Written evidence submitted by Barnardo’s (CYP0088)

Maisie Davies, Senior Policy and Research Officer

About Barnardo’s

Barnardo’s is the UK’s largest children’s charity, with over 800 services across the UK. In 2019-20 we supported work with 358,800 children, young people, parents and carers, thanks to our network of services, our partnerships and the expertise and commitment of paid colleagues and volunteers.

During 2019-20, we supported 55,000 children and young people through our mental health services, including 45,100 in school based programmes, and 9,900 in our mental health services. This includes supporting the delivery of Mental Health Support Teams (MHSTs) in Swindon, Solihull and Cumbria, for example. However, supporting good mental health and wellbeing runs through everything we do. Our services support children affected by almost all the vulnerabilities identified as risk factors for poor mental health and wellbeing. We work with commissioners of services across health and social care sectors to ensure a holistic approach to supporting the mental health and wellbeing of the most vulnerable.

At Barnardo’s we believe it is important that children and young people are included in discussions about the issues they face and what the solutions could be. We would welcome the opportunity to support the committee to speak to young people Barnardo’s supports to inform this inquiry.

Summary of Recommendations

Context

●        Even before the COVID-19 pandemic, the mental health system was failing children and young people, leaving far too many children and young people reaching crisis point before they were able to access support. Too many children are ‘falling through the gaps’ of the system and facing a ‘cliff edge’ of support at 18.

●        Now children and young people’s mental health needs are skyrocketing, with the system ill-equipped to deal with the increasing demand[1].

●        81% of Barnardo’s frontline workers are reporting increases in mental health issues among the families they work with[2], and child mental health is the top reason for referral to the Barnardo’s Department for Education-funded See, Hear, Respond partnership programme- making up 68% of all 54,564 referrals received to date (as at February 2021).

●        Barnardo’s frontline workers are reporting increases in self-harm and suicide ideation among children and young people, and evidence suggests self-harm in younger children has doubled in the last six years[3].

Mental health in schools

●        Faced with the trauma of the COVID-19 pandemic schools must continue to be given flexibility in the curriculum as pupils return to school. ‘Summer classes’ should prioritise mental health and wellbeing - children should be provided a summer of free resilience activities and not put under pressure to ‘catch up’ academically.

●        Longer term, Barnardo’s is calling for a rebalancing of the wider education system so that wellbeing is on par with academic achievement, and that schools and educational settings are trauma informed.

●        While the Government’s Transforming Children and Young People’s Mental Health Green Paper in 2017 was welcome (and Barnardo’s is co-delivering some of the trailblazers), the timeline lacks ambition, with only a quarter-a third of children set to benefit from additional support in school by 2022/23. The Government must act faster to ensure that all children and young people benefit from the Green Paper proposals as soon as possible.

Wider mental health system

●        The ambitions of the NHS Long Term Plan for children’s mental health and the upcoming Health and Care Bill are welcome steps to improving the mental health system for children and young people, and reducing the number of transitions children and young people face.

●        However, urgent investment is needed for local areas to transform their mental health and wellbeing support - to shift focus from crisis interventions to early intervention and prevention, develop integrated and holistic service models, and to co-produce support and interventions with children, young people and families. Models like Solar in Solihull are already demonstrating what can be achieved to support better outcomes for children and young people.

●        Reducing barriers to access support must be a priority by developing targeted support for groups like care leavers and children and young people from Black, Asian and Minority Ethnic (BAME) communities. Barnardo’s Boloh helpline is an example of targeted support to BAME children and families[4].

●        Further integration of health and care will enable learning from best practice, and promote innovation. The voluntary and community sector (VCS) is a key partner in providing mental health and wellbeing support and should be considered a core partner in strategic decision making and delivery.

●        The Committee should consider the findings of this inquiry alongside other relevant reviews such as the Social Care Review and the Early Years Healthy Development Review, as well as the development of a National Centre for Family Hubs.

