Far from being "transformational", the plan fails to address the fundamental barriers to long-term improvements to the nation’s mental health
Photo by Redd Angelo on Unsplash
Jen Daffin, Sally Zlotowitz and Jessica Bond
By 2023, children in about a quarter of UK schools will learn about mental health and wellbeing in their PSHE (personal, health and social education) classes. Those who are struggling with their mental health will be identified by a trained staff member and will be supported by new Mental Health Support Teams or directed to the right specialist service - services that will be more accessible thanks to four-week waiting time targets.
At least that’s the plan. The finalised proposals, announced by the government at the end of July after a public consultation, are an attempt to improve the mental health of children and young people in the UK. They will be rolled out in pilot areas from the end of 2019, with the aim of reaching between 20% and 25% of the country’s children four years later.
From the beginning, the Department of Health and Social Care and the Department of Education have made much of their “transformational” plan’s focus on early intervention and prevention and the “brand new workforce” that will be created to carry it out. In our view, their initial proposal, published as a Green Paper in December, was woefully inadequate in this regard. As part of the public consultation, Psychologists for Social Change submitted an open letter signed by 1400 psychologists, teachers, social workers, counsellors, as well as young people with lived experience of mental health issues and their parents. We explained that the proposal was a huge diversion away from the real issues surrounding children, young people and families’ mental health because it failed to address poverty, reduced social mobility and the growing number of people living in inadequate housing. These issues have been indisputably linked to poorer mental health. We urged the government to “take a genuinely preventative approach” by acknowledging and addressing these societal risk factors and bringing an end to the austerity policies that have exacerbated them.
We were not the only ones dissatisfied with the Green Paper’s neglect of social disadvantage. The King’s Fund said the paper “lacks an overall narrative on inequalities” and a joint report from the Education and Health and Social Care Committees said -
"We know that there are key factors which are more likely to give rise to child mental health problems such as deprivation/poverty, chaotic family circumstance, behaviour problems and school exclusion, parental mental health especially perinatal mental health, Adverse Childhood Experiences, being in care and so on. Yet there is little or no mention of these issues in the Green Paper and virtually no proposals for targeting and joining up services to address them early."
In the open letter, we also called on the government to review the toll that exams and other ‘accountability’ measures are taking on pupils; a source of emotional distress for teachers and pupils alike, according to the National Union of Teachers. We also called for the government to adopt the principle of co-production in the development of all its proposals. This means that all those involved in services should have a way to give meaningful input into their design.
The finalised plan takes some steps towards some of these calls. On co-production, it states -
"The ability for areas to engage with children and young people will be one of the considerations for the selection of our trailblazer [pilot] sites. We will also consider how we can continue hearing from children and young people at a national level on the implementation"
On accountability, it is vaguer -
“We are also reviewing the way schools are held to account, aiming to remove unnecessary pressure from teachers, which can have an impact on pupils.”
For the first time, it includes a section on tackling disadvantage. It acknowledges the causal link between disadvantage and poor mental health and states that the government is “committed to taking action”. The six ways it plans to do this are -
1) improving perinatal mental health services
2) reducing parental conflict
3) the “transforming care” programme
4) the “troubled families” programme
5) the “healthy child” programme
6) by increasing funding to adult mental health services.
Read more about these programmes on page 15 and 16 of the report.
All these proposals continue to place the responsibility on individuals and/or their families for their disadvantage and its direct and indirect effects on health and well-being. They ignore the changes in social and economic policies implemented by the government that has led to rising poverty and hardship.
According to a recent report by the Joseph Rowntree Foundation, in 2014/15, 30% of all individuals in the UK were in households with incomes below the Minimum Income Standard, an increase of a fifth since 2008/09. In absolute terms, this means that 19 million people are living with household incomes insufficient to afford the things that the public thinks are needed to meet basic material needs and participate in society. This is an increase of 4 million since 2008/2009. Over the same period, the proportion of people with household incomes 75% lower than the minimum standard of living rose by 2 million people (compared to 2008/2009). This is well below what a person needs to meet their basic needs.
The risk of having household income below the minimum standard is three times as high for children as for pensioners (45% compared to 15%) while working-age adults sit between these two groups, at 30%. Policies such as Universal Credit have not helped. An independent audit published in June reported that 40% of full service claimants were experiencing financial difficulties. Amyas Morse, the chief auditor told the Huffington Post: “The [DWP] has pushed ahead with Universal Credit in the face of a number of problems, but has shown a lack of regard in failing to understand the hardship faced by some claimants”.
A missed opportunity
As well as poverty and hardship, the proposals ignore the impact of income inequality, reduced social mobility and living in insecure, overcrowded housing. They do nothing to support families to thrive before they reach the point where they need mental health service intervention. And when they do need intervention, austerity policies have hollowed out services. When it comes to parental conflict, for example, cuts to domestic abuse services have trapped people in abusive relationships which we know are harmful to health. In short, the proposals still fall desperately short of acknowledging and addressing the underlying barriers to long-term, intergenerational improvements to the nation’s mental health.
In addition to these blind spots, the proposals don't go far enough. We need policies that acknowledge and reflect a public health preventative perspective as well as an interventional one. Take the commitment to increase funding to adult mental health services. More money for cash-strapped services is always welcome but this won’t prevent parents from becoming distressed in the first place. A commitment to overhaul harsh welfare policies, provide safe and secure housing (where people’s existing support networks are), secure job opportunities and policies that aim to reduce the inequality gap would have a much more impact in the long term.
If the government are truly serious about tackling “the root causes and factors which have an impact on poor mental health in children and young people” then they have to address these issues head on. Otherwise their approach can only ever result in small gains. An easy first step would be to ensure that the “brand new workforce” is trained to understand the impact that social and economic determinants have on distress, as we called for in our open letter. However, there is no getting away from the fact that the ultimate early intervention and prevention must be policy that addresses deprivation.
Jen Daffin is a trainee Clinical Psychologist in South Wales. Sally Zlotowitz is a Clinical and Community Psychologist in London. Jessica Bond is a writer based in London.
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