Children's and adolescents' mental health and CAMHS - Health Committee Contents


7  The role of education and GP services

Schools  

190. CAMHS service providers, charities, voluntary sector organisations, commissioning organisations, and young people themselves have all agreed that schools have a crucial role to play in relation to children's and young people's mental health. This involves promoting good mental health and emotional wellbeing; detecting emerging mental health problems and supporting children with them, for example through in-school counselling services; educating children and young people about mental health issues; tackling bullying; educating children and young people about safety online.

191. At the Committee's meeting with young people on 11th June, the role of schools in mental health was frequently raised:

·  Young people described some school support for young people with mental health problems as really good, for example specific supportive teachers, and non-stigmatising environments (such as a separate learning support block) where young people could access support for mental health issues

·  But some young people felt that teachers were 'scared' of mental health issues, or lacked knowledge and ascribed problems to puberty or bad behaviour; improving teacher training was seen as very important. School nurses were also thought to require better training about mental health

·  Young people also highlighted the lack of education for young people about mental health in schools; they said they received lots of information and awareness raising about sexual health, pregnancy, drugs and finances, but none on mental health. Educating children about mental health issues from a younger age was also seen as important.

192. The NCB presented a similar overview in its written evidence:

    Feedback from the young people also suggests that schools are not primed to make the best contribution they should to their pupils' mental wellbeing. Many felt that there is a lack of teaching and learning about bullying or mental health and emotional well-being. Many children and young people also talked of receiving little or no support for their mental health support needs in school. These messages are corroborated by the NCB and NHS Confederation's 2013 survey of those working in the health service which found that the 89% felt the potential of schools for supporting health is not being fully realised.[236]

SUPPORT FOR YOUNG PEOPLE WITH MENTAL HEALTH PROBLEMS WITHIN SCHOOLS

193. Mick Cooper, Professor of Counselling Psychology, at the University of Roehampton, estimates that approximately 61-85% of secondary schools in England provide young people with access to counselling, meaning that between 50,000-70,000 young people attend school-based counselling per year in England, similar to the numbers in this age range attending specialist CAMHS. This makes school-based counselling one of the principal forms of CAMHS intervention in England.

    Due to its short waiting times, convenient location, and broad intake criteria, school-based counselling is perceived by many stakeholder groups as a highly accessible intervention. It is able to offer a wide range of young people professional therapeutic support in a direct and immediate way. Indeed, there is evidence to suggest that young people may be as much as ten times more likely to access a school-based mental health service as compared with a non-school-based one. This means that school-based counselling may have the capacity to act as an effective early intervention: supporting young people to address their difficulties in a timely manner, with the possibility that this will then inhibit the development of more serious problems at a later date.[237]

194. However, many commissioning organisations described difficulties in getting schools to engage with mental health: Mental Health Commissioners Network argue that

    … the multiple agencies involved in these children's lives seem to be increasingly focused on their own single issues-'we do education' or 'we do social work' for example. And increasing complexity in the education system is leading to further embedding of those silos, particularly amongst those types of schools specifically focused on academic attainment at the cost of the 'softer' personal support of pupils; leading, for example, to the exclusion of children displaying behavioural difficulties rather than referral to appropriate support.[238]

195. Other commissioners described a similar situation:

    In addition and despite the very positive role of the BOND project, it is very difficult to fully engage schools as commissioners of CAMHS and EWB as they tend to see these issues as being the responsibility of the local authority and health commissioners. The engagement of schools in the commissioning of CAMHS is a critical factor in delivering early recognition and intervention.[239]

    We have commissioned a CAMHS Tier 2 service which works with universal services to build their capacity to manage children and young people with emotional problems and emerging mental health difficulties. However, their challenge is made greater by current education policy which leads schools to prioritise academic achievement over emotional wellbeing needs and there is an expectation that CAMHS will deal with all emotional wellbeing needs.[240]

196. Dr Liz Myers of Cornwall Partnership NHS Foundation Trust described the impact that in her view this disengagement can have on CAMHS:

