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Cynulliad Cenedlaethol Cymru Y Pwyllgor Plant, Pobl Ifanc ac Addysg Gwaith dilynol ar yr adroddiad Cadernid Meddwl MOM: 08 Ymateb gan: NSPCC Cymru ___________________________________
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National
Assembly for Wales Follow-up on the Mind over Matter report MOM 08 Response from: NSPCC Wales ______________________________________ |
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Mental Health is the biggest concern among Childline callers
For over 30 years Childline has provided a safe confidential space where children and young people can talk, be listened to and receive support, advice and information about the issues they are worrying about. In 2018/19, the total number of counselling sessions delivered by Childline in Wales where the main concern was mental and emotional health, suicidal thoughts and feelings or self-harm was 4151, or 47 per cent of all sessions delivered.
Of these, mental and emotional health concerns made up 2670 counselling sessions (30 per cent) This aligns with the UK Childline trend, where mental and emotional health is the most common concern discussed in counselling sessions. Counselling sessions delivered to children and young people in Wales where the main concern was suicidal thoughts and feelings or self-harm numbered at 850 (ten per cent) and 634 (seven per cent) respectively.
“I feel really alone and don't know what to do? I feel like no one really wants me here and that no one would actually notice or care if I died tonight. I never seem to be good enough at anything, so it feels like there's just not much point in me being here”. (Girl, aged 15-17)
Children and young people in Wales raised a number of additional concerns during counselling sessions about mental and emotional health, suicidal thoughts and feelings and self-harm. Of the 4151 sessions delivered, 7 per cent (n=299) also raised sub-concerns about a category of abuse. These include sexual and online sexual abuse (n=151), emotional abuse (n=76) physical abuse (n=57) and neglect (n=15). Research suggests that one in three adult mental health conditions relate directly to adverse childhood experiences (ACEs) (Young Minds, 2016). The following quote from a Childline user articulates the impact of adverse experiences on young people’s mental health:
“I bottle everything up from the trauma I went through when I was growing up. I was a victim of sexual assault when I was 11 and still get nightmares from it all. I am scared of my own thoughts and turn to self-harming to cope” (Girl, aged 16-18)
Please note that all names and potentially identifying details have been changed to protect the identity of the child or young person. Quotes are created from real Childline service users but are not necessarily direct quotes from the child or young person.
The care system is still not adequately supporting children and young people’s mental health
NSPCC Cymru/Wales welcomes the progress that has been made toward reaching recommendations 22 and 23 of the Mind over Matter report, with £15M invested into the Integrated Care Fund to support prevention and early intervention services for care experienced children and young people. However, we are concerned that the mental and emotional health of vulnerable groups like care experienced children has not been highlighted as a priority area in the response to the Mind over Matter report.
Research has consistently illustrated that care experienced children are a potentially vulnerable group who can be around four times more likely to have a diagnosable mental health problem (Bazalgette et al., 2015). Recent statistics demonstrate a steady rise in the numbers of children looked after in Wales. In March 2019, Welsh Government released statistics that show there are over 6,800 children looked after, a rise of 7 per cent on the previous year. This rise in number continues a long trend; between 2015 and 2019 there has been a 22 per cent increase in the number of children looked after in Wales.
The higher prevalence of mental health issues in care experienced children is often the result of experiencing trauma and ACEs. In Wales, the proportion of children in care due to abuse and neglect has remained between 65 and 68 per cent for the past five years (Bentley H. et al., 2018). These early negative experiences can lead to a number of mental health problems developing, making placement breakdowns more likely (Bazalgette, 2015). Care experienced children are therefore at an increased risk of developing mental health problems from their past adverse experiences. This is why it is crucial to develop a support system that meets the unique needs of this vulnerable group from the beginning of their entry into care.
NSPCC Cymru/Wales has worked with Voices from Care Cymru to explore how care experienced children and young people’s emotional and mental health needs are being assessed and supported. In the consultation ‘Listen. Act. Thrive: The emotional and mental health of care experienced children and young people’, two key issues were identified:
1. The challenges related to mental health assessments for care experienced young people
2. The difficulty faced by care experienced children and young people in accessing mental health services.
Mental Health Assessments
Effective early and ongoing mental health assessment is essential for monitoring the needs of care experienced young people, and for providing early access to support. An NSPCC Cymru/Wales consultation, capturing the views of 46 Independent Reviewing Officers (IRO’s) and 26 Looked After Children’s Nurses (LAC Nurses), demonstrates some of the key challenges related to mental health assessments. These include a lack of clear guidance around mental health assessments, training and trust.
