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Review of Future in MindReport of Mental Health Taskforce Focusing on CAMHS Pathways and Easy Assessment and InterventionA Personal Viewhttps://www.gov.uk/government/uploads/system/uploads/attachment_data/file/414024/Childrens_Mental_Health.pdf

RICHARD SHIRCORE M.SC. FRSPH

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The CAMHS CollaborativeFocus – our position• MENTAL HEALTH IS A COMPLEX PHENOMENA • DEFINITIONS CONTESTED• AETIOLOGY VARIABLE AND CONTESTED• MENTAL HEALTH SERVICES ORGANISATIONALLY COMPLEX – SPLIT

RESPONSIBILITIES BETWEEN FAMILIES AND HEALTH, EDUCATION, SOCIAL SERVICES AND YOUTH JUSTICE

• IDENTIFIED WEAKNESSES: TOO MANY SOLUTIONS IN SEARCH OF UNASSESSED PROBLEMS/CONDITIONS

• FAILURE TO APPRECIATE CONTEXTUAL ISSUES FOR YP AND MENTAL HEALTH ISSUES

3Consequences

Report of Select Committee House of Commons on CAMHS Nov 2014.

A Commissioning “fog” due to lack if information regards the mental health needs of children

Early Intervention very important but weak Increased waiting times for YP referred Child and Parent “battles” to be seen and then heard

4How Does “Future in Mind” respond?

As if only structural, methodological or organisational problems exist.

With regard to our concerns – clinical pathway, early intervention and early assessment, evidence: Number of times issues mentioned/referred -

Pathway: 1 ref (child comment) Early Assessment: 1 ref Prevention: 7 refs (1 being in Contents, 1 being in Exec)

Summary) Early intervention: 7 refs. Evidence: 3 ref 2 refs to treatment, 1, epidemiology

5What does it say?

The Foreword by Norman Lamb says all the right things then does not mention them again. “We need a whole child and whole family approach, where we

are promoting good mental health from the earliest ages”. “What is needed is a fundamental shift in culture. A whole

system approach to mental ill-health, early intervention and recovery” p3.

What then happens is a classic example of “Dynamic Conservatism” (Donald Schon) where organisations work hard to stay the same.

6Foreword – Sam Gyimah

“…I am so pleased to be the first minister in the Dept. of Education with a specific responsibility for child and adolescent mental health.”

Focus: PSHE developments and expansion of “Counselling” in schools.

“….DfE has, ….identified mental health as a specific priority within its £25 million voluntary sector grant scheme -….we will be supporting a range of exciting projects”.

7Foreword Simon Stevens CEO NHS England

No comment on “definition”, early assessment nor diagnosis.

8An Open Letter to children and young people from Dr Martin McShane (NHS England) and Jon Rouse

(DoH)

A curious statement – suggesting mental health issues are unavoidable but that with the right “systems” in place all will be well.

It is highly individualistic. If you are mentally unwell you got something wrong, but we will “help you get back on track”. P9.

Rather rashly they say “…we know what works”.

9Critical Review pt 1 The lack of reference to any concern over defining mental health

as a health state. Nowhere is the interplay of mental health, behaviour explored and the environment explored.

The Collaborative stresses: the importance of a “tabula rasa” approach to children and adolescents presenting with mental health or behavioural issues. The Taskforce Report sees mental health as being non-problematic concept.

: evidence in relation to assessment of issues is not mentioned. Evidence only referred to in relation to proven treatments.

: Solutions chasing problems. The unqualified references to “Counselling, Peer Mentoring and other therapies” is also a concern. MH responses must be ethical – based on assessment and prescription relevant

10Critical Review pt 2

We stress the importance of: Context in understanding mental health and behaviour. Report

makes no reference to Context as an important variable. Pathway to relevant intervention/response – The Report talks

about “difficulties in access”. But who or what do you access if you don’t know what the problem is????

A clear and rigorous methodology for early assessment to identify issues and appropriate specialist referral or immediate action. The Report focuses on organisational re-arrangement.

11The Future – selected Govt. aspirations p16

By 2020 a hard hitting anti-stigma campaign (Comment: Saying what exactly?) Empower young people to self-care through quality assured apps and

digital tools .(Verging on the unethical)? Develop access and waiting time standards Joined up services through commissioning changes Professionals who work with children and YP are trained in child

development and mental health, and understand what can be done to provide help….. (Comment – this does not happen currently then?)

Testing clear access routes between schools and specialist services

12Summary – Richard Shircore

The Taskforce Report is strategically flawed. Its intentions are good but fail to engage with the fundamental questions

practitioners are faced. What I am looking at? The closer union of schools and mental health might be beneficial but……

No definition of mental health – The “it” problem still exists. The lack of appreciation of the need for early assessment of YP to

identify the type of Health issue to be addressed No recognition of the different agencies involved and consequences of

split responsibilities. Reliance on generalised “solutions”, e.g. counselling, CBT, without

assessment of suitability Children to have responsibility of own mental health care e.g. mentoring.

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Thank you for listening

RICHARD SHIRCORE M.SC. FRSPH

SHIRCORE@HEALTHPROMOTION.UK.COMTEL: 01753 575655

MOB: 07943 404 388