Suicide and Self-Harm

●        The Government must shift focus on to early intervention and prevention, as recommended by the APPG Suicide and Self-Harm Prevention’s recent inquiry. This should involve bringing forward NHS funded investment in children’s mental health, but also additional investment in community based services often provided by the third sector[5].

What progress have the Government made on children and young people’s mental health?

Mental Health in Schools

Barnardo’s welcomed the direction of travel set out by the Government in its response to the consultation on the Transforming Mental Health Green Paper[6]. However, we felt the proposals lacked ambition and would leave too many children waiting too long for the help they need.

Since the launch of the Green Paper in 2017, the global COVID-19 pandemic has seen us facing one of the biggest public health crises in a generation. But the pandemic is also having a significant impact on the nation’s mental health and wellbeing, and there is evidence to suggest that children and young people are disproportionately affected. 81% of Barnardo’s frontline workers told us that they were seeing increases in mental health and wellbeing issues as a direct result of the pandemic[7]. Of those who had seen an increase in issues amongst children and young people, 81% reported an increase in anxiety, 63% an increase in sleep dysregulation and 57% stress. The Centre for Mental Health predicts that an additional 1.5 million children in England will require new or additional support for mental health as a direct result of the pandemic[8].

COVID-19 has reinforced how critical schools and education settings are in promoting and protecting children and young people’s mental health and wellbeing. 88% of school staff surveyed by Barnardo’s last year said they thought the pandemic would affect the mental health and wellbeing of their pupils. Many highlighted the lack of daily contact with their more vulnerable pupils, or their concerns for children and young people who may become newly vulnerable due to the pandemic which would leave them hidden from view[9]. Barnardo’s See, Hear, Respond partnership was set up to respond to families who were struggling because of the pandemic. To date 68% of all referrals to the programme have been for child mental health issues - the biggest reason for referral. As schools and other education settings return to a ‘new normal’, they will face huge challenges, which schools simply cannot face alone.

Barnardo’s welcomed the commitment to Mental Health Support Teams (MHSTs) in schools, and we know first hand how they can make a real difference to children’s outcomes. Barnardo’s is the lead agency responsible for delivering MHSTs in Swindon, supporting 40 schools by delivering early interventions for mild and moderate mental health difficulties and supporting schools to implement whole school approaches to mental health. Barnardo’s is also supporting other areas such as in Solihull, where Barnardo’s manages the North Solihull MHST through our existing integrated Solar model[10]; in Morecambe Bay, where Barnardo’s is a delivery partner across South Cumbria and North Lancashire; and in the Isle of Wight (IoW) where Barnardo’s delivers MHSTs with IoW NHS Trust and IoW Youth Trust. However, we are concerned that the goal of reaching just a fifth to a quarter of the country, as set out in the Green Paper, does not go far enough as it would leave three quarters of areas with no improvement at all. This could result in a postcode lottery of support. We believe all children and young people must benefit as soon as possible from the Green Paper proposals.

Recommendation: The Government should ensure that all children and young people benefit as soon as possible from the aims of the Transforming Mental Health Green Paper - not just those living in the trailblazer pilot areas. The Government must communicate with and support all schools in England to adopt a ‘whole school approach’ to mental health and wellbeing.

We think there is a need to go further, building on the aims of the Green Paper to aspire for schools and the wider education system to be trauma-informed. This is more important now than it ever has been in the aftermath of the ‘collective trauma’ of the COVID-19 pandemic. The pandemic has caused understandable anxiety and distress for children, young people, their families and education staff. However, we are concerned that the wider education system does not always facilitate a mentally healthy school environment with Ofsted finding that their own inspections are a source of stress for teachers[11]. Measures that reduce pressures on education staff and pupils, and minimise distress, will support better mental health and wellbeing outcomes.

Of school staff we surveyed last year:

●        71% said they need access to tools or resources that can be used with children to support their mental health and wellbeing.

●        67% said they needed more support for their own mental health and wellbeing.

