Mental Health and the NHS Long Term Plan

In January 2019, the NHS published their Long Term Plan – a plan which outlines how the service will develop over the next 10 years. The plan is a published response to changing needs – with a population that is increasing in size, as well as in age, and some significant challenges that will also need to be addressed (e.g., funding, staffing, inequalities). The plan outlines seven chapters which aim to address such challenges, and includes the development of a new service model, further funding (e.g., to upgrade technology), and tackling workforce pressures, amongst others. Chapter 3 outlines how care quality and outcomes can improve, and includes further support for child and young people’s mental health services, and adult mental health services – of relevance to the Mental Health in Childhood and Education Hub.

 

 

 

 

 

Mental health services for children and young people

Funding

  • Over the next five years, access to mental health services in the community will expand, so that an additional 345,000 children and young people between the ages of 0-25 will be supported (e.g., via Mental Health Support Teams based in schools or colleges)
  • Eating disorder services will receive additional investment – this will enable services to maintain the treatment standard (e.g., urgent cases receive treatment within one week, and four weeks for non-urgent cases).

Access

  • Age-appropriate crisis services will be expanded, and a single point of access through NHS 111 will be explored.
  • Support for mental health will be available within schools and colleges – providing additional capacity for early intervention.
  • The transition to adulthood for young people aged between 18 and 25 will be supported – this may involve extending service models to offer support for those aged 0 – 25 years, and integrating a number of sectors (e.g., social care, education).

 

 

 

 

Mental Health services for adults

Common disorders

  • Access to Improving Access to Psychological Therapies (IAPT) services will be expanded – focusing on adults and older adults with a long term condition.
  • Standards for patients requiring community mental health treatment will be delivered across in NHS in the next 10 years.

Emergency support

  • Mental health crisis services will be expanded – a 24/7 community-based response will be available in England by 2020/21 (for adults and older adults). Alternative forms of support will also be explored (e.g., safe havens).
  • A single point of access via NHS 111 will be developed.
  • Waiting time targets will take effect from 2020 for access to emergency mental health services.
  • Ambulance staff will be trained to support individuals in a mental health crisis.

Suicide prevention

  • Suicide prevention and reduction is a priority over the next 10 years – this includes the development of a Mental Health Safety Improvement Programme.

Further information about the Long Term Plan can be viewed here.

Blog post written by Dr Rachel Moss (Twitter: @DrRMoss), Research Associated on the PGR Wellbeing project at the University of Portsmouth (School of Education and Sociology).

 

 

 

 

 

 

Self-care (and support) for Parents and Carers

With the festive Season over and the start of a New Year, many parents and carers may find themselves struggling to recover, not only financially but from the burden of extra stresses and strain placed on them by personal and societal expectations to deliver an environment filled with peace, love and cheer – at least to their children; when things may not always be quite what they seem. There is no doubt that the pressures placed on parents and carers to provide for their children on all levels are high, but do expectations and reality marry up? And are parents being provided adequate support to give them the chance to do so?

Parenting Partners

Some believe that schools are now being expected to take over parenting responsibilities of their pupils, with many primary schools brushing children’s teeth, providing free food and taking on other hygiene responsibilities that are arguably, the job of the parent. The question arises, is this right? Should schools be doing this and why are schools doing this? Of course, no child should have to suffer, but many argue that shifting all the responsibility on schools is not the answer. Perhaps more support for parents is the way forward?

It is widely accepted that 50% of mental health problems first appear before the age of 14 and as such the ‘prevention and early intervention’ policy is touted in the government’s 2018 green paper, Transforming Children and Young People’s Mental Health provision. This suggests that the role of parenting in the development of children’s mental health and wellbeing is absolutely paramount but the main focus of the paper is prevention and intervention linked to schools, colleges and NHS services; perhaps it is missing an essential component, the role of parents and carers, especially as we see an increase in real terms funding cuts to schools and the NHS CAMHS (Children and Adolescent Mental Health Services). So, it is vital that parents and carers are supported to provide their children with the best possible start in life.

