Transforming mental health support for young people must be about their real needs, not just symptoms and diagnosis

Barnardo’s Scotland welcomes and fully endorses this call from the Children in Scotland Changing our World Advisory Group.

Appropriate and timely access to support for young people around their mental health and wellbeing is an issue that cuts across all of our services in Scotland and impacts on almost all the children and young people we work with. We are therefore delighted to be part of the Children and Young People’s Mental Health Task Force supporting the work stream looking explicitly at children and young people at risk of not having their need for mental health support met.

We know how important it is to authentically embed the views and experiences of young people into our policy work. So we have been working with the Youth Commission on Mental Health to ensure the voices of young people within Barnardo’s Scotland services are heard as part of the current national debates around mental health.

In February this year we organised a participation workshop involving children and young people, aged 12-23, from across our services to hear what they had to say about mental health and wellbeing services and provision in Scotland.

What did our young people say?

When discussing barriers to accessing support, our young people talked about not being taken seriously; not being seen as ‘ill enough’; not knowing how to talk about their situation; negative internal thoughts such as thinking nothing good will come from seeking support; fear that professionals will tell family members, and fear of being dismissed.

“Feel like you were a burden at school, I had to downplay issues to make it ‘easier’ – if one more person tells me to drink water and exercise I might blow up.”

Several young people talked about services being ‘too clinical’ and almost all young people mentioned waiting times for all services and supports being too long.

Another key issue raised by our young people was the importance of skilled, trained professionals who are able to listen, provide non-judgemental support, and build strong, stable, trusting relationships.

“More staff you can trust that will be around and not leave constantly.”

Several young people also highlighted the need for better provision within schools, including mental health being part of Curriculum for Excellence and being taught in PSE; the inclusion of mindfulness, coping strategies and how to manage strong emotions within education, and the importance of friendly, warm environments.

“No matter how many assemblies’ school has about mental health, it comes across as insincere, need to have a good relationship first.”

All of these issues reflect what our frontline practitioners are telling us. Last year we spoke to 40 Barnardo’s staff members across 10 of our services in Scotland about their experiences of working with young people trying to access Child and Adolescent Mental Health Services (CAMHS) [1].

They told us one of the key reasons for young people being rejected from specialist services is symptoms not being severe enough. They also told us that lack of stability and lack of engagement by young people is a key reason for being unable to access services.

What do we want to see?

We are focusing on transformational change in four key areas based on what we have heard from our young people and our practitioners:

• We want to see alternative mental health and wellbeing services for children experiencing emotional and psychological distress who do not reach the thresholds for CAMHS. These services should be rooted in children’s experiences and environment, take a trauma-informed approach and be available at the point of need. We therefore welcome commitments in the Programme for Government to look at developing community mental wellbeing services for 5-24 yr olds.
• Along with colleagues in the NHS Health Scotland Public Health Team and others, we are looking at what a public health approach to children and young people’s mental health would look like – where there is no wrong door, mental health and wellbeing is everyone’s business and services and supports are based on the needs of the young person, not just symptoms or diagnosis.
• We want to see Social and Emotional Learning built into Curriculum for Excellence at the earliest possible stage. Teaching children how to deal with strong emotions, how to name their feelings and how to develop positive coping strategies is essential for building resilience. OurPATHS® Programme for Schools (UK Version) [2] is an example of a programme which can be built into the curriculum and embedded as a whole-school approach to mental health and wellbeing. This is supported by the Early Intervention Foundation. [3]
• Lastly, we want to see trauma-informed and responsive adults working with all children and young people in a relational way. Children and young people need safe, stable, trusting relationships in order to lay the foundations for good, positive mental health and wellbeing. We are working to develop materials which highlight some of the simple things all adults can do to provide therapeutic, healing moments for children and young people.

Footnotes:

[1] Barnardo’s Scotland (June 2018) “Audit of Rejected Referrals to Child and Adolescent Mental Health Services in Scotland: Experiences of Barnardo’s Scotland staff working in children’s services”

https://www.barnardos.org.uk/report-rejected-referrals-camhs-services-scotland.pdf

[2] Barnardo’s Scotland (February 2019) “What happens in a PATHS® school? Examples from Glasgow”

http://www.barnardos.org.uk/paths_good_practice_booklet_-_final.pdf

[3] Early Intervention Foundation (December 2017) “Social and emotional learning: Supporting children and young people’s mental health”

https://www.eif.org.uk/report/social-and-emotional-learning-supporting-children-and-young-peoples-mental-health

Nicki Lawrence is the Policy Lead for Mental Health and Wellbeing for Barnardo’s Scotland

She is responding to Call 3 of our 25 Calls – “All children and young people should have access to mental health support when they need it, based on rights, trust, privacy – and without discrimination.” Click here to read the call