    Part of our increase in referrals has been young people who really should have been dealt with at school and the problems should never have got to the stage they got to. But they are not getting picked up and they are not getting the support. I am not quite sure how we can change that, given the way that education is right now. It can only be done with a lot of very clear and quite directive instructions around collaborating together.[241]

197. Jody Tranter of Christ Church Primary School described the picture from a school perspective, arguing that schools need better access to CAMHS services:

    As a school it is our responsibility to teach the whole child, including his/her emotional health and wellbeing but we are not mental health professionals and cannot be given all the responsibility for working with very distressed, dysfunctional or damaged young children. In short, we need help: help that is effective, available and easy to access.

    My recommendations would be thus:

    A trial of a hub/school based access to lower-tier CAMHS provision

    An increase of resources available to CAMHS in order to increase capacity and provision for children at risk of disengagement or exclusion

    A re-thinking/re-classification of the boundaries of what qualifies as a mental health issue so that children that are violent and aggressive are not simply dismissed or forwarded to social workers or parenting groups who are not equipped or qualified to make mental health interventions[242]

198. We did hear examples of successful collaboration between schools and wider CAMHS services:

    Schools are completely vital in identifying early signs of mental health or low­lying issues that might develop into something serious. The role of the school nurse is particularly important in supporting those young people. For instance, in Essex, a lot of counselling is taking place in schools. We have quite a mixture of services that are provided straight away when we identify self­harm or an eating disorder. We are trying to create a rapid response to a GP or to a psychiatrist when things get a little bit more serious. We do not want schools to feel that they are vulnerable and have to deal with some of these very difficult situations all on their own. I think it is about providing support to the school nurse and the teaching staff, and also doing a lot of training with the teaching work force on issues such as self­harm and eating disorders.[243]

    In schools in Derbyshire, we are trying to roll out a model whereby networking of those services within the school provides a platform whereby the school can monitor what is happening, who needs help, who might be in trouble, who might be being bullied and who might be at risk of self­harm. They can respond and they can draw down help from specialist services like CAMHS, rather than exporting the problem and making a referral for somebody else to deal with—they can bring the services into the school and provide the help within the school. We have had examples where there has been a sharp increase in presentations of things like self­harm, and the school, with those services, puts on a series of information events for students and for parents, bringing in people from the safeguarding board and other services to talk about online security, and opening parents' eyes to what is actually going on—the bullying that can take place. They are providing that information so that the parents are getting help and the young people are getting information and help. That has shown that young people refer themselves for help; it is almost unprecedented within CAMHS, but they will do that in a school where there is a CAMHS presence. It can be done discreetly, in their lunch hour or after school, on their terms, the way they feel comfortable. Clinic­based services that are not integrated cannot deliver that; young people would not buy into it. [244]

199. However, we heard that the school nursing resource was "very thinly spread", and also received descriptions of helpful services being removed or restricted:

    That was delivered at schools. That was an excellent service and still is, but because of how it was restructured they simply turned round and said, "We will not see now any children below the age of 10." So all the counselling services for all those below that age just disappeared…[245]

    An example was the targeted mental health in schools programme, which was exactly that—putting service into the schools. It ran for a period of years and has come to an end ….It built some awareness. Our experience is that it has not made a huge difference. A service was there, was provided for a brief period and then it disappeared.[246]

GUIDANCE AND TRAINING FOR TEACHERS

200. Along with the young people we met, several organisations and witnesses agreed on the importance of the inclusion of mental health issue in teacher training. Liverpool CAMHS Partnership suggested that

    A clear recommendation for prevention and early intervention however is to ensure mental health and emotional wellbeing is a key component of teacher training and built into continual professional development of the children's workforce.[247]

201. Children and Young People's Mental Health Coalition state that

    Teachers are often the first people young people will go to if they are experiencing mental health problems. However, teachers have little or no training in mental health and child development. We believe that these topics should be incorporated within their initial training and within Continuous Personal Development (CPD). We suggest that as a minimum, schools access e-learning via the MindEd e-portal.[248]

