The government’s plans to improve mental health services for children and young people are “not ambitious enough” and risk placing more pressure on already stretched services and staff, according to a new report by MPs.
In their critical joint report examining the government’s proposed green paper on child mental health, both the Commons education committee and health and social care committee also warned the pace of change was too slow meaning hundreds of thousands of children could miss out on vital support.
“To deliver the proposals effectively, the government must take account of and mitigate against workforce pressures”
Key concerns include the capacity of education and health services to deliver the plans, which would see schools and colleges appointing a “designated senior lead for mental health”, the creation of Mental Health Support Teams to work with schools and trials of a four-week waiting time for access to Children and Adolescent Mental Health Service (CAMHS).
The two committees of MPs heard evidence from education and health experts who warned services like CAHMS were already under severe pressure and would struggle to cope with extra responsibilities.
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“Both health and education services are under great strain with significantly stretched resources, and workforce recruitment and retention concerns,” said the report – titled The government’s green paper on mental health: failing a generation.
“To deliver the green paper’s proposals effectively, the government must take account of and mitigate against workforce pressures. The proposals cannot be effective if the workforce, including teachers and CAMHS practitioners, does not have the capacity and capability to deliver,” it said.
“This would leave institutions with less support than before and further increase the demand on NHS services”
The plans to transform support and care were unveiled against a backdrop of cuts to young people’s mental health services in recent years with difficulties recruiting and retaining teachers, psychiatrists and other professionals.
“There has been a reduction of counsellors and educational child psychologists in our schools, and mental health nurses are reportedly among professions where providers find the greatest difficulty in recruitment,” said the report.
It flags up figures that show “significant shortages” in the CAMHS workforce including 5,000 fewer mental health nurses since 2010.
“Stakeholders have highlighted existing staff shortages within CAMHS. They raised concerns that these shortages might not only impede implementation of the green paper proposals, but that attempts to deliver these proposals given current workforce pressures may jeopardise the care of children and young people with the most severe needs,” said the report.
MPs said it was vital to get a much clearer picture of existing provision in order to monitor the impact of any changes.
“Their report highlights the scale and urgency of the challenges surrounding children’s mental health”
When she gave evidence to the committees Professor Lisa Bayliss-Pratt, chief nurse at Health Education England and interim regional director for London and the South East, was asked whether she knew how many roles, including peer mentors, counsellors and educational psychologists, had been cut in schools. She admitted the body did not currently get that kind of data.
Under the green paper proposals, the government would fund new Mental Health Support Teams that would work closely with schools and be supervised by CAHMS staff with their work jointly managed by schools, colleges and the NHS.
These teams would be linked to groups of primary and secondary schools and to colleges and provide a range of interventions for children and young people with “mild to moderate needs”, which might include cognitive behavioural therapy for depression and anxiety and group sessions on body image for girls at risk of anorexia.
They would also support young people who have experienced trauma and have a role in assessing children and young people and referring them to more specialist services.
In addition, such teams would be expected to work closely with professionals like school nurses and provide training to others such as family and early help workers, social workers and teams who work with young offenders.
“We want to see more evidence that government will join up services placing children and young people at their heart”
The plans for Mental Health Support Teams and new waiting times will be tested through a series of “trailblazer” pilot projects, but the committees suggested this approach was too slow with schemes reaching only a fifth to a quarter of the country by 2022-23.
One worry expressed by MPs was that the promise of extra support would encourage schools and colleges to make more cuts to any existing provision around mental wellbeing before new services were in place.
“We are concerned that an unintended consequence of the government’s proposals would be that financially stretched schools and colleges could further cut their current provision of mental health support, assuming that Mental Health Support Teams will be there instead,” said the report.
“Given the delays inherent in the proposed timeframes for implementation of the government’s strategy, this would leave institutions with less support than before and further increase the demand on NHS services,” it said.
The suggested speed of delivery “will leave hundreds of thousands of children with no improvements in provision for several years and with possibly worsened provision if staff leave to join trailblazer areas elsewhere”, the report added.
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It also criticises a lack of emphasis on early intervention – a key concern raised by members of the Royal College of Nursing, which said the document failed to consider the needs of young children from birth to five or recognise the important role of health visitors in working with families to spot potential issues and prevent them escalating.
“Evidence shows that holistically supporting families from the outset of parenthood (pregnancy) will bring about bigger impacts on the physical and mental health of children than trying to fire-fight established mental health difficulties in older children,” said the college’s response to the green paper proposals.
Health and social care committee chair Dr Sarah Wollaston, Conservative MP for Totnes, agreed the plans needed “to go much further in considering how to prevent mental health difficulties in the first place”.
“We want to see more evidence that government will join up services in a way which places children and young people at their heart and that improves services to all children rather than a minority,” she added.
Education committee chair Rob Halfon, Conservative MP for Harlow, said “urgent action” was required.
“This strategy does not go far enough, which raises the very real prospect of hundreds of thousands of children missing out on the getting the help they so desperately need,” he added.
Deputy chief executive of NHS Providers, which is part of the umbrella organisation the NHS Confederation, Saffron Cordery, welcomed the committees’ “strongly-worded critique”.
“Their report highlights the scale and urgency of the challenges surrounding children’s mental health,” she said. “Trust leaders tell us demand for mental health care is growing rapidly, particularly for CAMHS.”
She said progress had been made in some areas including perinatal mental health and trusts were “doing all they can to provide the best possible care with the resources available”.
“But it is extremely worrying that MPs on these highly respected committees have found the government’s strategy on child mental health falls so far short of what is required,” she added.
“We completely reject any suggestion that our plans lack ambition”
However, the Department of Health and Social Care hit back at the suggestion the plans were not ambitious enough.
“We completely reject any suggestion that our plans lack ambition – these changes will transform mental health services for children and young people, including the first ever waiting time standards for those with the most serious problems,” said a spokeswoman.
“This will be supported by a new workforce – larger than the entire current workforce – and backed by £300m of additional funding that will also provide significant additional resources for all schools. This builds on what good schools are already doing, without adding to teachers’ workloads.
“We agree that every young person should be able to access mental health support – however we need to ensure we get this right, which is why we will pilot this approach to make sure services are correct.”
The department said it would publish a formal response to the consultation on the green paper in coming months, which would include more detail on its plans.