One-in-four adults and roughly three children in every classroom suffer from a mental health disorder. The increased coverage in recent years has acted as a ‘double-edged sword’, increasing awareness in general. However, this has also in part contributed to the demand the NHS now faces, and which is being met with insufficient resources. Only one percent of NHS funding is being spent on the Child and Adolescent Mental Health Service (CAMHS) (YoungMinds, n.d.) while mental health is costing the economy £105bn. It is time that a culture of positive mental health was instilled at an earlier age. Primary and secondary education would serve as an appropriate environment to address this with accountability being enforced through traditional Ofsted inspections (England).
The Rise of Mental Illness
With more attention on mental health, the increased prevalence of mental health issues among children and young people has been blamed on various factors, such as increased social media use, although no studies have shown a strong correlation. The role of mainstream media reporting of professional athletes and celebrities struggling with their own mental health has drawn an even larger focus to the issue. The lack of comparative or recognised studies on the causes of this trend has meant greater attention being paid to the system to support those in need.
Charities and Non-Governmental Organisations (NGOs), such as the Time to Change campaign, have eroded in part the dehumanising stigma that has been attached to the issue of mental illness for decades. This increased awareness has in part, however, contributed to the increased demand for health services. Only within recent years has the government sought to achieve parity between physical and mental health.
Young People’s Mental Health
Statistics show that one-in-eight children have a diagnosable mental health disorder, with half of these mental health problems manifesting by age 14 and 75% by age 24 (YoungMinds, n.d.). These issues are likely to be more prominent in adulthood and contribute to the broader problem of common mental disorders. The consequences of common mental disorders are potentially fatal, with suicide rates among males increasing in each age group up to 50-years-old. Another negative effect of mental health problems is the cost to the economy through lost productivity and labour turnover, equivalent to a loss of £105bn a year, according to the NHS.
CAMHS
The Child and Adolescent Mental Health Service (CAMHS) was introduced in the 1990s, and now finds itself underfunded and struggling to adapt to rising demand. Early successes meant that CAMHS resources were distributed to other government departments through the Crime and Disorder Act (1998) and the Quality Protects Programme (1998) (Cottrell & Kraam, 2005). Despite these success, the use of CAMHS in other government departments meant that resources were not enough to cope with the increase in demand. This increase in demand is demonstrated by a 26% rise in referrals in the last five years (BBC News). Cuts to CAMHS funding have also meant that it now receives only 1% of the entire NHS (England) budget (National Audit Office, 2018).
The foundation – or Tier 1 – of this model provides ‘universal’ care, involving early prevention and intervention and includes actors such as parents, educators, school nurses and local general practitioners. At this stage, there is less of a service being provided, however implicit assessment and evaluations of CYP takes place for potential mental health issues. It is much more difficult to quantify the struggle for access or quality of service in Tier 1 as it consists mainly of proactive activities or discussions promoting awareness, therefore isolating benefit on a case-by-case basis is unfeasible. Upper tiers are regarded as ‘specialist’ and require referrals so that consultations and treatment can be prescribed. The notable and publicized failings of CAMHS has often revolved around the failure of the referral system and the delays in eventual treatment (Davis, 2018). The government aims for treatment to begin within four weeks, however, recent studies show that the current wait times are double that, with approximately 133,000 referrals to specialist services being rejected in 2018-2019 (Crenna-Jenning & Hutchinson, 2020).
The attention drawn to these failings have encouraged a myopic view that increasing specialist care is the primary remedy to the problem. The problem is currently viewed only in terms of the number of children and young people needing treatment, and fails to take into account those left undiagnosed. A green paper produced in December 2017 entitled “Transforming Child and Young People’s Mental Health Provision” highlights this issue, and recommends a £1.9bn investment to address the rising waiting times for specialist care (Department of Health and Social Care, 2018).
The Role of Education
The role of the education system in addressing this problem is paramount in instilling a culture of positive discourse about mental health. The current universal tier of care CAMHS aims to provide is being underutilised, particularly in education. Preventative measures, such as those delivered in a school environment can reduce the demand on the CAMHS specialist care services and could save care providers money (National Mental Health Development Unit, 2010).
The 2017 green paper did endorse some progressive changes including a proposal to introduce a Designated Senior Lead for mental health within every school. This aims to reduce the most significant barrier to help-seeking behaviour for children and young people, which is based around a lack of awareness or the confidence to proactively engage with available services (Gulliver, et al., 2010). Data from the Care Quality Commission’s review of CAMHS (2017) suggested that that such a measure drew positive feedback from students. Similarly, the British Journal of Psychiatry published a study, concluding that short educational workshops can produce positive changes in attitudes towards mental health (Pinfold, et al., 2003). The incorporation of mental health support teams was an additional proposal from the Transforming Child and Young People’s Mental Health Provision paper serving as an excellent link between the ‘universal’ stage of care to the second tier of the CAMHS services. The disjointed nature of the relationship between the tiers of care and the overall level of care being received is the result of the involvement of numerous agencies (Care Quality Commission, 2017).
Proposed Solution
A policy solution that would be suitable to address this issue, that could be administered by the Department for Education would be amending the current inspectorate framework that the Office for Standards in Education and Children’s Services (Ofsted) adhere to. Despite recent changes (Whittaker, 2019), it is viewed by many as unambitious, with minimal reference to mental health and wellbeing (YoungMinds, 2019).
The pressure on schools to maintain or improve academic attainment is closely linked to financial pressures. This is felt by teachers, staff and students undertaking exams or being observed (Shaw, et al., 2015) and has a detrimental effect on their mental wellbeing. There are many studies giving evidence to show the link between health and education are synergistic. Countries such as Sweden, Finland and Australia are all examples of nations that place ‘overall development’ as more central to their education policy (Bonell, 2014). Neglecting student wellbeing can also be harmful, particularly to those from disadvantaged backgrounds especially when we take into consideration that those living in the lowest 20% income bracket are twice as likely to develop mental health problems than those at the top (Marmot, 2008).
A shift from the current attainment dominated inspection framework would serve as a means of regulating and in part holding schools accountable for the wellbeing of their students. With an amended inspection framework that catered more towards the wellbeing of students, inspection criteria would evaluate the support systems and universal programmes run by schools. This would be in conjuncture with the government’s current aim to release formal statutory guidance on Personal, Social, Health and Economic education (PSHE), to be implemented in 2020 (Department for Education, 2019). It would not be the role of the Ofsted to inspect the wellbeing of the students, as the mental wellbeing of individual students should not reflect poorly on the school. Mental health and wellbeing are contingent on numerous factors, the majority of which are out of the school’s control. Measures in the new framework, focusing on universal care (targeting the whole school population) programmes, would be based around inclusivity.
From a broader health perspective, it would encourage a more positive culture surrounding mental health and would promote early intervention. It would also be an inexpensive and straightforward measure to implement, that would require no involvement from other agencies.
Jordan Bowen is currently studying for a Masters in Public Policy at the University of Stirling, and has interests in education and health policy. Email jordanbowen1996@hotmail.com.
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