Dr Joe
Dawson, Head of Service SEN and Disabilities/Principal
Psychologist, Leicester City Council gave a general introduction on
children’s health and wellbeing in the City and outlined some
of the key challenges.
As
general background, Dr Dawson commented that:-
- Approximately 10% of school age children would require some form
of professional support for mental health issues, and they were
more likely to be boys rather than girls and be aged 11-15 years
old than 5 -10 year olds.
- There
were a range of known environmental factors that could impact upon
mental health, including housing and social
deprivation. There was a significant
association between poor mental health and educational outcomes,
which then often led to poor attendance and poor life outcomes.
These could then be exacerbated into a cycle of
entrapment.
- Mental
health had impacts upon life changes and these could lead to
criminality and a whole host of resource heavy behaviours which
often resulted in poor life experiences of people.
- There
was a clear understanding by those involved that this needed to be
addressed for both the individual concerned and for the effective
use of resources.
- 50% of
looked after children were likely to have clinically diagnosed
mental health disorders; which is significant and needed to be
taken seriously.
- The
risks and protective factors for children young people and their
families had long been documented by the Audit Commission and the
Mental Health Foundation, and, whilst these factors were well
known, the real issues were about the need to put into practice
something that recognises those risks and resilience factors and
deals with them in the best interest of the children and young
people.
- There
was a focus on children and young people but some of the processes
within the system could often cloud the vision of what was being
done and could stop the system having a clear overview of what it
was delivering as a whole.
- Language could also be a barrier both within the system and
accessing it as there was a range of different terms used such as
mental illness, mental health, emotional wellbeing and
psychological wellbeing etc. This was
both a barrier to people in understanding what professionals were
talking about and sometimes it was used by professionals to keep
people out of the system and by others to reinforce the perception
of needing to involve a specialist and to transfer the
responsibility of care to others. This
delineation was often encouraged as a consequence of the referral
process. There was a view that the
language used was jargon laden, which could became impenetrable to
some trying to access different parts of the system.
- Different agencies also had different targets and these could be
competing with and, sometimes working against, other local
authority, health, criminal justice and voluntary sector
agencies’ targets.
- Budget
pressures could also impact on services as reducing preventative
protective measures were often the first services to be withdrawn
as part of budget cuts, but this could result in increased
pressures for specialist services at a later date.
- Diagnosis was not a straight forward process. There was a general belief that when a doctor,
psychologist or psychiatrist gave a diagnosis, it was readily
understood by everyone and meant the same thing to
everyone. Unlike a diagnosis of a
physical illness or condition, a diagnosis of a psychological or
psychiatric illness could have a range of difficulties and
categorisations within them and were, therefore, problematic in
creating difficulties comprehension and expectations. It could also cause difficulties in accessing
services. Services were generally
organised in a tiered model approach; but children and young people
didn’t move in tiers. They moved up and down within models
and tiers and it was often forgotten that if a child needed a high
level of intervention, then it did not necessarily mean that the
lower levels of intervention should automatically drop
out. These lower levels of intervention
were equally important to support and reinforce the higher level
interventions.
- The
needs of the young person should be considered as a whole, as the
lines between being sad and depressed or experiencing social
difficulties and having autism could be finely balanced and open to
interpretation. Some of the diagnostic
toolkits worked on the principles of providing a best fit approach
to a diagnosis, which may always be appropriate.
- ‘Service-land’ as a whole was controlled by those
operating within it and sometimes people could get lost within the
system. Changes in thresholds and resources could prevent access to
the service point and provide barriers that resulted in people
getting lost between services. There was still more work needed to
have better joined up working practices and there were still some
examples of a silo approach. Even where
partnership working existed, there was a need to have more
partnership and creative working to achieve better outcomes to meet
children’s needs.
- There
were sometimes inherent barriers between professionals as they did
not always know who did what within other parts of the system, or
what types of service were available to make referrals and
sometimes where and how to make those referrals. Language could be used as a barrier and could
sometimes be barrier between professions and whether the person
receiving a service was a client or a patient.
- The
process of change always presented difficulties in moving from the
relative comfort of current practice to what was
required.
- Leicester had a history of being a pathfinder for targeting
children’s mental health issue with good links between the
police, schools, specialist CAMHS services and school nurses and
local authority teams etc. The city had
been a national leader in such practices and experiencing their
demise as funding was withdrawn.
- External factors which could impact upon children’s mental
wellbeing included mental stress, anxiety, financial pressures,
homelessness, family pressures etc.
These could all add to, and exacerbate, the state of mental
health.
- Changes in statutory obligations and responsibilities could
often be disruptive as professionals could become pre-occupied with
understanding what was needed in the changed circumstances instead
of delivering the services.
- There
was a need to create a better model for service delivery to remove
barriers so that the best outcomes were achieved for children and
young people who were in need of help and intervention
measures.
In
response to the Chair’s question, Dr Dawson commented that
there were specialist and targeted services both within schools and
in community settings. The city also
had an innovative service which he believed did not exist in any
other local authority. A number of
psychologists were employed by the Council (funded by CCG) to look
at those young people that didn’t meet the CAMHS specialist
service thresholds and who were hovering around Tiers 2 and 3
within the system. The psychologists
worked with this cohort in their homes, schools and in group work
to stop them getting worse and hitting
the CAMHS threshold in the future.
There were also other good therapeutic interventions in Leicester;
but these were under increasing pressures from resources, which
meant they could not be delivered as widely as would be
liked. It was acknowledged that this
pressure was faced by other local authorities
The
Strategic Director of Children’s Services commented that both
officers and schools recognised the importance of outcomes for
children. These issues were dealt with
on daily basis and were taken seriously. Everyone was keen to work
in partnership across services and agencies to address
this. There was a need for officers and
schools to understand the whole system; as various organisations
and agencies had individual parts of the system but not all of the
system. There was an issue of trying to
understand the complexity of the whole system in delivering both
universal and specialist services and to trying to identify where
gaps existed or where there was duplication of
services. It was felt that this series
of presentations would help with a better understanding of the
specialist services. It was also
recognised that this work been ongoing for many years and was
always developing and changing to reflect the constant changes
evolving in society as a whole.
Board
Members made the following comments and observations:-
- It was
recognised that there were issues in a linear model of service
delivery, whereas users were more exploratory in their nature of
navigating through the system.
- There
was a clash of social models of intervention and support with
medical models. There was a need for
collaborative working in providing open and clear pathways and to
be collectively more creative in service delivery.
- There
was support for everyone using the same language to fully
understand other services within the system. For example, ‘early help’ was often
interchangeable with ‘early intervention’ in some
services, but had different meanings to others in the system. All
words/phrases used within the service should have the same
meaning.
A
member of the public asked a question in relation to the loss of
subjects such as drama, music and dance etc from the school
curriculum that he felt provided support and helped the wellbeing
of children and young people. He
also asked if teachers received training to detect early changes in
children’s and address them in order to prevent issues
developing and requiring specialist support.
In
response, Dr Dawson commented that he was unable to comment upon
curriculum changes, as there was little evidence to say these
subjects had an impact on mental health. However, the Social and Emotional Aspects of
Learning programme (SEAL) had been evaluated and had showed
significant impacts on wellbeing and resilience and was a useful
resource within schools to support children’s, teachers and
staff resilience. It had been a
national decision to remove psychology of development in children
from teacher training courses and colleges; however the service did
offer this training to maintained schools and
academies.
The Chair thanked Dr Dawson for
his informative and thought provoking introduction.