●        67% said that changes in the curriculum structure and exams process would help them support children and young people’s wellbeing[12].

●        62% said they needed more funding to support mental health and wellbeing initiatives.

●        58% said they needed training and development for school staff in supporting children’s mental health and wellbeing.

“They [the pupils] will be very worried to return to school and will not understand what is happening. They may not cope with the changes needed to ensure safety for all in school.” (School Counsellor/Educational Psychologist, Special School[13])

“Change or freedom in the curriculum to support our children’s mental health and wellbeing rather than greater emphasis on narrowing the gap or catching up on teaching. Children cannot learn if they are not emotionally stable or ready to learn.” (Headteacher/Deputy Headteacher, Primary School)[14]

We want to see all schools supported to adopt whole-school approaches to mental health and wellbeing, making mental health ‘everybody’s business’. This should also include the wider education system, which should be rebalanced so that wellbeing is on par with academic achievement. Barnardo’s is supporting this ambition through our recently launched Barnardo’s Education Community[15] and through pilots of Wellbeing Spaces in Scotland (see more information below).

We also believe colleges and universities need to be safe, nurturing learning environments for students and Barnardo’s Education Community is available to all education settings, including in further and higher education. Some young people are particularly vulnerable to experiencing mental health challenges in further and higher education, including for example care leavers who have less access to support networks, and young people from families living in poverty. Colleges and universities must also be trauma informed, and offer pastoral support for their students.

“I often dream and think about the impact it [Covid] could have on my future. I used to dream about university being the time where I flourished but if there’s still social distancing I don’t know how I’ll meet up with people and make friends. I think it’s made me worry more often. It’s affected my motivation, even though I’m getting sent work I have no motivation to complete the work, feeling like I’m in a slump. I’m more self critical about my work because I don’t have as much of the face to face content.” (Young Person)

Recommendations:

●        Rebalance the educational system so that it prioritises child welfare and wellbeing, including affording schools a readjustment period, with flexibility in the curriculum to meet the educational and psychological needs of their pupils, as more return to school. 

●        Recent announcements of ‘summer classes’ during summer of 2021 must have an emphasis on supporting mental health and wellbeing. We want to see a programme of free summer resilience building, social activities, open to all children and young people, but prioritising the most vulnerable. The relationship based programme should focus on re-establishing connections and include creative therapies and one-to-one support for the children who most need it. It should take advantage of unused buildings, such as unopened school buildings, sports or arts venues.

●        We would urge the Department for Education to build upon the aims of the Transforming Mental Health Green Paper, and consider the role of the wider education system on wellbeing, including the role of Ofsted. It should set out how the Department for Education and Ofsted will work towards adopting trauma-informed policy and practice themselves, as well as supporting schools to become more trauma-informed, in recognition of the traumatic nature of COVID-19. This might include piloting clinical supervision in schools or providing training in trauma and adversity to school staff.

Wider changes needed in the system as a whole, and to what extent it should be reformed in favour of a model that focuses on early intervention in children and young people’s mental health to prevent more severe illness developing?

Even before the COVID-19 pandemic the mental health system was failing to support children and young people’s mental health in a timely way, with too many children having to reach crisis point before they were able to access support. Children and young people are continuing to ‘fall through the cracks’ of the system, with many being rejected from Child and Adolescent Mental Health Services (CAMHS), but their needs deemed too high for universal services. Research by the Education Policy Institute (EPI) found that CAMHS are turning away over a quarter of children referred to them for treatment[16]. Rejection rates have not improved in four years, despite additional investment in children’s mental health, and the stated ambitions of the Green Paper and the NHS Long Term Plan. Children are also still waiting too long for treatment - an average of two months (56 days) in 2019, meaning that waiting times are still double the Green Paper standard of four weeks[17].

Last year, young people co-produced a report with Barnardo’s on the impact of the pandemic on children and young people’s mental health and wellbeing, and how the mental health system could be improved[18]. Young people highlighted three key themes:

●        Inequalities: The impact of COVID-19 has not been equal - COVID-19 and the measures to contain it have had a disproportionate impact on children and young people’s mental health and wellbeing, especially the most vulnerable and marginalised in society.

