young people and families at the earliest opportunity to provide the support they need and where possible, prevent any escalation in need. However, this focus cannot be at the expense of more specialist services. Some children and young people’s needs are such that they will need intensive specialist support, access to this must be straightforward and timely.