CONSULTATION ON THE NEXT MENTAL HEALTH STRATEGY
Introduction
Children in Scotland (CiS) is the national membership organisation for the children’s
sector in Scotland, representing over 500 members in the public, voluntary,
community and independent sectors.
Children in Scotland welcomes the Scottish Government’s announcement on the
development of a new mental health strategy for Scotland and welcomes the
opportunity to comment on its purpose and objectives.
Our specific responses to the consultation questions are presented below and we
are pleased to provide any further detail on request. This response has been
informed by the views of Children in Scotland’s members through a special
convened meeting of our Children’s Sector Forum on 21st March. It has also been
informed by the views of children and young people gathered through our projects
and Enquire1 participation and engagement work.
Key Question: What outcome do you want to achieve for mental health in
Scotland?
Children in Scotland’s believe that all children should have the opportunity to grow up
with good mental health and have access to the necessary mental health support
where required.
Currently too many children and young people still experience mental health
difficulties and barriers to accessing appropriate support. The most up to date
figures suggest that one in ten children will have a diagnosable mental health
problem2, but this evidence is relatively old now and requires updating.
We know that many mental health problems are not currently diagnosed and that
children and young people experience a number of barriers to help seeking for
mental health problems3. With evidence suggesting that adolescence is the most
1
Enquire is the national advice service on additional support for learning
Green, H., McGinnity, A., Meltzer, H., et al. (2005). Mental health of children and young people in
Great Britain 2004. London: Palgrave.
3
Gullivar A, Griffiths KM and Christensen H (2010) Perceived barriers and facilitators in mental health
help-seeking in young people; a systematic review, BMC Psychiatry, 10:113)
2
common period for the onset of mental health problems across the lifespan4, there is
a strong case to be made for strong action to prevent mental health problems in
children and young people and mitigate the many negative outcomes associated
with poor mental health both in childhood and adult life.
It is important that children and young people at risk of developing mental health
problems are identified early, based on known predictors of mental health problems,
such as poor parental mental health, bereavement, experiencing abuse, bullying or
discrimination5.
To achieve this we believe there are three key areas where change is required over
the lifetime of the next mental health strategy: Participation and Inclusion, Early
Intervention and Prevention, and Inequalities and Poverty. Details of our
recommendations in these three areas are incorporated into our response below.
Overall framing for the next Mental Health Strategy
CiS is generally supportive of the three ambitions laid out in the discussion paper
and view them as appropriate areas for change.
Measuring outcomes
We strongly agree that concerted effort is required to develop and measure
outcomes to enable individuals, service providers and commissioners to know
whether interventions provided are having their intended impact.
It is essential that for children and young people, mental health outcomes are linked
to Getting it Right for Every Child (GIRFEC), our national approach in Scotland to
improving outcomes and supporting the wellbeing of children and young people and
the eight SHANARRI indicators for wellbeing6. This will ensure that the focus of the
mental health strategy aligns with statutory obligations under the Children and Young
People (Scotland) Act 2014, which affects all services and institutions that have a
responsibility towards the wellbeing of children and young people.
It is also of vital importance that outcomes are meaningful for the individual children
and young people concerned and must consider what a successful outcome would
look like from their perspective. We strongly recommend that participation and
engagement work with children and young people is required in order to achieve this
goal.
Primary care
Primary care continues to be the place where most mental health problems are
identified and treated, including for children and young people. However research
indicates that GP surgeries are not always the most friendly or accessible services
4
Kessler, RC, Amminger GP, Aguilar-Gaxiloa S, Alonso J, Lee S & Ustan TB (2007) Age of onset of
mental disorders: A review of recent literature, Curr Opin Psychiatry, July 20(4): 359-364.
5
http://www.who.int/mental_health/mhgap/risks_to_mental_health_EN_27_08_12.pdf
6
http://www.gov.scot/Topics/People/Young-People/gettingitright/background/wellbeing
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for children and young people, particularly those with mental health concerns and
consequently many children and young people go unsupported7.
The Transforming General Practice and Mental Health Services fund8 provides an
opportunity to improve the accessibility of primary care to children and young people
and enhance the mental health support provided. Steps such as young people’s
clinics, or children and young people lead GPs, and specific young person online
information websites can all help9. We recommend that the new mental health
strategy includes a specific commitment to ensuring that general practice’s mental
health offering is more child and young person appropriate (including children and
young people with additional support needs) and includes specific indicators to
measure progress. This should also include action to identify children and young
people at risk of developing mental health problems, whether because of poor
physical health or poor parental mental or physical health for example.
Balance of healthcare
Given the impact mental health problems can have on a whole range of other
outcomes including educational attainment, employment and relationships, and
physical health, it is essential that mental health services are, at the very least given
parity of esteem with other significant health conditions. Considering the impact
mental health problems in adolescence can have on a good transition to adult life10,
we strongly recommend a significant focus on early intervention with this age group.
Additionally, investment in preventative approaches that build protective factors and
mitigate risk factors is also recommended, starting from the perinatal period and with
a strong focus throughout the early years. Approaches to improve parenting skills
and reduce poor parental mental health are recommended and should be built into
universal services such as midwifery and health visiting. The new Universal Health
Visiting Pathway in Scotland11 offers an opportunity to do this, and again it is
recommended that the new mental health strategy includes a commitment to building
up capacity of midwives and health visitors to support good mental health and
wellbeing.
Anticipated priorities
Children in Scotland support the anticipated priorities of the new mental health
strategy, with some caveats as outlined below.