Meeting Needs

Recently, the media has broadcast several reports of children whose needs are not being met by mainstream education. They are unable to secure a place at a specialist school meaning that these children are not receiving the quality education they are entitled to. This is being blamed on recent real-term cuts in funding. Children with SEND are already at greater risk of developing mental ill-health and such a dire situation with regards to their schooling when measures are meant to improve things, means they are not moving things forward. The IPSEA provides legal advice to parents and carers who wish to challenge the decision not to place their child in a special needs school.

On the flip side, there is evidence that parents with mental health disorders are more than twice as likely to have children who develop an emotional disorder. So looking after the mental health and wellbeing of parents and carers is a crucial component to ensure that children have the best possible chance of developing good mental health and wellbeing. The charity Mind provides information and support on parenting with a mental health problem.

Children in Care

For children in care, the situation is dire. The recent Channel Four programme Superkids: Breaking Away From Care, which aired in November 2018, demonstrates how it can be argued that the system is failing these children. There is clear evidence that children who grow up in care are at a distinct disadvantage, without privilege or entitlement; and do not receive the same level of support as those brought up in a birth family environment. It is estimated that 45% of looked after children have a diagnosable mental disorder, compared to 10% of all children. This shocking statistic has an influential impact on the life trajectories of these children, including their mental health and wellbeing.

This begs the question, where is the support that parents and carers so desperately need? And what can be done to ensure this much needed support is provided? Countries such as Australia, offer free online parenting courses such as Parent Works and have previously made parenting a priority as part of their government strategy, the Raising Children Network; and in 2012 Scotland released a National Parenting Strategy. In the UK, the charity Young Minds has a parent helpline – but this is a far cry from a government strategy and policy-led parenting classes.

Where can parents and carers find support?

 

 

 

 

 

Of course, a visit to the GP and a potential referral to an appropriate mental health service must be the first port of call but with long waiting times there are options for parents, carers and their children in the meantime. There are many resources available to address mental health issues for families, these include:

Charities

Care for the Family provides a list of Parent Support Organisations.

Family Lives offer support and advice on all aspects of parenting and family life.

Safe Lives are dedicated to ending domestic abuse and support families to become safe.

The Parenting Network is a Portsmouth based Community Interest Company that provides a much needed service for local families in Portsmouth.

Mindfulness

Mindfulness exercises for parents includes the 100 day mindfulness challenge, free meditations and free training.

How to be a calmer parent – Headspace is an App with a variety of mindfulness meditations designed for different scenarios that you can try for free.

EFT for Managing Parental Overwhelm – Emotional Freedom Therapy involves tapping on acupressure points to release tension, stress and anxiety.

Stress Relief for Parents – Classes and More by Full Potential Parenting providing information

Talking Therapies such as CBT – cognitive behavioural therapy are available through your GP.

Wellbeing for Mums and Dads page on the Berkshire Talking Therapies website.

DHC Talking Therapies Service provide practitioners who can provide a psychological therapy.

Lifestyle choices

Tips for Healthy Eating and Physical Activity for parents and children which are known to contribute to mental health and wellbeing.

Healthy Lifestyle Choices for New Mums and Dads on the Australia’s parenting website.

Spending time with your children – Advice for Parents by The Children’s Society’s 2018 Good Childhood Report.

Blog post written by Kayleigh Rivett BSc (Hons), MA, PGCE (Twitter: @Klebee3), Research and Innovation Officer at the University of Portsmouth (Twitter: @uopresearch).

 

Insight, help-seeking and family well-being

“Seldom, very seldom does complete truth belong to any human disclosure, seldom can it happen that something is not a little disguised, or a little mistaken”

From “Emma” by Jane Austen 1816

Below, the Johari window explains four quadrants of consciousness, dividing experience into that which is known and unknown, seen and unseen (Halpern, 2015). For example, awareness of a physical illness is generally familiar. A fever, pain, exhaustion. Outward signs are seen, as well as felt and noticed by others with empathy, not stigma. Such visible issues sit in the Arena and Façade quadrant of the Johari window; either everyone knows, or an individual knows but chooses to conceal it. But social emotional and mental needs are more obscure and my task here is to backpedal and question how families might recognise they need support.

