We can’t fail to be aware of the mental health crisis in the UK at the moment- in any given year 10% of children under the age of 16 and 25% of adults will experience mental health problems. Our newspapers are full of stories about mental health services under pressure and individuals waiting months and sometimes years to be seen if they make it that far. It’s easy to feel overwhelmed by the scale of the problem but we can’t afford to bury our heads in the sand.
I joined Platform for Life in 2019 and we work with families struggling with the twin challenges of poverty and poor mental health. We offer free counselling and play therapy and I know from the work we do in two areas of Chester, that we can make a difference to individuals, families and communities mental health. Yes, it’s small scale at the moment, but we’re adopting a different approach that works and which we believe can be scaled up and replicated elsewhere in the future.
So, at the start of this new year and decade, isn’t it time to change our approach to mental health care?
I’m not sure if it was Einstein or another wise person who said “Insanity is doing the same thing over and over again, but expecting different results.” Whilst everyone working in NHS mental health services such as IAPT and CAMHS are undoubtedly trying their best under enormous pressure, what’s provided isn’t fit for purpose- only the most serious cases get seen, in institutional settings, after what can be a very long wait and for a limited number of sessions (around 6-8).
And that’s without even considering the majority of individuals with mental health issues who don’t meet the threshold for these services. MIND estimates that only 24% of individuals with common mental health problems receive any treatment. If they’re not considered seriously ill enough for these services there are precious few alternatives available to them or their GP (except medication) unless they go down the path of private therapy, a luxury many in this country simply can’t afford.
When a person suffers from poor mental health, being able to access a service quickly (within a few weeks) and locally in familiar and low clinical surroundings is critical. Each person’s mental health journey is different and the support they’re offered should be tailored both in approach and duration. It’s much more cost effective in the long-term to help individuals back to full mental health rather than reduce short-term symptoms, only to see them back at their GP a few months or a year later in the same situation.
Research by the Mental Health foundation (2018) suggests that once established and without being properly addressed, mental health problems have a detrimental impact on individuals, leaving them disadvantaged throughout their life. If they then go on to have children the cycle continues into the next generation. The financial costs to the UK of mental ill-health are staggering- estimated by the OECD to be more than £94bn per year in terms of treatment, social support costs and losses to the economy from people unable to work.
Helping individuals when they first start experiencing poor mental health or better yet putting in place actions to prevent them becoming ill in the first place, makes so much sense. And yet very little funding is currently provided for early intervention mental health services. A report published by the Children’s Commissioner in April 2019, found that spend on ‘low level’ or early access mental health support for children averaged £14 per child in England (£226million in total) in 2018/19– with close to half this spend coming from the NHS and half from local authorities.
A key part of any early intervention approach should be providing more support to schools who operate on the front line every day, dealing with children and young people with multiple challenges and mental health issues. Although schools are experiencing a large increase in the incidence of poor mental health amongst pupils, they have few if any resources available to help them. Poor mental health amongst individual pupils affects other pupils and staff at school and can have a profound and negative impact on the whole school community.
Schools have pupils in their care for around 30 hours a week and are ideally placed to recognise children experiencing or beginning to struggle with poor mental health. If they have funding to engage external counselling resources or access to internal counselling resources, they could be quick to help children and give them the support they need at an earlier stage. For children, receiving counselling in a school setting is less disruptive and less intimidating than attending a clinical environment and has far less stigma attached. We work in a number of local schools and see time and time again the difference meeting pupils in an environment they’re comfortable in, makes to their attendance and level of engagement in counselling sessions.
The Chief Medical Officer for England has identified children with parents who have mental health problems or substance abuse issues, as at much higher risk of developing their own mental health problems. No one is an island and those closest to us often have a big impact on how we feel about our self and life and how we respond to it. The issues or mental health difficulties a child may be experiencing can be caused or exacerbated by parental behaviour. As one headteacher remarked:
“Only when we see a change in the parent do we see a change in the child.”
It’s sometimes only by addressing such behaviour and helping the parents, that any long-term recovery is possible for the child.
Yet conventional mental health services tend to focus only on the individual who’s referred to them and do not consider or work those close to them who may be negatively impacting their mental health.
Only then will the cycle of poor mental health being passed down from one generation to the next be halted.
Around 14 million people in the UK (22% of the population) live in poverty, with just over half of these (7.7 million people) living in persistent poverty. That’s a shockingly high number that urgently needs addressing. The prevalence of mental ill health in the UK maps closely to areas of deprivation with children from the lowest income families 4x more likely to experience psychological problems than children from the richest families. (Mental Health Foundation 2018). Poverty forces people to live in in areas where crime rates are higher compromising personal safety, in poor housing conditions with less green space around them and with the constant struggle of making ends meet- often resulting in debt they can never afford to repay. Poverty and poor mental health end up becoming a vicious cycle that can be difficult to break free from- poverty increases the chance of developing mental health problems and poor mental health increases the risk of poverty.
To compound matters, although people struggling with poverty and poor mental health are most in need of mental health services, in practice they are least likely to access them. They cannot afford to pay for private therapy and most will not be deemed serious enough to qualify for public services or have found these difficult to engage with- perhaps because of a requirement to travel or issues with affording child care to enable them to attend.
This includes making appointments available in their local community so no travel is required; not penalising them if they don’t attend every session or cancel at short notice because of the chaos they may have in their lives; not restricting the number of sessions they can access and instead recognising there’s no one size fits all solution; and working with families rather than just individuals, recognising that they may all be impacted by poverty and poor mental health.
Over the course of this year we’ll be talking again and again on our blogs, social media and hopefully face to face with some key decision makers about each of these areas in more detail. We believe they’re important and whilst we know change isn’t easy, we need to start thinking differently and not expecting a different result from the same conventional approaches. It matters if we’re to stand any chance of ending the misery of poor mental health that’s blighting our country. Let’s make this year matter!