Child & Adolescent Mental Health
We strongly believe that commitment to supporting child and adolescent mental
health needs to be broader than the stated commitment to addressing ‘adverse
7
Gullivar A, Griffiths KM and Christensen H (2010) Perceived barriers and facilitators in mental health
help-seeking in young people; a systematic review, BMC Psychiatry, 10:113)
8
http://news.scotland.gov.uk/News/Transforming-GP-and-mental-health-services-22bf.aspx
9
http://www.phf.org.uk/wp-content/uploads/2014/11/how-to-guide-two.pdf
10
Kessler, RC, Amminger GP, Aguilar-Gaxiloa S, Alonso J, Lee S & Ustan TB (2007) Age of onset of
mental disorders: A review of recent literature, Curr Opin Psychiatry, July 20(4): 359-364.
11
http://www.gov.scot/Resource/0048/00487884.pdf
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childhood experiences, further improve child and adolescent mental health services,
bring down waiting times’. Whilst these are all important aims, we believe that
preventing mental health problems from developing must be the primary focus of the
next strategy.
One consistent recommendation from our members is for an increased focus on
mental health within school settings. There are a number of dimensions within this
including:
- Increased focus on mental health awareness within the curriculum (this
recommendation is also supported by the Scottish Youth Parliament’s Speak
Your Mind campaign)
- Ensuring teachers receive appropriate training to enable them to respond to
distress in school settings
- Providing school based mental health support and better links with CAMHS
- Including support for families, which places the child’s mental health needs
within the context of their family life.
With regards to child and adolescent mental health services, we recommend that the
definition of a young person is extended to 25 years, in recognition of the
inappropriateness of many adult mental health services for this age group.
Address inequalities
Children in Scotland agree that the next mental health strategy should include a
focus on addressing inequalities; including inequalities relating to geography and
deprivation. We would also like to see the strategy respond to the inequalities
children and young people with additional support needs experience with regards to
their mental health. Evidence from our Enquire helpline and our members indicates
that children and young people with additional support needs experience many
barriers to having their mental health needs adequately supported, including being
excluded from traditional CAMHS services. We recommend that all mental health
services (including primary care) seek to include rather than exclude children and
young people, and are trained to understand and respond to additional support
needs accordingly.
Better responses to primary care and better responses to distress responding to
distress
See above in relation to primary care.
Children in Scotland agree with an increased focus on responding to distress, and
encourage the strategy to include reference to this in relation to children and young
people. Responding appropriately to distress is a skill that all adults who support
children and young people should hold, and schools have a particularly important
role to play in this regard. Findings from children and young people taking part in our
Leaders of Learning12 project indicate that distress may not always be vocalised, but
can still have a significant impact on learning nonetheless;
12
http://www.childreninscotland.org.uk/sites/default/files/LeadersofLearning(printready)small.pdf
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‘I want teachers to be aware that I might be putting on a brave face and to take the
time to understand what I might be going through at home and within myself.’ (Young
Person, Leaders of Learning)
‘Sometimes I feel sad and have lots of worries. I want teachers to understand that
when I feel sad it’s hard to learn.’ (Young Person, Leaders of Learning)
In order to respond appropriately to distress, school staff should receive appropriate
training and guidance.
Promoting wellbeing through physical activity
Children in Scotland support the promotion of wellbeing through physical activity.
Programmes such as the Daily Mile13, provide excellent examples of the impact
physical activity can have on children’s physical health and mental wellbeing.
However, we are not convinced that promoting wellbeing should be limited to
physical activity alone, given that evidence also exists about other approaches. The
New Economics Foundation Five Ways to Wellbeing14 offers evidence based
approaches to support positive mental health and reduce the potential development
of mental health problems. They are: Connect, Be Active, Take Notice, Keep
Learning, Give.
Children in Scotland would like to see the focus on promoting wellbeing extend
beyond physical activity into these other evidence based approaches, with a
particular focus on school settings. Curriculum for Excellence and GIRFEC offer the
opportunity to embed these approaches within schools.
Better responses to Trauma
Children in Scotland view better responses to trauma as a welcome addition to the
new strategy. We recognise that current resources to support staff encountering
children and young people who have experienced trauma are limited, and we would
welcome additional training and guidance in this area.
We would also recommend that attention is given to responding to trauma in specific
populations of children and young people, such as those who have been recently
bereaved, those experiencing trauma as a result of ongoing neglect and refugee and
asylum seeking children and young people. Consultation with young people through
our Enquire service has provided insight into the needs and experiences of young
refugees15, with a strong focus being ensuring that young people need support with
their education and building a life in their new country. In responding to trauma it is
also important that the new mental health strategy links in with the Scottish
Government’s planned child protection review.
13
http://www.gov.scot/Resource/0047/00476174.pdf
14
More information available from http://www.neweconomics.org/projects/entry/five-ways-towell-being
15
http://www.enquire.org.uk/youngpeople/wordpress/2013/09/young-refugees-talk-to-enquire-aboutsettling-in-and-learning-english/
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Patient rights
Children in Scotland recommend that the new mental health strategy is written to
uphold and promote children and young people’s rights, as outlined in the United
Nations Convention on the Rights of the Child16. Article 12 (respect for the views of
the child) and Article 24 (right to good quality health care) are of particular relevance
in regards to mental health support, and should be considered when developing any
strategy or service which aims to address the mental health needs of children and
young people. One important step to achieving a child rights approach to mental
health would be increasing access to independent advocacy in all settings; this
recommendation is strongly supported by our members.
Additional areas
Children in Scotland would like to see reference in the new mental health strategy to
a continuing effort to challenge mental health related stigma and discrimination. We
support findings from the Scottish Youth Parliament, who have highlighted
addressing stigma as a key priority area for young people, and recommend more
high-quality education on mental health in schools as a key way of overcoming this
issue.
Contact details
Amy Woodhouse
Head of Policy
Children in Scotland
[email protected]
16
http://www.unicef.org/crc/files/Rights_overview.pdf
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