To my mind, my life is perfectly normal. Is that because it was the right way? Or simply that it seems right to me, because it is verified by those around me? We repeat the ways in which our families have operated over generations through systemic functions (Dallos & Draper, 2015), barely noticing what makes them unique. Bruner (1986; 1991) suggests that identity emerges as we process and display our understandings of our world. Our reality is subjective, woven by strands of experience which create a complicated and endlessly evolving story of self.

In the Blind Spot of the Johari window, an outsider has noticed a characteristic which the individual has not. Perhaps this is what Hayden & Jenkins (2014) meant by asking troubled to who? when they considered the “Troubled families” of the Conservative government’s flagship social policy. The idea that some lives are “normal” and that others are “troubled” permeates the children and families sector; it is a critical benchmark against which professional agencies assess need and justify essential action to protect children. The final quadrant is the Unknown, where issues are concealed from everyone. This is the point where experiences are so shrouded that individuals cannot see they need help, and the need is obscured from those that could offer it. Think here of the woman who has experienced so much control in her relationship she cannot see it as abuse, and her child who accepts this because she does, and continues to accept it throughout her life. The question is, how can people get help when distress has become so normal that it is unnoticed?

Both these latter quadrants orientate around a question of “insight”, crucial in both mental health and children’s services. Insight is crucial in a patient’s ability to manage their illness; to know when they need help signifies the ability to stay well and lead a normal, functioning life. In children’s services, it is seen as the bedrock of parenting capacity (Oppenheim & Koren-Karie, 2002; Donald & Jureidini, 2004; Tucker & Trotman, 2010). Parents who are insightful are considered able to prioritise their child’s needs, because they understand them. My doctoral research suggests that finding that insight is an intricate task of reflection and learning, in ways which resonate with individuals and families (Bruner,1986; 1991). In order to do this we need to access the intricate web of lived experience encountering subjective reality, normality, and stigma, and to normalise vulnerability in all our lives. It seems to me that we need to create a calm and non-threatening space in which adults and children can reshape their reality, and continue their story of self to enhance their social, emotional, and mental health.

Blog post by Emma Maynard (Twitter: @maynard_emma), Senior Lecturer and MICE Hub Deputy at the University of Portsmouth (School of Education and Sociology).

Reference list

Bruner, J. (1986) Actual Minds, Possible Worlds. London: Harvard University Press.

Bruner, J. (1991) The Narrative Construction of Reality. Critical Inquiry. 18 (1) 1-21

Campbell, S.M., & Roland, M.O. (1996). Why do people consult the doctor? Family Practice, 13 (1), 75-83. doi: 10.1093/fampra/13.1.75

Dallos, R., & Draper, R. (2015) An Introduction to family therapy: systemic theory and practice. Maidenhead. Open University Press.

Donald, T. & Jureidini. J. (2004) Parenting Capacity. Child Abuse Review 13 (1), 5-7. doi:10.1002/car.827

Hayden, C., & Jenkins, C. (2014) ‘Troubled Families’ programme in England: ‘Wicked problems’ and policy –based evidence. Policy Studies, 35(6), 631-649. doi: 10.1080/01442872.2014.971732

Oppenheim, D., & Koren-Karie, N. (2002) Mother’s insightfulness regarding their children’s worlds: The capacity underlying secure child-mother relationships. Infant Mental Health Journal, 23 (6), 593-605. doi: 10.1002/imhj.10035

Tucker, S & Trotman, D  (2010) Interpreting Risk; factors , fears & judgement. ch in G. Brotherton, H. Davies, & McGillivray Working with Children Young People and Families. London; Sage.