202. Catherine Roche, of Place2Be, developed this point further:

    We need to train teachers and to build the understanding of school staff generally—teaching and nonteaching—around children's behaviour and what lies behind that behaviour, which is often just a manifestation of a child's mental health issue. Helping teachers understand and work with that is absolutely key. We have made numerous attempts to get something in there, but one of the challenges with teacher training is how packed the curriculum is. We have been doing some great work for newly qualified teachers, so that when a teacher has done their initial teacher training they can have some applied experience. They are in the classroom, beginning to experience some of those behaviours. [249]

203. During the course of this inquiry the Rt. Hon. Nicky Morgan MP was appointed as Secretary of State for Education; we wrote to her and asked for her to outline her views and policies regarding children's and adolescents' mental health. The written evidence submitted by the Secretary of State described the guidance issued to schools by her Department in June, stating that mental health is "an area where teachers and schools have said they would appreciate more guidance in order for them to ensure they have the right knowledge and skills". She also referenced MindEd, an interactive e-learning tool aimed at people working with children in universal settings and ACE-V, a tool developed by the BOND consortium to help voluntary and community sector organisations which provide mental health support to make better links to commissioners, including schools. She also mentioned reforms to processes around Special Educational Needs (SEN) and disabilities, pointing out that for the first time the new Code of Practice now recognises that possible mental health difficulties should be looked into, where a child or young person is displaying concerning behaviours.[250]

204. However, in the view of Anthony Smythe of BeatBullying, the DFE guidance falls short of providing a complete solution:

    The Department for Education has just released guidance on how schools should deal with mental health. It touched on CPD, but it was disappointing that there was not more in there. We need a lot more investment. The Government is very good at saying what needs to be done, but more needs to be done on the how—the sharing of good practice and the teacher training part of it. If you take an issue like bullying, one of the reasons teachers do not intervene at the earliest opportunity is that they do not know how to, or are a bit nervous of what to do, who to talk to and how to have that discussion with young people. That will be the same across all of these issues. There is a job to do on building the capacity of teachers, so that they can recognise signs and symptoms and intervene at the earliest opportunity.[251]

EDUCATION FOR CHILDREN AND YOUNG PEOPLE ABOUT MENTAL HEALTH

205. Although the Secretary of State for Education's written evidence referenced many initiatives aimed at improving teachers' and professionals' awareness of mental health issues, it did not include any reference to one of the key issues raised by the young people the Committee met - the need for children and young people themselves to receive better education about mental health issues in schools. A young person from the GIFT partnership described the importance of this:

    If funding was to be increased, trained CAMHS staff, could begin to tackle the problem in schools. For example doing monthly classes or speaking in school assemblies. This will greatly increase awareness of mental health in general and encourage help to be sort before crisis is reached. During my own time at school, I began showing/having symptoms of anxiety, but I didn't even know what the term anxiety meant. I got to year 10, without being taught and therefore not having, any kind of awareness of mental health symptoms and problems. This is shocking. At school, we are all taught if we have a physical injury to go to the hospital. Mental Health issues are not addressed.[252]

206. Both commissioner and provider organisations suggested that school curriculums should include emotional wellbeing and mental health[253], and the Children and Young People's Mental Health Coalition argues that:

    The Personal, Social and Health Education (PSHE) curriculum provides a good opportunity to help improve children and young people's understanding of mental health and wellbeing. However it isn't mandatory and we hear from young people that it isn't always well taught. Many young people believe that mental health should be on the curriculum. Two young women from North London have been campaigning to get mental health on the curriculum after one of them developed an eating disorder. Ofsted have reported that 40% of schools' PSHE provision required improvement or was inadequate. Ofsted also asked a panel of young people what they would like to learn about in school, but currently didn't. Young people told them that mental health issues were at the top of their list, with:

·  38% wanting to learn how to deal with bereavement;