●        Not being listened to: Children and young people do not feel listened to, or that the Government spoke to them - and said it was important that decision makers learn from children and young people’s own experiences of what has helped their mental health and wellbeing. We drew up a ‘What kept me well’ map based on their responses[19].

●        Lack of early intervention: Too many children and young people are having to meet crisis point before they access support - children and young people said they wanted to be supported with their mental health and wellbeing at the earliest possible stage, before their needs escalate.

Inequalities

COVID-19 has highlighted and further exacerbated existing health inequalities, and is a reminder that the most vulnerable and marginalised children, young people and families are disproportionately impacted by poor mental health outcomes. Barnardo’s In Our Own Words report highlighted the disproportionate impact on, for example, children and young people with special educational needs and disabilities, Black, Asian and Minority Ethnic children and young people, those living in poverty and young carers[20]. For example, we know that Black children are less likely to access mental health support, but as adults are four times more likely to be detained by the Mental Health Act[21].  This is indicative of wider systemic inequalities that contribute to poor health outcomes, and the Government must make tackling this a key part of their levelling up agenda. We believe services also need to be targeted and provide accessible support to the most disadvantaged children and young people.

“The responses [to the young people’s survey] highlighted to me that the needs and voices of the most vulnerable children and young people had been forgotten in the pandemic, with many of society’s most vulnerable children and young people left with no support at all. If we learn anything from coronavirus it must be to make a change, listen to and prioritise these groups of children and young people.” (Young Person)

Inequalities in mental health care are particularly prevalent amongst the looked after population.   Children who are looked after are over three times more likely to have a mental health condition than disadvantaged children, and over five times more likely to have a diagnosed mental health condition than non-disadvantaged children[22]. There are also problems for this group in accessing the mental health support they need - particularly as they get older and move from children to adult services - a review of support for care leavers by Barnardo’s in 2017 found that 65% of young people whom workers identified as having mental health needs were not currently receiving any statutory service[23]. Issues identified including a lack of awareness of mental health and inflexible services that could not meet the needs of this group of young people.

Early evidence also suggests that these problems have been made worse by the pandemic. Children living in care and care leavers have reported feeling 45% and 86% more anxious during the lockdown,  respectively while at the same time professionals report that placements made during COVID-19 have been made without ensuring access to much-needed mental health support[24].  Where services are available, new referrals are not being accepted and thresholds for support have been raised.  This risks creating a perfect storm in relation to mental health support available for children in the care system.

Recommendation: the government should use the recently announced independent review of children's social care to have a specific remit to improve mental health support for children in and leaving the care system.  Solutions should include:

●        Ensuring that extra support for children’s mental health is provided through schools and is designed to meet the specific needs of care experienced young people utilising  trauma-informed practices and approaches.

●        The Department for Education’s pilot scheme with the Anna Freud Centre, which trials a new bespoke mental health assessment and support package for looked-after children, should be extended across the country with learning from this pilot used to fast-track innovative approaches.

●        Improved mental health services for care leavers for example by embedding mental health support into leaving care teams and by ensuring all CAHMS services offer support up to 25 to avoid the cliff edge at 18.

Listening to Children and Young People

Children and young people told us about how they felt forgotten and ignored during the coronavirus pandemic, and left without the support they needed. Children and young people told us in their own words what kept them well during the pandemic and this reflected the wide range of factors that contribute to promoting mental health and wellbeing. We want to see the Government, national and local decision makers involve children and young people in the decisions that affect their lives. Barnardo’s is supporting this in a range of ways, from setting up virtual conversations between young people and Members of Parliament[25], supporting young people to speak to decision makers in the NHS, and in co-producing and co-designing services with them. Barnardo’s LINK social prescribing service is just one example of co-production supporting better mental health and wellbeing outcomes for children and young people (see more information below).

