Written evidence submitted by the Actors’ Children’s Trust (CYP0089)
ACT (the Actors’ Children’s Trust) is a Charitable Incorporated Organisation that gives grants, advice and support to professional actors with children. We were established over 120 years ago. In the 2019 – 2020 financial year we supported 584 children and young people, from 390 families.
In the course of our work with families we are frequently contacted by parents with concerns about their child’s mental health. As a national organisation we are witness to experiences from a wide range of areas, ages and circumstances.
With reference to the progress made by the Government on children and young people’s mental health, I would like to share our beneficiaries experiences in relation to:
This submission will also comment briefly on the case for early intervention, and how the Green Paper’s aim for schools to take a lead on supporting children’s mental health needs further investment and consideration of existing Safeguarding duties, if they are to tackle increasing rates of self-harm.
The submission will include examples from our work with families that illustrate the points made and are representative and indicative of frequent themes. They should not be dismissed as isolated incidents.
One of the key ambitions of the Green Paper was to reduce waiting times for NHS services, as in some areas these were considered ‘not good enough’ (Chapter 1.17). Sadly, this is still the case today. Although the Covid-19 pandemic has not helped, waiting times were an issue before Covid and it is incredibly important that the pandemic is not used as a scapegoat for a system that has been failing for years.
3.1 Case example
A case as illustration from one of the families we support: in June 2019 a GP made a referral to CAMHS for an 11-year-old girl who was hearing the voice of a ‘demon’ in her head, who told her bad things would happen. CAMHS told the family to expect up to a year’s wait for support, and to expect the child to be out of school for a year. Her mother was left with these worries with nowhere else to turn. In July 2019 she was so concerned she took her daughter to hospital, who contacted CAMHS on her behalf to try to speed up the process.
The child was assessed by CAMHS on the 29th August 2019. By this time her eating was hugely restricted because the demon had told her the food was poisoned, she was self-harming and talking of suicide. After the assessment she was put on a waiting list for treatment/support, and again told it would be approximately one year. To this day, 20 months later, she has still not received a service from CAMHS. The only action taken in this time has been to signpost her mother to a parent support group.
It must not be the case that CAMHS can report children like these as having accessed the service, when they have had nothing but an assessment.
3.2 Financial illustration
The above case is not an exception, multiple other similar accounts could be given. In the current financial year, which still has more than a month left to go, our charity has given almost £62,000 to fund private assessments and therapeutic support for children who simply cannot wait for the wheels of the NHS to turn. These children are the lucky ones, they are getting the help they need through us, but we are a niche charity and what of the children not eligible for our support?
3.3 Recommendation – further investigation and changing attitudes
The Government commitment to parity of esteem between physical and mental health has not been met. Operating entirely outside of the NHS, I cannot speculate on the reasons why this has not been achieved but suggest that honest conversations need to be had with the NHS about what they need to make this work, and the Government must act on that.
Certainly it is clear that complacency has set in over the years, and everyone from CAMHS staff, GPs, other statutory bodies and voluntary organisations to parents now accept this as the norm. I have been made aware of several occasions where GPs have advised parents to pay for private help if they can, to avoid the wait. The inequality this creates for those without financial means is obvious. The only people still shocked by the waiting times are the children themselves. We should all be scandalised by it. A sea change is needed.
Helping children before serious illness develops is plainly better than waiting for a crisis. Dismissing children’s real and genuine concerns compound them and teaches them they are not worth helping.
4.1 Case example
A case as illustration from one of the families we support: in February 2019, a 14-year-old girl who believed she had a mood disorder and who had been the victim of a sexual assault was assessed by CAMHS and told she “was not ill enough” to receive help. Because of that, she began to harm herself so that she would meet criteria, and was given a conciliatory three sessions of weekly CBT.
Three sessions clearly do not meet the NICE guideline for Depression in children and young people (1.6.5) and this young person now has a significant alcohol addiction.
