Reform child mental health care or face crisis, government warned

By Gabriella Jóźwiak

| 30 January 2019

The government risks creating a mental health crisis, if it does not prioritise children's mental health in legislation reforms, academics and MPs have claimed.

A mental health crisis could be averted by prioritising young people in new legislation, The All Party Parliamentary Group (APPG) on a Fit and Healthy Childhood has said. Picture: Newscast Online

A report by All Party Parliamentary Group (APPG) on a Fit and Healthy Childhood claims that a reformed Mental Health Act will be little more than "sticking plaster'' unless the needs of children feature "first, last and foremost".

The cross-party group of MPs has called for an overhaul of the way policymakers consider evidence before they make decisions.

In addition, they want to see a more cross-departmental approach to mental health service delivery, and for the government to introduce a wider range of therapies. 

The report, ‘Children's Mental Health Beyond the Green Paper: The Role of Practice Based Evidence,' also calls for a commissioned authority to ensure the establishment of unified policies and standards for the inspection of children's mental health.

Chair Jim Fitzpatrick MP, said: "The Prime Minister's pledge to reform the 1983 Mental Health Act is welcome in order to combat the ‘burning injustice' of the disparity she has criticised in mental health care.

"However, reform is long overdue. If new legislation focuses purely upon the adult population, it will be as ineffective as sticking plaster, because poor mental health often makes its first appearance in childhood and is either missed or dismissed.

"The resultant full-blown adult crisis becomes entrenched and measures to combat it will be correspondingly difficult and costly.

"Our report offers a ‘practice based evidence' approach.

"The needs of children are placed first, last and foremost and I am confident that the strategies outlined will contribute to a society that is mentally resilient as well as physically fit."

The government announced in December 2018 it would introduce a new Mental Health Bill, based on an independent review of the 1983 Mental Health Act

Among the proposals, the APPG wants to see the government adopt a strategy of using "practice based evidence (PBE)", which provides data based on outcomes achieved in real-life practice, as opposed to "evidence based practice (EBP)", which only looks at one-off trials. 

"The concept of EBP requires major revision to include PBE in order to demonstrate the effectiveness and efficiency of children's mental health practice," the report states.

In order to establish better working between government departments, the APPG called for the creation of a permanent, inter-departmental body to be responsible for monitoring and advising inspection and regulatory organisations about the implementation of evidence-based children's mental health.

These would include the Department for Education, Department for Health and Social Care (DHSC), Ofsted and the Professional Standards Authority, to ensure practitioners were adequately trained.

APPG member Lorna Lewis, who is chair of the British Council for Therapeutic Interventions with Children, warned of cases of individuals claiming to be play therapists after taking courses that did not meet accredited standards.

"The people writing and directing them have no way of establishing if the person is fit for practice both before the course and after completion," she said. 

"Often there is no monitoring of work done post qualification. There is not only the risk of unsafe practice, but also the waste of public funds through ineffective work and also the learning objectives are not derived from practice-based evidence."

Acknowledging the ambition of the government's December 2017 green paper, Transforming Children and Young People's Mental Health, which includes plans to place mental health support teams within schools, the report questioned what type of training teams would receive, whether the new responsibilities would be unique or added to existing posts, and whether schools would have statutory duties to make the appointments. 

The group also called for the government to fund research into new therapies such as touch therapies and extensions of play and creative arts, in addition to behavioural family therapy and cognitive behavioural therapy that are currently offered.

And the report warned against reliance on providing online support for young people, and the importance of forging relationships through one-to-one conversation.

"A face-to-face counselling/play therapy base in school (or similar organisation) offers a safe ‘holding space' apart from everyday life so that feelings may be shared more freely," the report said. 

"Children who access online counselling services from their bedrooms will encounter a ‘virtual' screen human rather than derive benefit from a real life therapeutic relationship characterised by a crucial attachment and bonding process that cannot be compromised by a ‘virtual' equivalent."

CYP Now has contacted DHSC for a response.

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