Feature: Mental health goes mainstream

She might be reluctant to admit it, but Jackie Colley, commissioning manager for child and adolescent mental health services (CAMHS), and her colleagues in Derby are ahead of the game. Since 2005, the local authority has been running multi-agency training courses in mental health for everyone in the city working in children's services. So far, 510 school nurses, teachers, learning mentors, youth workers and other professionals have attended.

The government has caught up with the work that Colley and her colleagues have undertaken and is expected to flag the course as an example of good practice in the forthcoming CAMHS review. The interim report, published in the summer, said "child development and approaches to improving mental health and psychological wellbeing should be a specific aspect of training" for anyone who comes into contact with children and young people as part of their job.

In 2004, when the Department of Health increased the CAMHS grant nationally, Derby's council and primary care trust decided that one of their priorities was to increase awareness of mental health problems that the entire children's workforce have to deal with. The council's commitment to workforce development and multi-agency training made the creation of such a course an obvious step.

"We wanted to make sure children and young people in Derby got the support from the people working with them," explains Colley. "For children, their teacher or learning mentor will be their first point of contact. We wanted to equip these staff with the skills to identify whether there was an issue with mental health and raise awareness of what they could do, rather than assuming everything gets picked up as a referral into specialist services."

Working with YoungMinds

The council commissioned YoungMinds, a charity working to improve young people's mental health, and together they developed a tailored, two-day course. The first course was targeted at schools in the city that had children with behavioural and attendance problems, but now delegates come from a mix of agencies.

Roger Catchpole, principal consultant at YoungMinds, helped Colley and Arshie Mushtaq, CAMHS workforce learning and development co-ordinator, set up the course and deliver the training. The aim though was always to have the course delivered in-house.

Catchpole says the course demystifies mental health and shows that mental health is a responsibility of all staff working with children and young people. On the first day delegates look at national prevalence rates - Derby mirrors the national picture. They learn about attachment and the implications that poor bonding as a baby can have on brain development.

"A lot of what we see in a 16-year-old is likely to have its antecedents in what happened to them as a two-year-old. You can see people thinking about their own children or their own childhood," says Catchpole.

At this point, reveals Catchpole, a lot of delegates throw up their hands, believing it's too late for them to make a difference. But the course then looks at how staff can have an impact. "It's about recognising achievements and providing opportunities for children to succeed - we can build strings of resilience," he says.

The second day of the course focuses on CAMHS locally and delegates are given the opportunity to talk about a child they work with and are worried about. There is also a real-life case study to show how progress can be made with the right help.

Local trainers

One of the key aspects of the course is that the trainers are all local. YoungMinds runs a trainers' course once a year and delegates must have attended the original course first. Trainers volunteer to go on the course and are mostly specialist CAMHS workers as well as educational psychologists and people who have supported the healthy schools programme.

Adrian Pugh, a mental health practitioner in CAMHS and one of the trainers, says that he learns as much on the course as any of the delegates. And he and his co-trainer Wendy Hardy, who works in a pupil referral unit, are both keen to stress that they are not taking the course as experts. "Trainees are bringing their expertise to the two days. We haven't got all the answers. Most of what they learn is in the discussion," says Hardy.

Pugh says the course is structured, but there is also a lot of room for open discussion and feedback. One of the most positive things, he says, is seeing people from different agencies and backgrounds make connections with each other. On a recent course a special education needs co-ordinator found out she was able to make referrals to Pugh and now makes excellent referrals using the right information.

Colley and her team are not stopping at the CAMHS training and are currently piloting a training course for people working with 16- and 17-year-olds, a group whose needs are more complex than the younger age group.

Any organisations wanting to follow Derby's lead should ensure that commissioners of CAMHS are behind them and that partnerships are strong, advises Colley. She agrees that Derby is further forward than a lot of other areas but adds: "Our approach works because we deliver it here, but it depends on the organisation. The way we do it is not the only way."

IMPACT OF THE COURSE - Trevor Clarke, youth support worker

"I am a youth worker and I support young people aged 16 to 18 who have had mental health problems. I'm the link between the clinician and the young person. They have their therapies and I'm doing active work. I've always worked with young people but this is a new post, set up a year ago.

"Once I started to understand the disorder on a medical level I could do my work better. One of the things we did on the course was to have group discussions on workplace scenarios.

"I was struggling to engage with a young man and was worrying that his father was left out. The father was blind and he relied on the son. When I talked about this to the group, they suggested I take the father out and I put him in contact with Derbyshire Association for the Blind.

"A lot of the time you are picking up the phone and talking about an individual, but once you put a face to a name and get to know that personality it makes it easier.

"My working practice has improved immensely as a result of the course. I don't label young people with a mental health tag. In the past I might gee up a young person but now I'm more likely to lay off them because they might see that as bullying.

"It would have been good to have been provided with a bibliography of recommended books as I want to take what I learned on the course a bit further."

IMPACT OF THE COURSE - June Green, lead behaviour professional

"I work in a large inner-city primary school and my job is to provide individual and strategic level planning for behaviour across the school. I had never done any specific training in mental health, although prior to this I was a deputy headteacher at a special needs school.

"The course was very useful and fitted in so well with the work I'm doing with a nurture group I run two afternoons a week. I have identified six children who have problems with self-esteem and building relationships - the kids who have fights in the playground.

"I'm also hoping to do one-to-one work with parents to try to get some case histories. I want to talk to them about their children and how they manage them at home. I also want to find out about their children when they were young. The children I'm working with are aged seven to eight. It's much easier to change a child's behaviour at this age than at 12 or 13.

"I'm doing some training at school and I'm using some of what I learnt on the course. I want staff to know how to go a bit deeper and look at underlying issues.

"Meeting people from other agencies was very helpful and I would like to have termly meetings organised through this forum. It was great to make specific links and find out who you can talk to and what services you can access."