“Recognise that we exist. Include us in policy development and not as an add on at some unknown future date.” (Young Person)

Early Intervention

Many local areas have reduced funding for low level, early intervention mental health support for children and young people, with nearly 60% of local authorities seeing a real-terms fall[26]. Wider early intervention support - such as youth services and children’s centres - has also reduced. Analysis by the Children’s Services Funding Alliance shows that funding for early intervention has been cut by 49% since 2010[27]. By failing to intervene early, we are only storing up problems for the future and spending increasing resources on late interventions, which are more costly. NHS projections showed that only one in three children with a diagnosable mental health condition would receive access to the support they needed[28] and the number of young people attending A&E due to a psychiatric condition has almost more than doubled since 2012-13 and almost tripled since 2010[29].

“There needs to be more activities for young people to get involved, with more funding to make this happen – not just in therapeutic services but [with] more emphasis on community based projects.” (Young People in Bristol)

We believe the Government needs to be more ambitious and invest to transform the mental health system so that it works better for all children and young people. It must ensure joined up, easily accessible and appropriate support services for as long as needed, and a system that prioritises early intervention and prevention. Not all children and young people with mental health difficulties will need a specialist CAMHS service. Early support is effective and cost effective.[30] This means providing a whole spectrum of social and clinical support to children and young people, targeted to individual need and made accessible to all. Such services should include (this is not an exhaustive list):

●        1:1 therapeutic interventions, including innovative and alternative therapies.

●        Social prescribing services targeted specifically at children and young people.

●        Commissioned peer support groups and networks as well as advocacy groups.

●        Additional support for children and young people on waiting lists for specialist services and who have been discharged, such as access to self-management tools and early intervention services.

●        Support for children experiencing bereavement, grief and loss as a result of the pandemic, especially those from groups most affected such as children and young people living in poverty and from Black, Asian and Minority Ethnic communities.

●        Access to personal mental health support budgets that can be used flexibly and tailored to buy services that are appropriate to meet needs in the way young people want.

Recommendations:

●        Involve children and young people in ‘recovery planning’ and give children and young people a role in national decision making on the policies that affect their lives.

●        The Government should provide long term, sustainable funding for the redesign of local support for children, young people and families’ mental health and wellbeing, prioritising:

○        Innovative partnership working between local authorities, health, education and the charity sector, to develop an integrated, whole systems approach.

○        Early intervention and prevention to meet children and young people’s needs at the earliest possible stage, and before they escalate.

○        Improvement of local responses to trauma, adversity and loss – supporting local professionals and services to become trauma informed.

○        Ongoing co-production of local solutions with children, young people and families. This must include communities that face barriers to accessing mainstream provision, such as BAME, LGBTQ+ or children in care and care leavers.

○        A whole spectrum of social and clinical support (including digital) is available to children and young people, continuing up to age 25 – including 1:1 support, social prescribing, peer support networks, and new and alternative therapies.

○        Provision of specialist mental health services based on need. We must review the current system of ‘tiers’ which can exclude children who don’t meet specific thresholds, and end the ‘cliff edge’ of support at age 18.

○        Development of contingency plans and flexible services in the case of future local, regional or national emergencies.

○        Evaluation of the impact of interventions on children and young people’s mental health and wellbeing outcomes, including those relying on traditional and digital forms of support.

●        The above transformation of local support should also come through more flexible personal budgets; children and young people supported by health and social care services should have a personalised support plan, supported by an integrated health and care system which uses a single point of access and record for children. Services should consistently allow children, young people, parents and carers to self-refer for support.

