Mental Health Inequalities (Wales) - consultation response

The purpose of this consultation was for Health & Social Care Committee to identify:

• Which groups of people are disproportionately affected by poor mental health in Wales and what factors contribute to worse mental health within these groups?
• For the groups identified, what are the barriers to accessing mental health services were, how effectively can existing services meet their needs, and how can their experience of using mental health services be improved?
• To what extent has Welsh Government policy recognised and addressed the mental health needs of those groups and where the policy gaps are?
• What further action is needed, by whom and where to improve mental health and outcomes for the groups of people identified and reduce mental health inequalities in Wales?

Our response

We drew upon evidence from our State of Child Health data and recommendations around mental health, family and social environment and long term conditions. We highlighted our position statement on the role of paediatricians in supporting children and young people's mental health.

We also referred to our College strategy, Paediatrics 2040 and our Facing the Future service standards. 

Our recommendations

• Half of adult mental health problems start before the age of 14; therefore, it is vital services are built around the individual child or young person specific to their individual needs.
• Child health outcomes are the product of complex, inter-connected social, economic, personal and political factors. An individual child’s health is inevitably influenced by the world and environment around them, not only by the quality of care they receive from the health system, but also by the services they are able to access and by their family’s lifestyle.
• Adoption of a cross-governmental approach to ‘child health in all policies’ recognises that child health should be considered in all decisions at both national and local levels. We would welcome a commitment from Welsh Government to include children’s health in all policies, specifically how this would be delivered and built into policy making in the future.
• There is considerable variation in how mental health services for children and young people are delivered across the UK. Our position statement on the role of paediatricians in supporting children and young people’s mental health calls for better integration with mental health services and makes key recommendations to ensure their mental health needs are met.
• The impact of adverse childhood experiences in later life has been well documented and researched and we welcome the policy focus on preventing exposure to adverse childhood experiences (ACEs). Welsh Government recently announced the development of an ACEs plan. We would welcome this but would ask for Welsh Government to engage and consult with the Royal Colleges in developing this plan.
• Feedback from paediatricians highlighted that children and young people who experience higher levels of mental health issues often have long term health conditions. We called on Welsh Government to establish key clinical networks and provide appropriate resources for long term conditions including asthma, epilepsy and diabetes. We asked for these networks to include links to mental health, education and transition and include input from both multidisciplinary professionals and family / young person engagement.
• A resilient child health workforce of sufficient number and skill is crucial to efforts to improve the health of children and young people in the UK, not simply paediatricians, but also children’s nurses, health visitors, mental health professionals, primary care and allied health professionals. Child health inequalities cannot be addressed effectively without the support of an adequate workforce that is able to meet their needs, particularly those of vulnerable groups.
• We understand that Welsh Government is reviewing the demand and capacity within neurodevelopmental services. Many neurodivergent young people experience mental health problems and there are overlaps also in terms of the workforce who care for them, including in community paediatrics. We hope this review will highlight any inequalities and share learning or proposals to help mitigate.
• Centralised care was considered to be a barrier to children and young people accessing the mental health services that they needed to support them. The lack of more local services and limited places across Wales further widens geographical inequalities. Children and young people said that they wanted to have more options around accessing mental health services such as virtual / online appointments. We feel this is an important area to be developed further and modernised in the future to ensure they are supported adequately.
• Infants, children, young people and families should have equitable access to cross-sector services, resources, advice and support within the local community to support their health and wellbeing. Local Authorities should have adequate resource to provide services to meet the local needs of the population they serve.
• In order to reduce mental health inequalities it is important to recognise that these services be co-designed with those it intends to support. Services cannot be designed effectively unless we know what their needs are, to ensure that they can be met optimally.
• Extra support and resources are needed for those that have an increased risk of a mental health condition. It was suggested that further work needs to be done around early intervention, preventative measures and appropriate treatment to address the policy gaps.
• We would welcome initiatives to increase resilience and improve mental health throughout the population of children and young people. We cannot respond effectively to child health inequalities without ensuring that services such as Child and Adolescent Mental Health Services (CAMHS) who are there to support the most vulnerable are adequately resourced.
• We would welcome and encourage integrated working between organisations and agencies across the whole children’s workforce. Integration of practice, education, pathways and commissioning will ensure that prevention, recognition, early intervention, support and onward referral is commonly addressed by professionals. This would clearly benefit children and young people that are most vulnerable, making the whole system work for them much better in the future.