The majority of participants indicated that more guidance was needed on how to carry out mental health assessments. 65 per cent (N=17) of LAC Nurses and 63 per cent (N=27) of IRO’s surveyed indicated that there was not enough guidance around how to assess mental and emotional health needs, which was described as a ‘grey area’. Resulting from a lack of guidance, professionals are often relying on their own skills and experience to determine whether a child or young person is experiencing a mental health problem ‘…not enough guidance is given on how to assess this, just use my professional judgment’ (LAC Nurse). The complexity of mental and emotional health issues highlights the importance of making clear guidance available to professionals: ‘more specific guidelines would be helpful for professionals i.e. examples of wellness/behaviour that would cause concern’ (IRO).
As part of this consultation, some LAC nurses also suggested the importance of training professionals so they can develop an informed understanding of varied and complex issues children in care can experience, including development trauma and attachment difficulties. The need to ensure that professionals had adequate knowledge to assess mental and emotional difficulties was considered essential, so that assessments were carried out by ‘appropriately qualified and experienced practitioners’ (LAC Nurse). There was also a strong sense among LAC nurses that assessments of emotional and mental health would need to be carried out by professionals who had built a trusting relationship with the child or young person to be effective. It was felt that young people may limit what they share with a practitioner about their mental health before a relationship could be established: ‘That child does not know you, is often scared and does not know when to share things with until they have had time to settle’ (LAC Nurse)
This consultation highlighted a number of challenges to carrying out mental health assessments with care experienced young people. Without clear guidance and training on how to assess the specific mental and emotional health, as well as trauma and attachment difficulties that may be experienced by children in care, professionals are having to rely on their skills and experiences to identify these often complex needs.
We therefore reaffirm the Listen. Act. Thrive. recommendations that:
An expert panel from the Together for Children and Young People, Early Intervention and Resilience Workstream should work with the Welsh Government to:
· Review how emotional and mental health of care experienced children and young people is currently being assessed and;
· Develop a comprehensive emotional and mental health assessment framework which will include an evidence based assessment of need.
Accessing mental health services
Childline data illustrates that the accessibility of mental and emotional health services was a cause for concern for some children and young people. Counselling sessions concerned with mental and emotional health in Wales included the sub-concern of services, which include issues like accessibility of services. For those who are impacted by concerns of mental or emotional health, finding support services difficult to reach can be challenging. The quote below illustrates the real problems faced when services in Wales have not been accessible:
“I am just in a place where it is hard to do anything about it. I don't want to tell my family and I can't see my GP because I live in Wales and the nearest doctor is miles away. I have no way of getting there without my family being involved, otherwise I would have gone to the doctors by now.” (Boy, aged 16-18)
As part of NSPCC Cymru/Wales Listen. Act. Thrive. project, care experienced young people were asked about what children need to help with their mental and emotional health and what they were receiving. The difficulty of accessing mental health services arose as a significant theme. The majority of young people talked about how challenging it is for those in care to access CAMHS services because of the high threshold for referral. Many spoke about needing to have a mental health diagnosis or be in ‘crisis’ before receiving support. They spoke about long waiting times to access CAMHS and how a young person would have to start again and be placed at the bottom of the waiting list if they moved placements into another local authority. Statistics in Wales show that nine per cent (n=640) of care experienced children went through three or more placements during 2019. Research illustrates that mental disorders are 18 per cent more likely amongst children who had been in their current placement for less than a year than children who has been there for over five years (Channa, 2017). Therefore, placement movements are a challenge faced by care experienced children and young people and can disrupt their access to mental and emotional well-being support.
Young people talked how they felt it was important to have priority access or dedicated CAMHS resources for those who are care experienced, including therapeutic services and counselling. Care experienced young people also talked about the importance of having access to a variety of services to support their mental health, including emotional wellbeing services, such as yoga, the gym and access to outdoor activities.
NSPCC Cymru/Wales welcomes the progress made by the Ministerial Advisory Group (MAG) in further developing community based services to ensure a wide range of therapeutic support is available for emotional and behavioural problems experienced by care experienced children. Significantly, the further £0.2m investment in every Regional Partnership Board and building the Listen. Act. Thrive recommendations into the corporate parenting work of the Together for Children and Young People Programme are positive steps forward. However, we believe that further work must be done to ensure this development continues in order to provide the necessary therapeutic support for care experienced children and young people.
We therefore reaffirm the Listen. Act. Thrive. recommendation that:
· Care experienced children and young people should also be offered access to emotional wellbeing services like yoga, outdoor activities, mindfulness, and painting
And further recommend that:
· Welsh Government commit to an ongoing review into the access to community based services for children and young people who need support but who do not meet the threshold for CAMHS.