·  33% wanted to know how to cope with stress and

·  nearly a third wanted to know more about eating disorders such as anorexia.[254]

207. Anthony Smythe suggested that while progress has been made in adding cyber-bullying to the computer sciences curriculum, on more work is needed to clarify mental health's place in the curriculum:

    In terms of the curriculum, there has been a good development in relation to cyber-bullying, which will be embedded in the computer science curriculum from September. On mental health, there is still a lot more work to do. A lot of it is down to PSHE, which is inconsistent. In terms of mental health provision in schools, we would like to see greater representation in the curriculum and for it to be a bit more concrete in terms of where it stands. In my view, what schools do to educate young people around mental health is inconsistent.[255]

208. Much of the Department for Education's recent focus in relation to mental health has been on providing guidance and education about mental health issues to schools and teachers. However, an equally important message to emerge from young people who contributed to this inquiry is that children and young people themselves want better education and awareness about mental health issues. This would encourage young people to look after their own mental and emotional wellbeing as well as their physical wellbeing; would help young people to recognise the signs of mental health issues and seek help sooner; would encourage peer support; and, crucially, would help normalise talking about mental and emotional health and wellbeing, and reduce the stigma attached to mental health issues.

Conclusions and recommendations

209. Schools have enormous potential to help address emerging mental health issues in children and young people. We heard many examples of good practice, where schools are able to act as a central 'hub' for the wider community based provision, as well as providing support themselves. But when we spoke to young people, we heard that while some teachers and schools provide excellent support, others seem less knowledgeable or well trained, and can even seem 'scared' of discussing mental health issues.

210. The need for better support and training for teachers about mental health was raised by many of those who gave evidence to this inquiry; the launch of MindEd, together with new guidance for schools on mental health, are both welcome steps towards addressing this deficit. However, with both of these, the onus is on individual schools and teachers to find time to prioritise this, and within a sea of competing priorities, it may be difficult to ensure that all schools and teachers use these tools. We consider that awareness of mental health issues, including their relationship to normal child development, conduct issues, and impact on education, is important and we recommend the Department for Education looks to including a mandatory module on mental health in initial teacher training, and should include mental health modules as part of ongoing professional development in schools for both teaching and support staff.

211. The evidence we have received suggests that in some areas schools are already working innovatively and collaboratively with their wider communities to offer good mental health support, but that this is not happening universally. We recommend that the Department for Education conducts an audit of mental health provision and support within schools, looking at how well the guidance issued to schools this year has been implemented, what further support may be needed, and highlighting examples of best practice. OFSTED should also make routine assessments of mental health provision in schools.

212. It is clear that education about mental health could and should contribute to prevention and support for young people. We recommend that the Department for Education consult with young people, including those with experience of mental health issues, to ensure mental health within the curriculum is developed in a way that best meets their needs.

Digital culture, social media, bullying and cyberbullying

213. Children and young people are now major users of computers and the internet, with some 85.5% of children belonging to a social networking site, and the proportion of young people playing computer games for two hours or more a night during the week standing at 55% for boys and 20% for girls in 2010.[256] Public Health England cite research suggesting that increased screen time and certain internet activity can have a negative impact on young people's emotional wellbeing:

    Increased screen time and exposure to media is associated with reduced feelings of social acceptance, and increased feelings of loneliness, conduct problems and aggression. Certain internet activity (social network sites, multi-player online games) have been associated with lower levels of wellbeing. The evidence suggests a "dose-response" relationship, where each additional hour of viewing increases the likelihood of experiencing socio-emotional problems[257].

