Children’s mental health: a clear case for investment and reform
Three children in every classroom in England are likely to have a diagnosable mental health problem. Two thirds of these children and young people will present with behavioural problems. Children who develop poor mental health early on not only suffer significant distress but some also experience much poorer life chances than other children.
Despite the prevalence and seriousness of mental health problems among children and young people, there are a number of serious glitches in our current system of providing support to them. We need a sea change in the way that we fund, organise, and design support for children’s mental health and emotional wellbeing to put right these systemic weaknesses.
There are two major shortcomings in the system. First, we have problems with access to help and unmet need. While most parents of a child with a diagnosable mental health problem seek professional help, only around a quarter get the help that can make a difference to their recovery and life chances. And in many areas we have a system riddled with gaps when children need help – a system which is still predominantly oriented towards waiting for children to slip into crisis. These gaps in the system store up problems both for children and for a range of more expensive public services later on.
And second, we have problems with the quality and design of what is available for children and young people who need help. Services can often feel irrelevant and they are rarely co-produced with young people. And when young people and parents try to negotiate their way around the system, it feels maze-like. Sometimes the system can seem like a fortress – impossible to penetrate even if you can see what you might need and with its own confusing language.
These problems lead to major missed opportunities to support children’s mental health and wellbeing as they develop and grow. For example, we should start to maximise a child’s resilience before birth during a mother’s pregnancy. We know that a mother’s poor mental health during pregnancy and after birth can be a major risk factor for an infant’s wellbeing and future mental health. Improved identification, effective help and a focus on supporting the mother/baby relationship can do much to strengthen wellbeing yet fewer than half of mothers with poor mental health are identified and even fewer get effective help. Left unresolved, these problems are costly. A recent estimate put the costs of mental health problems during and after pregnancy at some £8.1 bn every year in England.
Children who develop early starting behavioural problems (before secondary school) also tend to get overlooked despite the very serious and lifelong effects of unmanaged behavioural problems. Yet evidence-based parenting programmes are among the best tested interventions which can make a difference to these children’s futures as well as to family and parental wellbeing.
In recent years, schools have become the greatest missed opportunity to consistently support mental health and emotional wellbeing – with postcode variability in what’s an available, shifts in budgets which have led to mental health in schools being nobody’s business, a lack of understanding of the evidence which shows that you can’t excel in school if your starting point is poor mental health. The majority of children attend schools – and if we’re thinking of improving access to mental health support, whole-school-approach to improving mental health provides a golden opportunity to effect change.
We need to create an engaging and accessible system of support that offers children and young people a consistent safety net (without gaping holes) right from before they are born up until 25 when adult brains fully form. We also need a system which invests more in preventing crises, that recognises that early intervention works and saves money, but which also recognises something else that the evidence tells us – that it’s never too late to support children and young people’s mental health.
And it is essential that we listen to children and young people and co-produce solutions with them that make sense and which provide support on their terms, in the right way and in the right place. They need help that is adapted to the modern realities of their lives , recognising what it feels like to live in a world threaded with social media, which includes experiences of cyberbullying and pressures for involvement in sexting.
We need to invest in building a whole system safety net across the child and youth developmental years to stop children slipping into unnecessary and damaging crisis. Support systems need to be underpinned by more systematic tracking of children’s wellbeing with engaging and relevant early support when they move outside healthy ranges. We need more consistent investment in some currently missed golden opportunities – in supporting better maternal mental health and in consistently promoting a whole school approach to supporting children’s wellbeing. And we need radical reform of and improved investment in the comprehensive range of sectors providing Child and Adult Mental Health Services to prevent problems, distress and heavy costs from building and to improve children’s health now and for the future.
Lorraine Khan is the associate director (Children and Young People) at Centre for Mental Health