We must join forces to create integrated physical and mental health teams

Mental health and wellbeing have entered the collective conscience of paediatric medicine, with widespread speculation that social media use and rising academic stress are among the many new challenges impacting this generation of children and young people.

We wanted to build on the lively public discussion and rich media coverage with a new mental health chapter in our latest State of Child Health report.

We know that mental health challenges in childhood are associated with many life outcomes we wish to avoid—low educational attainment, poor long-term physical health and unemployment, to name a few. We cannot afford to ignore the rise of distress in our adolescent population, or the mental health comorbidities of our society’s most vulnerable children.

Unfortunately, the true picture of youth mental health in the UK is largely unknown, and our report highlights why—a lack of solid prevalence data. If we wish to intervene and improve mental health outcomes, we need to work differently on data collection. Without the requisite data, we cannot fully understand the landscape, and cannot make the best decisions in service planning and resource allocation.

That said, our report reviews the data available for child and adolescent mental health services (CAMHS). CAMHS have been under-resourced, leading to problems with access to services and bed availability. The NHS Long Term Plan addresses some of these issues but it is important that these commitments translate into delivery at service level.

The prevention agenda is also important, and this means a focus on early intervention, training for the entire children’s workforce to help spot the signs and emphasis on wellbeing in schools. It’s vital that we get services right ‘upstream’ as well as when a young person is in distress.

We have a responsibility... to promote parity of esteem—valuing mental health equally with physical health.

Paediatricians will be dealing with mental health challenges on a daily basis in hospital wards, in our clinics and within the community. We have a responsibility, along with the rest of the children’s health and care workforce, to promote parity of esteem—valuing mental health equally with physical health.

We need to treat every contact as an opportunity to promote mental, as well as physical, wellbeing. For many of us, this will involve upskilling to be better able to recognise mental health challenges when they are presented—and provide mental health first aid when it’s needed. We need to screen our high-risk patients and know where to send them for help. 

We must join forces with our CAMHS colleagues to create integrated physical and mental health teams, challenging management to enable working across professional and organisational boundaries. In doing so, we can provide the best possible care for children and young people. Without this, we remain fragmented and limited in our effectiveness.

We have an obligation to push for better local care at the severe end of mental illness, allowing young people to remain close to their families and communities through improved crisis care and intensive home treatment packages. We must advocate for those out of school, in care, in the criminal justice system, and refugees, so that they don’t just ‘fall through the gaps’.

Looking forward, the paediatricians of the future need the knowledge, skills and attitudes to address the mental and physical health needs of their patients. And to integrate our workforce with CAMHS to provide holistic health care for children and young people. The mental health challenges facing society are not going away—and must be a top priority.