Place children and young people at the heart of the strategy – A recent call by a joint UK Select Committee

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In their recent 1^st joint Select Committee report, May 2018¹, the Education, Health and Social Care Committees call upon the government to take a stronger stance on child and adolescent mental health and to join up the appropriate services in a way that places children and young people at the heart of its strategy². Their report comes a year after the publication of the Third Progress Report on the UK Government’s National Strategy for suicide prevention in England, published in January 2017³ and almost half a year after the joint Department of Health and Department for Education Green Paper, on child and adolescent mental health provision (published December 2017⁴.)

The National Strategy

The original National Strategy was commissioned in 2012 as a response to the growing rates of suicide in the UK. In the Third Progress Report, it is stated that while suicide rates remain comparatively low for people under 25, there has been an increase in suicide in the last three years, among adolescents between the ages of 15-19 years. Of those who died, over half had previously self-harmed⁵. Amid growing concerns from professionals working with at-risk children and adolescents, the report sets out a number of commitments to help achieve the aim of reducing the national suicide rate by 10% by 2020/2021. Notably there is an emphasis on the key role that schools and colleges can perform by directly engaging students e.g. through mentoring activities, such as Personal, Health, Social and Economic (PSHE) guidance, and age-appropriate lesson plans on mental health. The report also references the development of the joint Green Paper, which would provide further proposals for improving services and increasing preventative activities.

Transforming Children and Young People’s Mental Health Provision

The Green Paper adds further evidence for the need to act. It cites an Office for National Statistics survey which states that based on child reports, 7% of children aged 5-16 have self-harmed, rising to 28% for those with an emotional disorder⁶. It also refers to a recent study which reported that self-harm rates may have risen by as much as 68% in girls aged 13-16⁷, since 2011. The Green paper states that, despite suicide and self-harm prevention programmes improving knowledge, attitudes and help-seeking behaviours, there is little robust evidence that suggests they have anything more than a small effect in terms of reducing suicide rates⁸.  However, it does endorse the Third Progress Report’s stance on whole school approaches and makes a commitment to providing further mental health training to teachers and staff members and ensuring that at least one member of staff in every primary and secondary school is trained in mental health awareness⁹.  Such steps are welcome as, according to a Department for Education’s 2016 Teacher’s Voice survey, 23% of teachers did not feel equipped to identify behaviour that might indicate an underlying mental health need and 34% did not feel equipped to teach those in their class who had a mental health need¹⁰.

Failing a Generation

In spite of such commitments, the recent joint UK Select Committee has challenged the Government’s strategy as unambitious and unable to provide the kind of care that many children and adolescents desperately need¹¹. Whilst it supports the need for whole school approaches, it raises concerns about an over reliance on teachers and increasing the pressure on a workforce that is already struggling with its recruitment and retention of staff members¹². The Select Committee also highlights what it considers to be failings in the scope of the Green Paper, to take into account the needs of particular vulnerable groups and the lack of any serious attention to prevention and early intervention.  Given the reported rise in rates of child and adolescent suicide and self-harm, the Select Committee calls upon the government to place “greater emphasis on, and provide a strategy for, prevention, early intervention and dealing with some of the root causes of child mental health problems”¹³.

Key Points

• Research suggests that the rate of suicide and self-harm amongst certain groups of children and adolescents has risen in the last three years.
• In 2012, the UK Government implemented a National Strategy to deal with the rise of suicide and self-harm on a national scale, this has been followed up every few years with a progress report.
• Using the Third Progress Report and a joint Department Green Paper on the provision of child and adolescent mental health, the UK Government has set out a strategy and commitments to preventing suicide and self-harm in the UK.
• A recent joint Select Committee has challenged the ambition of the UK Government and has called for the needs of children and adolescents to be given a place at the heart of the National Strategy.

References

¹ House of Commons: Education and Health and Social Care Committees, The Government’s Green Paper on mental health: failing a generation, 9 May 2018

² House of Commons: Education and Health and Social Care Committees, The Government’s Green Paper on mental health: failing a generation, 9 May 2018, p.3

³ HM Government: CC-CMH&7DAY/11168, Preventing suicide in England: Third progress report of the cross-government outcomes strategy to save lives, January 2017

⁴ Department of Health and Department for Education, Transforming Children and Young People’s Mental Health Provision: a Green Paper, December 2017

⁵ HM Government: CC-CMH&7DAY/11168, Preventing suicide in England: Third progress report of the cross-government outcomes strategy to save lives, January 2017, p.22

⁶ Department of Health and Department for Education, Transforming Children and Young People’s Mental Health Provision: a Green Paper, December 2017, p.6

⁷ Morgan. C, Webb. R, Carr. M, Kontopantelis. E, Green. J, Chew-Graham. C, Kapur. N, Ashcroft. D, Incidence, clinical management, and mortality risk following self-harm among children and adolescents: cohort study in primary care, British Medical Journal, 2017, 359

⁸ Department of Health and Department for Education, Transforming Children and Young People’s Mental Health Provision: a Green Paper, December 2017, p.37

⁹ Department of Health and Department for Education, Transforming Children and Young People’s Mental Health Provision: a Green Paper, December 2017, p.27

¹⁰ Department of Health and Department for Education, Transforming Children and Young People’s Mental Health Provision: a Green Paper, December 2017, p.41

¹¹ House of Commons: Education and Health and Social Care Committees, The Government’s Green Paper on mental health: failing a generation, 9 May 2018, p.3

¹² House of Commons: Education and Health and Social Care Committees, The Government’s Green Paper on mental health: failing a generation, 9 May 2018, p.3

¹³ House of Commons: Education and Health and Social Care Committees, The Government’s Green Paper on mental health: failing a generation, 9 May 2018, p.10

Read the Self-harm and Suicide Editorial of The Bridge by Dr Juliette Kennedy