214. The NSPCC highlight its latest ChildLine report which outlines the potential negative consequences of digital media for young people:

    Our latest annual ChildLine report highlighted the potential negative consequences of digital integration into young people's lives as in the past year there was an 87 per cent increase in the number of children contacting ChildLine about online bullying. From December 2012, ChildLine began to monitor instances when young people specifically mentioned bullying that related to social networking sites, chat rooms or gaming sites. From December 2012 to March 2013, ChildLine heard from 1,098 young people who mentioned these platforms.[258]

215. Dr Sebastian Kraemer provided a succinct overview on the impact that digital culture can have on children's and young people's mental health:

    It makes intimidation more alarming and more chronic. You can be teased in the playground and it has gone with the wind, but if you have got your photograph on Facebook then it stays there for ever. I do not believe these children are any different from the children I met when I started in 1980, but they have different means of upsetting each other—girls in particular. The medium is not the cause, but it certainly facilitates different ways of harming each other, of abusing each other, and that is what young children do. Some of these girls have been bullied into a state of despair because their attachments at home are not strong enough, so they rely on their friendships to be a family for them, and when that family crashes they feel they haven't got any, until family then appears like magic in the paediatric ward the next day and maybe some restoration can be created then.[259]

216. Mark Waddington, clinical lead at Thornby Hall, reports that "100% of the young people we have admitted over the last five years are reported to have had difficulties in the area of bullying predominantly as victim but also as perpetrator", and that "66% of the young people we have admitted over the last five years are reported to have had difficulties that have arisen through the internet and mobile phones." [260]

217. CAMHS provider organisations expressed similar concerns:

    Deeply concerning is the proliferation of pro-anorexia websites on the internet, in addition to pro self-harm sites which offer information about how to successfully commit suicide. Pro-anorexia (or Pro-Ana) websites can negatively impact the eating behaviour of people with and without eating disorders. One study of individuals without eating disorders demonstrated that 84% of participants decreased calorific intake by an average of 2,470 calories per week after viewing pro-ED websites. We believe that more studies into the effect of these websites, and more control should be exerted over their availability online.[261]

    Considering what might have caused the increase in complexity of cases, there is some anecdotal and clinical evidence about the negative influence of the internet and wide use of mobile phones on young people. We have had a number of children who have befriended other young people in different schools over the internet and formed a network of children who self-harm. These young people are using web cams and phones to send friends photos of themselves self-harming, usually by cutting, and this is having a very negative effect on all the children concerned, particularly as some of the young people are not themselves self-harming. Mobile phones can also be used for relentless bullying through messaging. There is also actual and anecdotal clinical evidence of young children taking photos of themselves or other young children, some as young as 11 or 12 years old, performing sexual acts and then sending photos around the school, which this leads to the dilemma of both how to deal with children who have uploaded child pornography onto the internet and also how to treat children psychologically traumatised by mass shame and internet bullying. External pressures around body image can also lead to eating issues and self-harm.[262]

218. However, YoungMinds suggest that it is unrealistic to limit young people's use of the internet and social media, and also suggest that the internet can be a positive source of support for young people:

    The 24/7 online world has the potential to massively increase young people's stress levels and multiplies the opportunities for them to connect with others in similar distress. But the online world is where children and young people are and it is unrealistic to think we can suggest they limit their contact with social media. Websites like Tumblr where there has been a recent media focus on self-harm blogs must do all they can to limit triggering content and that which encourages self-harming behaviour. However young people we work with talk about all the help they've found from others online and that often this has been far more supportive than specialist services in the community. For every piece of triggering content there are young people online providing ongoing support to other young people in distress.[263]

ADDRESSING THE CHALLENGES OF DIGITAL CULTURE

219. We received many suggestions for addressing the challenges of digital culture. Anthony Smythe of Beatbullying argued that improved regulation was key:

    A lot of work that has gone into safety has been looking at the child protection side of it—child pornography images and so on—which is understandable. The Government have invested a lot in filter systems and parent filters, which is good … but there is a danger that it provides a false sense of security …

    If we do not get regulation, we will look to industry to regulate themselves. That is what they said they would do. I have been working on this since 2008, both in Government and doing my job in the charitable sector. My view is that industry has failed miserably. What they pass off as self-regulation is by and large self-assessment. Occasionally they will get in a peer to do some peer review. That peer tends to be pretty friendly. I say to industry, "If you want to self-regulate, you are only going to be as strong as your weakest member." There are some very weak members in that sector, and that is not being addressed.[264]

