Mental illness in children and young people is recognised as a major public health concern with evidence of rising prevalence, possibly exacerbated by COVID-19.1 It is thought that about 75% of mental illness starts before a child reaches their 18th birthday2 and yet, historically, child and adolescent mental health services have been under-resourced, even within the mental health field which has lagged behind physical health services.3 In recent years there has been greater recognition of the impact of mental illness on infants, children and young people and the necessity for effective interventions earlier in the developmental trajectory.4 The NHS in all parts of the UK has committed to additional funding for child and adolescent mental health with ambitions to increase access to services for 0-25 year olds. In England this is demonstrated in the prominence of both perinatal and children and young people’s mental health in the NHS Long Term Plan which, amongst other ambitions, aims for an additional 345,000 children and young people aged 0-25 to be able to access mental health support by 2023/24.5 Central to achieving these ambitions is investment in an expanded and more diverse workforce and the NHS People Plan has committed to increasing the number of child and adolescent psychotherapy training places in England by 25% in 2020/21 as a step towards this.6
Child and Adolescent Psychotherapists are one of the 12 core NHS Psychological Professions7 and work alongside a range of other professionals in multi-disciplinary teams in many different settings. Infants, children and young people, especially where needs are severe and complex, require access to effective specialist services that can offer a range of treatments at the right time in the right place.8 Such services should include professionals with a range of skills, competences and trainings working together in well-led multi-disciplinary teams. In turn these services need to be informed by evidence of clinical and cost effectiveness.
The Psychological Professions Network has suggested that evidence-based practice might be viewed as a tripartite model in which research evidence is contextualised by service user choice and clinical experience. I would add to this that the research component should include evidence about service user experience of different treatments and also research that examines the process of psychotherapy to optimise its effectiveness with individual patients, including those from Black, Asian and minority ethnic communities. A range of research methodologies are required to better understand how services can be tailored to the needs and preferences of individuals and therefore to identify what workforce skills, competencies and trainings are required to deliver those services effectively.
The empirical evidence base for psychoanalytic and psychodynamic psychotherapy with infants, children and young people has been slower to develop than for related fields, in part due to the relative underfunding of research in psychological therapies and on children and young people.10 However, published reviews demonstrate a growing evidence base which suggests that psychodynamic and psychoanalytic therapies might be effective for children and young people presenting with a range of clinical issues.11 The Association of Child Psychotherapists (ACP) has commissioned a further systematic review, due to be published this year, that will provide an update on the evidence published between January 2017 and May 2020 and will show further improvements in both the quality and quantity of research evidence.
Within the profession of child and adolescent psychotherapy there is increasing engagement with a variety of approaches to research, and the importance of these in both developing clinical practice and evaluating its efficacy. The majority of trainings in the UK now lead to a doctoral qualification and the papers in this edition of the Bridge are testament to the range of interests and areas where child and adolescent psychotherapists are making important contributions.
References
1 Vizard, T. et al. (2020) Mental Health of Children and Young People in England, 2020: Wave 1 follow up to the 2017 survey. NHS Digital: https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2020-wave-1-follow-up.
2 Kim-Cohen, J. et al. (2003) Prior Juvenile Diagnoses in Adults With Mental Disorder Developmental Follow-Back of a Prospective-Longitudinal Cohort. Arch Gen Psychiatry. 60(7), 709-717. doi:10.1001/archpsyc.60.7.709.
3 Association of Child Psychotherapists (2018) Silent catastrophe: responding to the danger signs of children and young people’s mental health services in trouble. Association of Child Psychotherapists: https://childpsychotherapy.org.uk/news-media-0/acp-policy-reports/silent-catastrophe.
4 Parkin, E. and Long, R (2020) Support for children and young people’s mental health. House of Commons Library: https://commonslibrary.parliament.uk/research-briefings/cbp-7196/.
5 NHS England (2019) The NHS Long Term Plan. NHS: https://www.longtermplan.nhs.uk/.
6 NHS England (2020) We are the NHS: People Plan for 2020/2021 – action for us all. NHS: https://www.england.nhs.uk/ournhspeople/.
7 Psychological Professions Network (2020) Career map for the Psychological Professions. Psychological Professions Network: https://www.ppn.nhs.uk/resources/careers-map.
8 Association of Child Psychotherapists (2019) Children and young people’s mental health: specialist provision for complex needs. Association of Child Psychotherapists: https://childpsychotherapy.org.uk/news-media-0/acp-policy-reports-0/specialist-provision-complex-needs.
9 Tierney, E. (2020) An update on our evidence-based practice project. Psychological Professions Network: https://www.ppn.nhs.uk/our-work/news/item/an-update-on-our-evidence-based-practice-project.
10 MQ (2015) UK mental health research funding: MQ landscape analysis. MQ: https://b.3cdn.net/joinmq/1f731755e4183d5337_apm6b0gll.pdf.
11 Midgley, N. et al. (2017) Psychodynamic psychotherapy for children and adolescents: an updated narrative review of the evidence base, Journal of Child Psychotherapy, 43(3), 307-329, doi: 10.1080/0075417X.2017.1323945.
