Children’s Commissioner for Wales Professor Sally Holland is dedicated to promoting and protecting the rights of children. Recently the Commissioner published a key report on services for children and young people. Matt Pearce spoke to the Commissioner to find out more about the report’s findings, and how mental health support for young people should be improved…
Your recent report shows that children and young people who experience mental health problems are being bounced between services who cannot agree who is responsible for their care. What needs to change?
We need to stop the situations where different services argue over the heads of children and young people over who is responsible for their care, by making sure that those services work together as a matter of course, and as early as possible from when a child or young person needs help. That is why in my report I highlight examples like the single point of access (SPACE-Wellbeing) panels in Gwent. This is where children whose needs are complex have their needs considered by a panel of people from across lots of different services, including mental health, social services and education, but might also include mental health charities, youth services, housing services, the local authority’s sports and leisure providers and others. Children are then given help and support quickly after their options have been properly considered by this panel of experts.
My report also highlights ‘early help and support hubs’, such as those in Conwy, where many different services are brought together under one roof in family centres, the idea being that families looking for support have everything in the one place so they don’t have to keep contacting lots of different people and having lots of different appointments.
I would also like more places where young people could go for immediate advice and support on mental health issues, like the Maison des Adolescents network in France or the ‘one stop shops’ called for by our Youth Parliament.
How do we ensure that specialist mental health services are prioritised for those in highest need while also ensuring that those who do not require such specialist support still get help?
The resources we have in Wales for children and young people with the highest need are scarce. We have a very limited number of mental health inpatient beds, for example, and no NHS secure accommodation for children with mental health issues. The resources we do have in Wales are too often not the right fit for those who need it, and we regularly hear from families where a child or young person finds themselves in a sort of limbo between community-based mental health support and inpatient settings. Sadly, we often hear of children being placed on adult wards in Wales because there is no provision for them, or who are sent away to settings outside of Wales.
This needs to change. This is why I have called for new residential provision to be provided for those children and young people with the most complex needs, which provides for both their mental health and social needs. Welsh Government have promised to take action on this, working with Regional Partnership Boards, and I continue to hold them to account for this promise, ensuring real action is taken before the end of this Welsh Parliament in May 2021.
What do you think are the key ways that mental health support for young people in Wales can be improved?
We need to diversify the offer for those with the highest level of need – meaning that there are more options available than just a mental health inpatient unit, which often can’t meet the needs of children and young people. For those children and young people for whom inpatient units are the best fit for them, we need to make sure they receive this support quickly.
We also need to diversify the offer for children and young people with ‘lower level’ mental health needs. If you are a child or young person, support for mental health and wellbeing should be there for you when you need it, wherever you are. You should be able to ask for help in school and in your community, and you should get a response which responds properly to your individual needs. Our Youth Parliament has also called for better advertisement of services, and more easily accessible information, as well as more options for seeking help anonymously, for example on-line.
Work on whole school approaches and school based interventions is taking place across Wales, and the Welsh Government is producing guidance for all schools to help them create a supportive and nurturing environment, as well as being equipped to support those with higher levels of need. The new curriculum has much more of a focus on wellbeing and awareness around mental health than before. But for these to make a real difference, we need to fundamentally shift how all the services supporting children and young people work together.
Is there a risk that young people’s experiences and normal life events are being medicalised?
Children and young people face many stresses and strains as they grow up – from having to worry about school and getting the grades they need, to understanding the world around them and the relationships they form. At the moment, they also have to deal with restrictions on their everyday lives and in seeing their friends and family, as well as all the uncertainty when it comes to their education or going into the world of work.
There is a risk that the experience of growing up can be medicalised, and that is exactly why it is so important that we normalise mental health and wellbeing in our society. We all have mental health. We all need to look after our wellbeing. I think we have come a long way in recognising this, but we need to make talking about mental health, and creating a nurturing environment for children and young people at school and in their community, the mainstream. We need to do more to ensure children and young people are supported through those difficult times, while recognising that some will need more specialist support.
Service users are concerned that funding for mental health should not be diverted away from those in greatest need and towards supporting the responsibilities of public-facing general services to protect the mental wellbeing of their clients. What do you think the mental health funding priorities should be?
I agree that funding for those in greatest need should always be the priority, and certainly funding should not be diverted away from those scarce resources at the higher end of provision. It is my role as Commissioner to push for greater investment across all children’s services, and it is clear to me that many areas of the system are really struggling.
From my point of view we need more investment in the mental health system at all levels. There is definitely a need for early help and prevention, which is currently being addressed partly through the whole school approach to wellbeing. We also don’t have enough provision at the ‘higher end’ of mental health support to properly care for those who need it most. It just doesn’t exist as it should in Wales. That absolutely needs to change – no child or young person experiencing serious mental health problems should be told they don’t reach the ‘right threshold’, or are placed somewhere unsuitable which can make things even worse. Sadly, I hear from many who experience this.
Overall, I’d like to see more investment and concentration on children and young people’s mental health across the board. It is possible that the appointment of a dedicated Minister for Mental Health will help with this. I’m sure she will be hearing from all of us about what the priorities should be!
Find out more about the Commissioner’s work for young people @ https://www.childcomwales.org.uk/
Hafal, Matt Pearce, 2020