System changes that support improved mental health and wellbeing outcomes for children and young people must also include support in the early years. Research suggests that a baby’s earliest experiences shape their brain development and have a lifelong impact on their mental and emotional health. Adverse Childhood Experiences or trauma early in a child’s life such as child abuse (in any form), parental mental illness or substance abuse, or experiencing domestic abuse, are evidenced as the underlying factors most likely to lead to social and behavioural problems[31]. Yet our analysis shows that council spending on early intervention services for children, including children's centres and youth clubs, fell  by 49% to £1.9bn since 2010. This amounts to the closures of more than 1,000 children’s centres[32]. As part of the Government’s Early Years Healthy Development review, the Government must put support for the first 1000 days, early years, and early intervention for families, at the heart of the domestic policy agenda. This will help to promote better mental health outcomes at the earliest stage.

Recommendations:

●        The Government should commit to a long-term plan for the early years, which is backed up by a central Early Years Fund to safeguard early support programmes locally. ‘Building back better for families: a vision of support for every family in every community’ should be the Government’s new vision to ensure every parent or carer can access the ‘village’ it takes to raise a child - in-person or virtually, and should include:

○        A commitment to long-term, sustainable funding and planning cycles at national level, and long-term commissioning cycles at local level.

○        A commitment to conducting (and funding) evaluations and sharing learning/‘what works’, which must include new and innovative models of service delivery.

○        Targeted support for the most vulnerable children and families, as part of universal services.

○        Cross-government, cross-agency working, which we think is a prerequisite of effective early support. This must include integrated health and social care services which develop personalised health and social care and support plans for children and young people with a single point of access.

○        Co-design of services and strategy with parents, carers, and families.

○        Recognising the importance of digital in providing agile and flexible services, which enhance - but do not replace - face-to-face support for families.

How can Government learn from best practice, including other countries?

The Government must learn from best practice across the system supporting children and young people. There is a wealth of expertise across the system - with many services not badged as mental health services supporting children and young people’s mental health outcomes in a holistic and integrated way.

The move towards integrated health and care has potential to increase shared learning and best practice across the system, with practitioners from different disciplines learning from each other. A good example of this working in practice is in the Solar service in Birmingham - a partnership between Birmingham and Solihull NHS Foundation Trust, Barnardo’s and Autism West Midlands.

It is also important that the Government learns from UK-wide practice in mental health and wellbeing, with Scotland and Wales among those developing good practice around adverse childhood experiences (ACEs) and trauma. The Scottish Government coordinates the Scottish ACEs Hub to progress national action on ACEs to raise awareness and understanding, develop an evidence base and policy and practice approaches to prevent ACEs and mitigate their negative impacts[33].  

Barnardo’s Scotland has worked in partnership with Public Health Scotland on a film about embedding relational, trauma sensitive approaches in education settings, for example[34]. Barnardo’s Scotland has a long history of working in partnership with schools and have identified a key issue being a lack of consistent, dedicated time for reflection and support for teaching staff in relation to their own mental health and wellbeing[35]. Barnardo’s Scotland are piloting ‘wellbeing spaces’ in schools for teaching staff to help them manage the emotional impact of providing care to children, young people and families. The project includes a workshop programme which supports schools who wish to embark on setting up a Wellbeing Space to learn about trauma informed practice, self-care strategies, wellbeing space theory, practice and models, and support to produce an action plan to adopt tailored models to meet individual needs[36].

Recommendation:

●        We are calling for additional investment to fund a trauma informed approach in England along the lines taken by Scotland and Wales through the establishment of a childhood adversity and trauma hub.

What measures are needed to tackle increasing rates of self-harm and suicide among children and young people?

At Barnardo’s, our frontline workers have told us they are working with more and more children and young people who self-harm. Of our frontline workers who are reporting increases in mental health issues due to COVID-19, nearly a third (32%) are reporting increases in self-harm among children, and nearly a quarter (23%) are reporting increases in suicidal thoughts or attempts. Some frontline workers are also reporting poor coping strategies including increased alcohol consumption and drug use during the pandemic.