4.2 Recommendation – service expansion
Services must be increased and expanded to support children before they get to the point of crises. Ideally, they should be based in a range of settings, not only in intimidating, medical-orientated hospitals. As one 17-year-old said to me recently “I’m not sick, I don’t need medication, I just need someone to talk to.”
Another key aim of the Green Paper was for schools and colleges to take a lead in supporting children with their mental health and I would like to now talk about that, and how it interacts with the inquiry’s question on the measures needed to tackle self-harm.
In order to understand how schools can integrate this ambition, there needs to be an understanding of their current practice. The Green Paper called for one designated senior lead for mental health, responsible for embedding whole-school approaches. This is a start, but it simply isn’t enough. Look at the number of Safeguarding leads in most schools and you will have an indication of the number of mental health leads needed to ensure the breadth and depth of understanding, expertise and coverage required. This must be appropriately funded. It cannot be an add-on to the already overloaded roles of teachers and without the funds to free up capacity to attend training and dedicate specific time to the duty.
5.1 Tackling self-harm and the interaction with the Safeguarding duty
Any approaches to self-harm must be considered alongside Safeguarding legislation and practice. Currently, if school staff notice harm on a child’s body they are duty-bund to report it via Safeguarding procedures to their Local Authority. Our experience has shown that they are so mindful of this duty that even if they feel confident the child has caused the harm themselves, they do not feel confident that they can risk assess and refer for mental health support instead. There is no mention of a procedure or approach for self-harm anywhere in Working Together to Safeguard Children.
A case as illustration from one of the families we support: in July 2020 a school contacted their Local Authority MASH team after noticing marks on one of their pupils, a previously Looked After Child who was adopted after serious abuse and neglect. The child has an EHCP and recent reports from an Educational Psychologist, a specialist Trauma Assessment and a Therapist that all clearly describe a history of self-harm due to complex trauma experienced in her early life, particularly when the child lacks structure and security. As this was only a few months into the pandemic and the child was attending school in a very different way (vulnerable and keyworker children only, usual TA was shielding), it was not surprising that the child regressed to harmful ways of coping.
The child’s mother was informed of the referral when she went to collect the child at lunchtime – school was only open for a half-day as it was the last day of term. Both she and the child were made to wait, separately, until 7:30pm in the evening in an otherwise closed school until the police arrived and placed the child with family friends while they investigated. The investigation was dropped and the child returned to their adoptive mother 4 days later, after the police read the professional reports mentioned.
5.3 Impact of failing to address the existing conflict
Having previously worked in a school I do not take schools’ Safeguarding duties lightly and nor do I envy their position. The school in our example felt they had no choice, despite being fully aware of the child’s history, and felt they were correctly carrying out their legal Safeguarding duty. However, this course of action caused untold damage to this family. The relationship between the mother and school has broken down and she has applied for her child to move schools. The huge amount of work she has done to show this child they have a permanent home was set back immeasurably.
Most importantly, this child and any others with knowledge of what occurred will now be highly unlikely to trust school staff, and potentially other authority figures, with a disclosure of self-harm or mental health concerns, for fear their parents will be accused of abuse and they will be removed from their home.
5.4 Recommendation – new guidance
If schools are to take a lead on mental health support, the Government must in turn support them by working with colleagues in the Department for Education to create new, clear guidance on supporting children who self-harm, that does not conflict with their Safeguarding duty. The guidance should afford them the expertise, permission, criteria and confidence to take appropriate and proportionate courses of action.
5.5 Recommendation – new, child-led materials
The Government should also create materials for children and young people that explain, honestly and clearly, what might happen if they ask for help with self-harming. These should be produced in collaboration with children and young people themselves, and with expert organisations like the NSPCC. The bravery it takes to ask for help with something as secretive as self-harming cannot be underestimated, and we must unsure that when children do that, it is a positive experience that leads to the help they need, otherwise the chance may be lost forever.
Head of Family Support