220. Mr Smythe also argued that there was a 'lack of leadership' from Government in this area:

    The problem with that in terms of cyber-bullying is that it is fast becoming nobody's responsibility—everyone is pointing at one another. As I mentioned earlier, somebody somewhere needs to pick this up and lead.[265]

221. Beyond the high-level issue of internet regulation, we also heard that CAMHS services need to update their practice to ensure they are able to help children and young people manage the challenges posed by the online culture and social media, and also to ensure that they themselves are better able to exploit the opportunities of web-based and mobile technology, to give children and young people better access to support. YoungMinds argue that "Many professionals feel completely out of touch with, even intimidated by social media and the net", and that further support is needed:

    Statutory mental health services providers and others need help to make sure they have readily available online content on all platforms young people access. Providers need to go to where young people are, not expect young people to go to them. They also need to stay up to date as technology and the platforms young people use move on. In order to reach young people online who are suffering and need support providers and charities should be bringing in the expertise and ideas of young people of the same age group as those they cater to so that online support services are relevant and accessible to young people. Support services also need to be funded so that they are available for young people 24/7 both on and offline so that early access to support is provided at all times.[266]

222. This view is echoed by those working in CAMHS. Liverpool CAMHS partnership state that "CAMHS needs to update their practice in relation to digital culture to engage more with c&yp [children and young people]. However there needs to be guidance on this specifically in relation to safeguarding and quality."[267] The University of Reading, which provide training to CAMHS staff as part of the CYP-IAPT programme, argue that "CAMHS staff appear to require specialist training in the assessment and management of risks posed by social media"[268] Tavistock and Portman suggest a "whole systems" approach:

    The internet has been used creatively by young people as a peer resource and there are opportunities to engage with young people therapeutically through the internet and social networking sites….CAMHS staff need to be aware of the centrality of digital lives to children and young people and to understand both the threats and opportunities the internet provides. This will need to be achieved through a whole systems approach, rather than individual trainings if CAMHS staff are to be able to engage with children meaningfully about their experience of the digital world…. It would seem that what we are witnessing now in terms of young people's online lives represents a fundamental change in human behaviour and enquiry about digital lives needs to become integrated into assessments including risk assessments.[269]

    Of topical concern is the impact of the internet on young people. This virtual world is an important part of most young lives in a way that would have been unimaginable for many CAMHS practitioners in their own youth…. There are a number of CAMHS initiatives, some associated with CYPIAPT providing psycho-education and information about services, however there is a potential gap to be filled by more specific health promotion material informed by the knowledge and skills available in CAMHS. The development would require creative commissioning investment and partnership with web designers, together with young people, who could, together produce age-appropriate material and training for staff.[270]

223. Leicester City Psychology Service describe innovations they are introducing:

    The digital culture provides numerous benefits. Whilst the incidence of referral to our service where cyber bullying is less than 1.0 % we nevertheless have taken heed of national trends and been proactive and have set up a number of initiatives to address potential issues around cyber and other forms of bullying. The Text Someone anti- bullying system in schools allow pupils to anonymously report incidents of bullying .On the City Psychology guidance information leaflets are available for professionals , parents and children on dealing with bullying. We are embarking on undertaking a survey of bullying in schools using a web based questionnaire page so that schools and children are able to access this information much quicker than was previously the case using other methods.

