Critical Review of Govt. Policy Document Furture in Mind". Presented 15th Jan 2016 - KCL, Guys Campus

1. Review of Future in
Mind
Report of Mental Health Taskforce
Focusing on CAMHS Pathways and Easy Assessment and Intervention
A Personal View
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/414024/Childrens_Mental_Health.pdf
RICHARD SHIRCORE M.SC. FRSPH
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2. The CAMHS Collaborative
Focus – our position
• MENTAL HEALTH IS A COMPLEX PHENOMENA
• DEFINITIONS CONTESTED
• AETIOLOGY VARIABLE AND CONTESTED
• MENTAL HEALTH SERVICES ORGANISATIONALLY COMPLEX – SPLIT
RESPONSIBILITIES BETWEEN FAMILIES AND HEALTH, EDUCATION, SOCIAL
SERVICES AND YOUTH JUSTICE
• IDENTIFIED WEAKNESSES: TOO MANY SOLUTIONS IN SEARCH OF UNASSESSED
PROBLEMS/CONDITIONS
• FAILURE TO APPRECIATE CONTEXTUAL ISSUES FOR YP AND MENTAL HEALTH
ISSUES
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3. Consequences
Report of Select Committee House of Commons on CAMHS Nov 2014.
 A Commissioning “fog” due to lack if information regards the mental
health needs of children
 Early Intervention very important but weak
 Increased waiting times for YP referred
 Child and Parent “battles” to be seen and then heard
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4. How Does “Future in Mind” respond?
 As if only structural, methodological or organisational problems exist.
 With regard to our concerns – clinical pathway, early intervention and early
assessment, evidence: Number of times issues mentioned/referred -
 Pathway: 1 ref (child comment)
 Early Assessment: 1 ref
 Prevention: 7 refs (1 being in Contents, 1 being in Exec)
Summary)
 Early intervention: 7 refs.
 Evidence: 3 ref 2 refs to treatment, 1, epidemiology
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5. What does it say?
The Foreword by Norman Lamb says all the right things then does not
mention them again.
 “We need a whole child and whole family approach, where we are
promoting good mental health from the earliest ages”.
 “What is needed is a fundamental shift in culture. A whole system
approach to mental ill-health, early intervention and recovery” p3.
What then happens is a classic example of “Dynamic Conservatism” (Donald
Schon) where organisations work hard to stay the same.
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6. Foreword – Sam Gyimah
 “…I am so pleased to be the first minister in the Dept. of Education with a
specific responsibility for child and adolescent mental health.”
 Focus: PSHE developments and expansion of “Counselling” in schools.
 “….DfE has, ….identified mental health as a specific priority within its £25
million voluntary sector grant scheme -….we will be supporting a range of
exciting projects”.
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7. Foreword Simon Stevens CEO NHS
England
 No comment on “definition”, early assessment nor diagnosis.
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8. An Open Letter to children and young people from Dr
Martin McShane (NHS England) and Jon Rouse (DoH)
 A curious statement – suggesting mental health issues are unavoidable but
that with the right “systems” in place all will be well.
 It is highly individualistic. If you are mentally unwell you got something
wrong, but we will “help you get back on track”. P9.
 Rather rashly they say “…we know what works”.
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9. Critical Review pt 1
 The lack of reference to any concern over defining mental health as a health
state. Nowhere is the interplay of mental health, behaviour explored and the
environment explored.
 The Collaborative stresses: the importance of a “tabula rasa” approach to
children and adolescents presenting with mental health or behavioural
issues. The Taskforce Report sees mental health as being non-problematic
concept.
: evidence in relation to assessment of issues is not mentioned. Evidence
only referred to in relation to proven treatments.
: Solutions chasing problems. The unqualified references to “Counselling,
Peer Mentoring and other therapies” is also a concern. MH responses must be
ethical – based on assessment and prescription relevant
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10. Critical Review pt 2
We stress the importance of:
 Context in understanding mental health and behaviour. Report makes no
reference to Context as an important variable.
 Pathway to relevant intervention/response – The Report talks about
“difficulties in access”. But who or what do you access if you don’t know
what the problem is????
 A clear and rigorous methodology for early assessment to identify issues
and appropriate specialist referral or immediate action. The Report focuses
on organisational re-arrangement.
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11. The Future – selected Govt. aspirations
p16
By 2020
 a hard hitting anti-stigma campaign (Comment: Saying what exactly?)
 Empower young people to self-care through quality assured apps and
digital tools .(Verging on the unethical)?
 Develop access and waiting time standards
 Joined up services through commissioning changes
 Professionals who work with children and YP are trained in child
development and mental health, and understand what can be done to
provide help….. (Comment – this does not happen currently then?)
 Testing clear access routes between schools and specialist services
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12. Summary – Richard Shircore
The Taskforce Report is strategically flawed.
 Its intentions are good but fail to engage with the fundamental questions
practitioners are faced. What I am looking at? The closer union of schools
and mental health might be beneficial but……
 No definition of mental health – The “it” problem still exists.
 The lack of appreciation of the need for early assessment of YP to identify
the type of Health issue to be addressed
 No recognition of the different agencies involved and consequences of
split responsibilities.
 Reliance on generalised “solutions”, e.g. counselling, CBT, without
assessment of suitability
 Children to have responsibility of own mental health care e.g. mentoring.
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13. Thank you for listening
RICHARD SHIRCORE M.SC. FRSPH
SHIRCORE@HEALTHPROMOTION.UK.COM
TEL: 01753 575655
MOB: 07943 404 388
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