Dr. Lisa McNally, Public Health Consultant at Bracknell Forest Council
The current controversy around young people’s mental health services isn’t really that controversial. In fact, you’ll do well to find an issue on which there is greater consensus. Everyone from the media to government ministers are queuing up to tell us that the system is “failing”, “inadequate”, “broken” or “in crisis”.
A key cause for concern is that many young people are waiting a long time for an assessment by NHS mental health services, only then to be told that they are not ‘ill enough’ for treatment. Many others, despite experiencing severe emotional distress, don’t even get on to the NHS waiting list in the first place. In short, the system is overloaded and many young people are dealing with significant mental health distress without adequate support.
Of course, one way to address this issue is to fund more capacity within NHS services. However, that can’t be the only answer. Especially when we consider that many young people’s poor mental well-being is not simply a diagnosable clinical disorder, but actually a natural reaction to the bullying, exam stress, family problems or other issues they may be facing. Maybe we need to invest in mental health support, not just mental health treatment?
Local authorities are crucial to ensuring this support is in place. Their involvement in education, youth services, social care, public health and many other systems means they are perfectly positioned to coordinate a whole systems approach to supporting emotional well-being in young people.
In Bracknell Forest we set ourselves two key challenges. First, we committed to create a local environment in which young people’s mental well-being was routinely supported, not just when a problem emerged. Second, we set out to ensure that, when a problem did arise, professional mental health support was accessible without a need for diagnosis or long waiting times.
To achieve the first aim, we regularly work with young people to co-create school based sessions aimed at promoting emotional resilience and breaking down stigma. The primary school programme encourages children to write stories about mental well-being based on a ‘superheroes’ theme. These stories are shared online either as written, illustrated stories or turned into animations (voiced and directed by the children themselves). View the films here. The secondary school programme co-produces short videos or drama productions with young people based on what they think is important in relation to mental health. Both involve discussion and the sharing of ideas about how we can look after our mental health just like we look after our physical health.
To achieve our second aim of ensuring early mental health support is accessible when needed, we turned to the internet. The kooth.com service provides our young residents with a range of online services including the support of professional counsellors, linking up with NHS services when necessary. Aside from being cost effective to deliver, internet based services have the advantage of offering support in an environment that young people are familiar and confident with. The result is less fear of seeking help. As one young person said:
“…thank you so much! I’ll definitely be using this site more often, it’s just nice to have someone to talk to who knows about this stuff! I was really scared for my first chat but you made it easy :):)”
While there is so much more to do, we have already seen an impact of this work. A significant increase in uptake of the online service coincided with the NHS CAMHS providers reporting a significant decrease in referrals. While causation can’t be confirmed outside of a controlled research trial, this finding does at least suggest some positive effects (brief evaluation here).
Of course we do still need more treatment capacity with young people’s NHS mental health services. But we also need to invest more in the contribution that other agencies can make, especially schools and local authorities, to reducing demand on those services. Only then will we have a complete response to an issue that otherwise threatens everything we are trying to achieve in our local communities.