    We believe that the digital media is an area to embrace and are in currently setting up an online training programme for staff on recognising and dealing with an array of issues including self-harm, bereavement, and missing children.[271]

224. Anthony Smythe emphasised the importance of educating children and young people about the risks posed by digital culture:

    Continue to invest in the education programmes that exist out there. I mentioned earlier that the new curriculum for 2014 will have safety from key stage 1 upwards, which is a good development. We will be looking with interest at how schools implement that. We do not want education around safety to be about how you secure your bank details—or not about that alone. It needs to be peer on peer.[272]

225. The Committee also heard about the importance of parental awareness:

    There is a role to build parents' understanding as well. Parents should recognise that the internet is there and that children of five or six are accessing it. Parents should not be afraid of that; they should embrace it and understand what it is about, so that as parents we can also help to direct and provide support for our children. Again I emphasise that, both offline and online, a child should be able to go and talk with a trusted adult, so that they can take responsibility for themselves, with help within families to provide that supporting network.[273]

    It is about having discussions about risks that they face online, in the same way that you would have those discussions about offline risks, such as violence that you may come across or bullying at school—whatever the risk may be. To do that, parents need to be supplied with greater information. In saying that, I do not think we can say this is for parents to deal with alone; the issue is too big. It needs everyone rallying around the child; it needs a child-centred approach. There is an old line that came out of Government many years ago but is still true: tackling bullying is everyone's responsibility.[274]

Conclusions and recommendations

226. For today's children and young people, digital culture and social media are an integral part of life; whilst this has the potential to significantly increase stress, and to amplify the effects of bullying, the internet can also be a valuable source of support for children and young people with mental health problems.

227. We have not investigated the issue of internet regulation in depth. However, in our view sufficient concern has been raised to warrant a more detailed consideration of the impact of the internet on children's and young people's mental health, and in particular the use of social media and the impact of pro-anorexia, self-harm and other inappropriate websites, and we recommend that the Department of Health/NHS England taskforce should take this forward in conjunction with other relevant bodies, including the UK Council for Child Internet Safety.

228. We have heard that CAMHS providers may need further support-both in helping the children and young people they treat to cope with the challenges of online culture and manage the impact it might have on their mental health - and so that they themselves are better able to use online means of communication for reaching out to young people. We recommend that the Department of Health/NHS England taskforce should also investigate and report on the most effective ways of supporting CAMHS providers to do this.

229. Children and young people also need to know how to keep themselves safe online. It is encouraging that e-safety will now be taught at all four key stages of school education. We recommend that as part of its review of mental health education in schools, the Department for Education should ensure that links between online safety, cyberbullying, and maintaining and protecting emotional wellbeing and mental health are fully articulated.

230. We recommend clear pathways are identified for young people to report that they have been sent indecent images of other children or young people, and that support is provided for those who have been victims of image sharing. Pathways should also be established for children and young people who have experienced bullying, harassment and threats of violence.

General practice

231. Evidence submitted by the Jane Roberts of the Royal College of GPs argues that GPs need better training in dealing with young people with mental health concerns:

    GPs are inadequately prepared for both consulting in general with young people and more specifically for addressing mental health concerns. This is reported in both the formal literature, from national surveys distributed through the RCGP and from the recent experiences of the RCGP Adolescent Health Group running national Master Classes with the BMJ and One Day Educational event at the RCGP.

    There is scant coverage of adolescent mental health in undergraduate curricula which might now cover the growing field of adolescent neurodevelopment using functional imaging to demonstrate the neuro-plasticity of the brain in the second and third decade of life.

    A direct consequence of inadequate preparation is that GPs report feeling anxious and uncertain when faced with YP in distress. Professional competence is challenged when a GP is unsure how to proceed and young people may be aware of this in the clinical consultation thus compounding their feeling of isolation.[275]

232. Dr Roberts described the situation in stark terms:

    We see an increasing number present with self-harm- cutting, alcohol abuse, exploratory behaviour associated with high risk such as driving whilst under the influence of alcohol , fighting, unprotected intercourse. There are higher rates of accidents When and trauma in poorer communities.... In a ten minute consultation it can feel overwhelming to open a 'pandora's box' and begin to look at what is troubling a young person and leading them to cut repeatedly or drink to oblivion, especially if the options for referral seem limited and difficult to access.[276]

233. Dr Roberts went on to explain to the Committee that within the Quality and Outcomes Framework (QOF), which determines priorities within primary care, children and young people's health accounts for less than 3% of QOF indicators, "so it is on nobody's agenda to do anything about it."[277]