With an increasing number of children referred to specialist CAMHS services, there has been a bottleneck for access, meaning children and young people are often waiting longer for help. This is evidenced by a high proportion (26%) of children being rejected from CAMHS and those who do access CAMHS on waiting lists for an average of two months, double the Government’s four week target[37]. High demand for services and high thresholds to access specialist services are a barrier for young people who self-harm to access support.  One of the young people we spoke to about self-harm said to us last year:

“Access to CAMHS has become almost impossible, unless a child is in crisis. Even young people who have made suicide attempts (taking pills) are seen in hospital and then discharged with no further follow up”.

It is vital that children and young people who require a specialist service receive one in a timely way. However it is also true that not all children and young people will require a specialist CAMHS service.  We believe there needs to be transformational change in service provision, which shifts focus to early intervention and co-produces solutions with children and young people. Last year, the All-Party Parliamentary Group (APPG) on Suicide and Self-Harm Prevention undertook an inquiry into the support available for young people who self harm. The inquiry heard from a wide range of experts and specialists in children and young people’s mental health, and they found overwhelming agreement that the single most impactful change to improve support available to young people who self-harm would be to shift the system away from crisis interventions towards a preventative model of support. This should include bringing forward investment in NHS funded mental health support, but also increasing investment in community-based, preventative services, often delivered by the third sector[38]. 

The Solar service in Solihull, where Barnardo’s works together with Birmingham and Solihull Mental Health NHS Foundation Trust and Autism West Midlands, focuses on creating a system designed around the needs of children and young people which keeps them healthy as well as treating those who are ill. The service prioritises resilience, partnership and co-production. Figures from the National Mental Health Data Set show Solar was one of the first community mental health services in the Midlands exceeding the regional target of a 32% increase in access to NHS community services for those with a diagnosed mental health issue.

Recommendations:

To tackle rates of increasing self-harm and suicide in children and young people, the Government should:

●        Focus on early intervention, driving a cultural shift in the way the NHS works especially in responding to the needs of children and young people who self-harm or are at risk of self-harming in the future. This requires working with statutory and voluntary sectors and listening and responding to what children, young people, their parents and carers want in service design and delivery.

●        Additional investment to fund a childhood adversity and trauma informed approach in England, with a focus on early identification of problems or risk factors which must then lead to appropriate intervention.

●        Additional support for vulnerable children and young people who may find it difficult to engage with CAMHS or other mental health service provision.

●        Faster roll out of the Green Paper ambitions so that all schools benefit from Mental Health Support Teams (MHSTs) and implement a whole school approach to children’s mental health.

Recommendations

Mental Health in Schools

●        Rebalance the educational system so that it prioritises child welfare and wellbeing, including affording schools a readjustment period, with flexibility in the curriculum to meet the educational and psychological needs of their pupils, as more return to school. 

●        Recent announcements of ‘summer classes’ during summer of 2021 must have an emphasis on supporting mental health and wellbeing. We want to see a programme of free summer resilience building, social activities, open to all children and young people, but prioritising the most vulnerable. The relationship based programme should focus on re-establishing connections and include creative therapies and one-to-one support for the children who most need it. It should take advantage of unused buildings, such as unopened school buildings, sports or arts venues.

●        We would urge the Department for Education to build upon the aims of the Transforming Mental Health Green Paper, and consider the role of the wider education system on wellbeing, including the role of Ofsted. It should set out how the Department for Education and Ofsted will work towards adopting trauma-informed policy and practice themselves, as well as supporting schools to become more trauma-informed, in recognition of the traumatic nature of COVID-19. This might include piloting clinical supervision in schools or providing training in trauma and adversity to school staff.

●        The Government should ensure that all children and young people benefit as soon as possible from the aims of the Transforming Mental Health Green Paper - not just those living in the trailblazer pilot areas. The Government must communicate with and support all schools in England to adopt a ‘whole school approach’ to mental health and wellbeing.

Wider changes needed to the system

●        The government should use the recently announced independent review of children's social care should have a specific remit to improve mental health support for children in and leaving the care system.  Solutions should include:

○        Ensuring that extra support for children’s mental health is provided through schools and is designed to meet the specific needs of care experienced young people utilising  trauma-informed practices and approaches.

