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Daniel OHare

Children’s mental health: we’re still not looking far enough upstream

08 February 2018 | by Daniel OHare

As we reach the mid point of Children’s Mental Health Week it’s pretty clear that the focus on how to ‘solve the problem’ of children’s mental ill-health is firmly rooted in an understanding that what needs to change, ultimately, is the child who is experiencing difficulties.

Occasionally there have been articles and news pieces that have suggested it isn’t all up to the child, if we change schools and reorganise them, this will help too. Schools can change by having a particular member of staff dedicated to the mental health of children. School staff can become mental health first aiders - ready to spot the signs of mental ill health and then liaise with a group of readily accessible professionals with an as yet unspecified level of experience or qualifications. 

Those familiar with these suggestions will recognise them as the government’s flagship ideas for transforming the mental health of children and young people. A further idea is to reduce waiting times for Child and Adolescent Mental Health Services down to four weeks - although only in some pilot areas and only to 20-25% of the country by 2022/23. 

While some of the aims of this plan to transform children’s mental health are laudable, it’s pretty clear that what we’re looking at is more of the same and that the same solutions are being offered: more money, more training for teachers and shorter waiting times for health services.

Of course the cynic might counter that it isn’t really more money, these plans don’t take in to account the exceptionally complex and demanding job that teachers do, and the already understaffed and overstretched resources of CAMHS. The emphasis is still on getting kids in to clinics and therapy rooms to ‘fix’ them. 

The parable of the river feels more important now than ever. I’m sure many of you are familiar with it but to summarise. 

One night villagers were sitting by their river bank about to eat when one villager noticed a young child floating upside down and drifting down the river. Several villagers jumped to their feet, dived in and tried to rescue the child. It was too late.

A short while later, another young child was noticed, coughing and screaming as it struggled to stay afloat. This time, the villagers were luckier and the child, although bruised and battered, lived.

This turn of events continued and the frequency with which the villagers had to attempt to rescue babies and children from the river increased. Sometimes the villagers were successful, but this was not always guaranteed.

Soon the resources and people power of the village were directed at saving as many children as they could. This activity occupied the villagers constantly and other endeavours they had previously pursued had to be forgotten - but this was accepted, as it was a worthy cause.

One day, two villagers began to walk away from the village heading upstream. They were questioned “Where are you going?! We need you here”. The villagers replied “We’re going upstream to find out why these children end up in the river”.

 This story frames the current response to the ‘crisis’ of child mental health as a response most concerned with pulling children from the torrent of the current. This needs to happen, of course it does, but how sustainable is this? The current focus on children, therapy, school staff training and reduced waiting times for clinic appointments characterises villagers who do not dare to venture upstream. 

Upstream we’ll find rising poverty, social and economic inequality, discrimination and oppression - all of which the World Health Organisation identified as determinants of emotional and psychological wellbeing. Not correlates, but determinants. 

As Educational Psychologists we see children who have anger or anxiety ‘issues’ which need to be dealt with and the proposed course of action currently seems to be to ‘treat’ the child. Give them a course of cognitive behaviour therapy to help them restructure their thinking. Maybe play therapy will help them ‘appropriately’ express their anger.

Now, there will be countless occasions where CBT or play therapy would be appropriate, helpful and effective, but maybe not having any electricity for the weekend until Mum gets her next lot of money is something to be angry about. Perhaps coming to school with no breakfast and being uncertain about where you are going to live is plenty of reason to experience anxiety. 

It can seem hard to imagine, but children are directly affected by the decisions made by governments and policy makers about the type of society we live in. A soundbite which ‘encourages people back to work’ has a direct influence on whether a parent can feed themselves and be in a position to emotionally support their child who might be worried about friendships at school.

An idea, which places a ‘designated mental health lead’ in every school, runs the risk of the ‘responsibility’ for children’s emotional and mental wellbeing being firmly placed on one member of staff.

As Dr Laura Winter recently articulated at the annual Educational Psychology conference, until we stop obsessing with what is going on inside a child’s head and actually start looking at what is happening in society, nothing is likely to substantially change.

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