234. The Minister undertook to write to us about GP training.[278] In his letter, he told us that Health Education England (HEE) will work with Royal Colleges and with professional regulators to seek to include compulsory work-based training modules in child health in GP training. HEE will also work with the Royal College of General Practitioners and the Royal College of Paediatrics and Child Health to develop a bespoke training course which will allow GPs to develop a special interest in the care of young people with long term conditions, which will be introduced by September 2015. HEE has also established a Mental Health Advisory Group to promote and enhance mental health training across the professions. The Minister writes that "there is already mental health experience included in GP training, and it may be that further modules are required to established GPs as part of their continuing professional development."[279]

Conclusions and recommendations

235. Like schools, GPs provide universal services which are open to all children and young people without prior referral, and because of this, they may be one of the first places children or their parents turn to when they are experiencing mental health problems. We have heard that many GPs currently feel ill-equipped and lacking in confidence in dealing with these issues, and that their current training does not prepare them adequately for this. We would like to seek further assurance that the issue of GP training in children's and adolescents' mental health specifically will be addressed by this work.

236. We ask Health Education England, together with the GMC and relevant Royal Colleges, to provide us with a full update on their plans for GP training in children's and adolescents' mental health. If children, young people or their parents turn to their GP for help with a mental health problem, they have a right to see a professional who has received sufficient training to be able to consult with them with confidence, and who is able to signpost them to other support, resources or more specialised services as appropriate.


236   National Children's Bureau (CMH0146), para 5.3 Back

237   Professor Mick Cooper (CMH0059), paras 2.2, 3.4 Back

238   Mental Health Commissioners Network (CMH0122), para 6c Back

239   Clinical Commissioning Groups within Staffordshire and Staffordshire County Council (CMH0142) para 2.2 Back

240   Worcester County Council (CMH0160) para 14 Back

241   Q172 Back

242   Jody Tranter (CMH0147) paras 4-5 Back

243   Q294 Back

244   Q296 Back

245   Q170 Back

246   Qq321-322 Back

247   Liverpool CAMHS Partnership (CMH0139), para 4  Back

248   Children and Young People's Mental Health Coalition (CMH0153) para 6.4.4 Back

249   Q312 Back

250   Department for Education (CMH0236) Back

251   Q311 Back

252   GIFT Partnership (CMH0159), section 3 Back

253   For example, West Midlands ADCS (CMH0115); The Huntercombe Group (CMH0179) Back

254   Children and Young People's Mental Health Coalition (CMH0153) para 6.4.6 Back

255   Q310 Back

256   Public Health England, (CMH0085) para 3.7 Back

257   Public Health England, (CMH0085) para 3.7 Back

258   NSPCC (CMH0136) para 16 Back

259   Q204 Back

260   Mark Waddington (CMH0088), p3 Back

261   The Huntercombe Group (CMH0179) para 3.3 Back

262   Barnet Child & Adolescent Mental Health Service (CMH0142) para 1.3 Back

263   YoungMinds (CMH0169), pp3-4 Back

264   Q328 Back

265   Q330 Back

266   YoungMinds (CMH0169), p4 Back

267   Liverpool CAMHS Partnership (CMH0139), para 2 Back

268   University of Reading (CMH0121), para 4.3 Back

269   Tavistock and Portman NHS Foundation Trust (CMH0074), para 2 Back

270   Central and North West London NHS Foundation Trust (CMH0132), p6 Back

271   Leicester City Psychology Service (CMH0197), p5 Back

272   Q328 Back

273   Catherine Roche, Q329 Back

274   Anthony Smythe, Q330 Back

275   Dr Jane H Roberts (CMH0217) p3 Back

276   Dr Jane H Roberts (CMH0217), p5 Back

277   Q27 Back

278   Q433 Back

279   Written evidence submitted by Rt. Hon Norman Lamb MP, Minister of State for Care and Support (CMH0234) p4 Back


 
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© Parliamentary copyright 2014
Prepared 5 November 2014