○        The Department for Education’s pilot scheme with the Anna Freud Centre, which trials a new bespoke mental health assessment and support package for looked-after children, should be extended across the country with learning from this pilot used to fast-track innovative approaches.

○        Improved mental health services for care leavers for example by embedding mental health support into leaving care teams and by ensuring all CAHMS services offer support up to 25 to avoid the cliff edge at 18.

●        Involve children and young people in ‘recovery planning’ and give children and young people a role in national decision making on the policies that affect their lives.

●        The Government should provide long term, sustainable funding for the redesign of local support for children, young people and families’ mental health and wellbeing, prioritising:

○        Innovative partnership working between local authorities, health, education and the charity sector, to develop an integrated, whole systems approach.

○        Early intervention and prevention to meet children and young people’s needs at the earliest possible stage, and before they escalate.

○        Improvement of local responses to trauma, adversity and loss – supporting local professionals and services to become trauma informed.

○        Ongoing co-production of local solutions with children, young people and families. This must include communities that face barriers to accessing mainstream provision, such as BAME, LGBTQ+ or children in care and care leavers.

○        A whole spectrum of social and clinical support (including digital) is available to children and young people, continuing up to age 25 – including social prescribing and new and alternative therapies.

○        Provision of specialist mental health services based on need. We must review the current system of ‘tiers’ which can exclude children who don’t meet specific thresholds, and end the ‘cliff edge’ of support at age 18.

○        Development of contingency plans and flexible services in the case of future local, regional or national emergencies.

○        Evaluation of the impact of interventions on children and young people’s mental health and wellbeing outcomes, including those relying on traditional and digital forms of support.

●        The above transformation of local support should also come through more flexible personal budgets; children and young people supported by health and social care services should have a personalised support plan, supported by an integrated health and care system which uses a single point of access and record for children. Services should consistently allow children, young people, parents and carers to self-refer for support.

Early intervention and family hubs

●        The Government should commit to a long-term plan for early intervention for families, including in the early years, which is backed up by a central fund to safeguard early support programmes locally. Family hubs offer accessible, integrated, whole family support.

●        ‘Building back better for families: a vision of support for every family in every community’ should be the Government’s new vision to ensure every parent or carer can access the ‘village’ it takes to raise a child - in-person or virtually, and should include:

○        A commitment to long-term, sustainable funding and planning cycles at national level, and long-term commissioning cycles at local level.

○        A commitment to conducting (and funding) evaluations and sharing learning/‘what works’, which must include new and innovative models of service delivery.

○        Targeted support for the most vulnerable children and families, as part of universal services.

○        Cross-government, cross-agency working, which we think is a prerequisite of effective early support. This must include integrated health and social care services which develop personalised health and social care and support plans for children and young people with a single point of access.

○        Co-design of services and strategy with parents, carers, and families.

○        Recognising the importance of digital in providing agile and flexible services, which enhance - but do not replace - face-to-face support for families.

Learning from best practice, including from other countries

●        We are calling for additional investment to fund a trauma informed approach in England along the lines taken by Scotland and Wales through the establishment of a childhood adversity and trauma hub.

Tackling self-harm and suicide

To tackle rates of increasing self-harm and suicide in children and young people, the Government should:

●        Focus on early intervention, driving a cultural shift in the way the NHS works especially in responding to the needs of children and young people who self-harm or are at risk of self-harming in the future. This requires working with statutory and voluntary sectors and listening and responding to what children, young people, their parents and carers want in service design and delivery.

●        Additional investment to fund a childhood adversity and trauma informed approach in England, with a focus on early identification of problems or risk factors which must then lead to appropriate intervention.

●        Additional support for vulnerable children and young people who may find it difficult to engage with CAMHS or other mental health service provision.

●        Faster roll out of the Green Paper ambitions so that all schools benefit from Mental Health Support Teams (MHSTs) and implement a whole school approach to children’s mental health.

March 2021