What is the Children and young people’s mental health Green Paper?
In 2017, the government asked people for their views on draft legislation to improve mental health support for children and young people.
The Green Paper focuses on earlier intervention and prevention, especially in schools and colleges. The proposals include
- creating a new mental health workforce of community-based mental health support teams
- encouraging every school and college to appoint a designated lead for mental health
- piloting a new 4-week waiting time for NHS children and young people’s mental health services.
Why is it needed?
Child and adolescent mental health services (CAMHS), which are provided by the NHS, are overwhelmed by demand and simply cannot provide help to all who need it.
Those working with children need to appreciate the mental health needs of the children they are working with.
How did the College respond to the Green Paper?
Our submission focuses on areas of the Green Paper that have particular relevance to the work of psychiatrists and the people they care for.
Our submission has been informed by a range of people, including carers, psychiatrists working in child and adolescent, general adult, perinatal, intellectual disability and eating disorder psychiatry, academics, researchers working at the National Collaborating Centre for Mental Health and professionals working at the College Centre for Quality Improvement (CCQI).
What are our top three recommendations?
We urge the Government to be more ambitious in the roll-out of the Green Paper.
By the Government's own estimates, a quarter of a million children and young people who could be helped by a Mental Health Support Team (MHST) will still be missing out in five years due to the time it takes to roll out the proposals.
Children younger than school-age will not benefit until they reach school, despite having similar needs and fewer services available, which are in decline. We cannot afford to leave desperate children and their families to struggle alone any longer.
We ask the Government to put in place measures to improve recruitment and retention of multi-professional teams, including child and adolescent psychiatrists.
The Green Paper's impact assessment (pdf) shows that, in the short term at least, the reforms are likely to increase demand on CAMHS as more young people are able to access the services they need.
With the number of consultant child and adolescent psychiatrists falling by 6.9% in the last four years, more resources need to be invested in CAMHS as well as adult mental health services to provide the necessary oversight and support to the newly formed MHSTs, and to ensure the four-week waiting time target can be met.
As a first step, child and adolescent psychiatrists, higher trainees and speciality doctors in CAMHS should be on the national shortage occupation list.
Ensure Mental Health Support Teams are integrated both within CAMHS and educational institutions, and test a model by which CAMHS would manage them.
Pilots to test NHS CAMHS leading MHSTs and holding resources for them should be introduced. This should be done alongside other pilots in which groups of schools and local authorities lead MHSTs.
As NHS CAMHS will provide oversight and support to the MHSTs, they could lead them clinically and managerially. This would help avoid overlap, unwieldy management and fragmentation. We can learn from models such as that in Oxford, in which CAMHS and schools work closely together.
Funding for CYP mental health needs to be protected to prevent it being spent for other purposes. Our analysis revealed 70 out of 209 CCGs spent less than planned on children and young people's mental health and eating disorders in 2016-17.
The organisations receiving funding also need to be held to account and provide an accurate transparent record of spend to ensure the funding is spent as intended. Previous RCPsych analysis of CCGs' CAMHS spend revealed inaccuracies in the way commissioners reported their spending in the Dashboard.
Our 24 recommendations can be found in our full response to the Green Paper (pdf).
We will continue to liaise with the Department of Health and Social Care and the Department for Education during the implementation of the Green Paper.
How can I get involved the work on children and young people’s mental health?
If you have anything you would like us to be aware of, please contact Zoé Mulliez at firstname.lastname@example.org.