Our Safeguarding Manager, Daniel Jarrett, writes about children’s mental health, a case study from his own experience on supporting a child with mental ill health, and where to find further resources.
Recent reports have shown an alarming increase in the rates of mental illness in young people as well as an increase in the rates of youth suicide. This also comes at a time when funding cuts to local authority CAMHS (Child and Adolescent Mental Health Services) have increased thresholds and made it more difficult for young people to access the right support at the right time. According to a Guardian article from February 2018, one in 10 children between the ages of five and 16 has a clinically diagnosable mental illness, and many go into adulthood with unresolved problems and 50% of mental health problems in adults were identifiable by the age of 14.
A report published by Spurgeon’s Children’s Charity that collated data from 32 NHS trusts in England evidenced the following:
● 60% of under-18s referred to their local CAMHS service were not receiving treatment.
● The number of under-18s admitted to A&E for self-harm has increased by 50% in five years
● Self-harm admissions to A&E departments for young people have increased for the seventh year running
● The sharp increase in the number of under-18s being admitted to hospital after poisoning, cutting or hanging themselves is more marked among girls, though an increase has also been seen among boys.
● Around 77% of A&E or hospital admissions for self-harm were made by girls from 2010 to 2016.
As a result of these increases, the UK government recently began consultation on its green paper whose main themes are improving emotional and mental health support in schools, increasing access to early intervention and improving access to specialist help.
One of the government’s suggestions is for every school and college to identify a senior lead for mental health whose work will be geared towards creating mental health support teams focused on early intervention. Their work will then be supervised by the local CAMHS, who at the same time will also be trialling a four-week waiting time to their service.
This suggestion has come under criticism by some who feel that this will place increased and undue pressure on CAMHS to keep up with a fast-rising demand for care if they are also given the job of supervising the new mental health support teams in schools. Concerns have also been raised that the professionals intended to provide the most support in schools and colleges may lack the skills to deal with pupils who are
self-harming, risk-taking or having conduct problems.
Bethany was 15 when I began working with the family. She was a high achiever at school but was displaying very risky behaviour, both at school and in the local community, and, at the point of referral, she had just been excluded from her secondary school for fighting and threatening a teacher. Alongside her risky behaviour, Bethany was regularly self-harming, had violent outbursts at home, and experienced suicidal ideation.
Bethany’s mum was struggling to manage her behaviour at home and was finding it difficult to install effective boundaries. This meant Bethany was out late in the local community and often put herself at risk by drinking heavily and taking drugs. Bethany had been open to CAMHS for several months but regularly did not attend – thankfully, the CAMHS practitioner recognised the high-risk nature of the young person’s behaviour and kept the case open despite her non-attendance.
The initial work with Bethany and her mother was around trying to ensure that she was engaging with her CAMHS practitioner so she could receive targeted support around the risks of self-harm and suicide. It was also paramount that an alternative educational provision was found for Bethany so she kept some routine and had the opportunity to complete her GCSEs and access further education.
We quickly managed to find Bethany a place at an out-of-borough provision that could cater to her educational needs as well as reducing some of the risks to her in the local community. Through several months of persistence and encouragement, Bethany began to access her CAMHS practitioner effectively and had a number of joint sessions with her mother to improve their relationship as this had deteriorated severely. A large part of the work was also around putting an effective safety plan in place with mum and Bethany to ensure she was keeping herself safe in the community as well as ensuring she had access to emergency numbers and knew which professional to turn to when needed. I also supported mum in installing effective boundaries in the home that Bethany would adhere to and for this I also referred mum to a parenting programme specifically aimed at the teenage years. This helped mum in managing Bethany’s outbursts at home.
By this time, there was a tight professional network around Bethany and her family which included CAMHS, her alternative educational provision, and myself who ensured there were regular review meetings and that the safety / action plan was adapted when needed.
After several difficult but rewarding months of work with Bethany and her mother, Bethany was successful in achieving her GCSEs and gaining a place at a local college to study catering. Through the targeted work with CAMHS, her mental health and ability to cope with stressful situations improved and she was discharged from the service with the proviso that she could access it in the future if she felt she was in need. Her
relationship with her mum improved as well and she was able to adhere to the boundaries set within the home and began to remove herself from risky situations in the local community.
Cuts to services have had a real impact on the rising thresholds for accessing CAMHS and it is becoming ever more vital that schools, colleges, and early intervention services are effectively supporting children and young people who experience mental health issues. Ensuring a close professional network around a family is also vital in making sure that the child / young person and their family feel supported from multiple sources and that these professionals are adaptive to the changing needs of the child / young person.
Concerns of high-risk to children / young people should also be reported to the local CAMHS duty team and Children’s Services to ensure the effective safeguarding of children and young people at all times.
Learning from Serious Case Reviews
A useful summary of risk factors and learning for improved practice for child and adolescent mental health services
Mental Health Coalition
The Children and Young People’s Mental Health Coalition brings together leading charities to campaign jointly on the mental health and wellbeing of children and young people.
Papyrus provide confidential help and advice to young people and anyone worried about a young person; help others to prevent young suicide by working with and training professionals, and campaign and influence national policy.
Samaritans is a charity aimed at providing emotional support to anyone in emotional distress, struggling to cope, or at risk of suicide.
YoungMinds is a charity championing the wellbeing and mental health of children and young people
*Any names have been changed