Reflections on the children and young people’s mental health Green Paper

There is much to welcome in the Children and Young People’s Green Paper. Its direct commitment to help prevent mental health problems emerging represents a shift in focus looking upstream to tackle the determinants of these problems at their root.

The government’s formal recognition of this need is very encouraging and presents new opportunities to shape appropriate measures to safeguard children and young people’s mental health and importantly, reduce the pain of mental distress and improve the quality of the lives of children and young people.

Addressing the inequalities associated with risk to mental health involves evolving and adapting our social arrangements and institutions. Public sector responsibilities do not reside solely in the health service and the Green Paper importantly reflects this.  Working closely with the Department for Education demonstrates the important role the education setting plays in advancing mental health equity and promoting measures to protect emotional and social wellbeing.

Delays in identifying children at risk and providing effective early intervention mean that many young people enter adulthood with emerging and all too often untreated conditions, while for other symptoms may only develop later in adulthood. Schools provide an important setting in which to support good mental health and wellbeing, equipping young people to progress into adult life as resilient, compassionate and socially engaged citizens.

Early years

In working to reduce the prevalence of mental health problems, to make the biggest difference, we need to start at the earliest point, focusing a good deal on child development from conception onwards. It is encouraging to see the Green Paper’s pledge to commission further research into interventions that support parents and carers to build and/or improve the quality of attachment relationships with their babies and young children. This reflects the latest evidence that emphasises that the security generated from this parent-child bond is central to a child’s psychological and social development, and one of the building blocks of resilience.

It is of the utmost importance that early years work is joined up across government. If viewed in isolation of other policies, there is a danger the Green Paper’s ambitions will not come to fruition. For example, the reducing number of health visitors is of great concern; it is precisely this kind of early support for families that needs to be strengthened. This being said, the Green Paper does make provisions to support the What Works Centres to promote guidance for local areas to encourage evidence-based commissioning of support for parents and carers, and that it will recommend that local authorities commission parenting programmes for which there is a good evidence base.  However, ‘encouraging’ areas to adopt approaches is not as strong as ensuring that these happen; we need to have the strength of conviction to say that we have to now do things differently for the future of our society. 

The commitment to evidence-based practice opens new avenues for early intervention which ultimately will help to reduce the high prevalence rates of behavioural and emotional problems that emerge in childhood and can ultimately lead to mental health problems. It will, however, require future investment in testing new and promising practice ‘in flight’, as there are gaps in evidence, particularly in the acceptability and effectiveness for different groups of families and people living in different cultures and contexts (for example, Black, Asian and Minority Ethnic [BAME] families, children whose parents have a mental health problem and children in care).  

'Whole-school' approach

Looking to the school setting, it is encouraging to see the Green Paper’s commitment to applying a 'whole-school approach' ( an approach that acknowledges the need to engage the whole school community, from pupils to head teachers, school nurses to teaching assistants.)

As it stands, the Green Paper enshrines responsibility for mental health in a single individual – the trained mental health lead – rather than taking a more all-encompassing school community-focused approach. There is mention of the role that this mental health lead will play in promoting a whole- school approach, and of course this leadership will be necessary, but it must run concurrently with a broader, systemic approach, which starts with teacher training. If our teachers are to be the key adult in children’s lives for a good part of each day, they need to understand and be committed to positive child development and to creating mentally healthy and nurturing environments.

If rolled out in the wrong way, the proposed approach could potentially result in staff feeling less empowered to engage with the wellbeing of children and young people, as well as their own wellbeing.  We have seen this happen in a number of different policy areas, such as where there has been an equality lead but no mainstreaming of the approach throughout the whole system.

It will also be crucial to ensure that we measure success appropriately, and that schools are incentivised to put mental health at the heart of the curriculum, with a successful school being measured first and foremost on the mental health of its pupils, rather than the focusing too much on attainment. A mentally healthy child will be better placed to learn and do well in life in many ways that are important. The Green Paper is a welcome and important turning point; we must ensure that its vision is realised, and that it does not become a missed opportunity to truly embed mental health prevention across the whole school setting.

Girls

There is a mounting body of evidence demonstrating that the mental health of young women and girls is deteriorating, and that the gap between boys’ and girls’ mental health has widened over recent years.  Today, young women are three times more likely than male counterparts to experience common mental health problems. Importantly, the Green Paper cites a recent BMJ study on the 68% increase in self-harm rates among girls, highlighting this gender-specific mental health concern. However, when it comes to recommendations to address this challenge, the only policy actions which specifically support women are in relation to perinatal care. This Green Paper is a good start for children and young people in general but a gender-sensitive lens also needs to be applied. Equally, it will be important to consider other equality issues to ensure that we address the increased risk of mental health problems associated with factors such as living with a learning disability, being Black, and managing a long-term physical health condition. 

Conclusion

While further clarity is required on what exactly the government’s commitment to prevention means in policy terms and will look like when implemented, the Green Paper opens up a new chapter in children and young people’s mental health protection and improvement; one that is desperately needed. The paper provides good reason for optimism and we look forward to working with the government to write this next chapter: establishing new paths and setting out preventative measures to improve mental health support for children and young people.