Transforming children and young people's mental health provision: green paper - consultation response

In February 2018 the RCPCH responded to this green paper by the Department for Health and the Department for Education. While we support the paper's ambition, we do not believe it is sufficiently ambitious to achieve the goals we outlined in our State of Child Health report. The green paper also misses vital aspects needed to ensure a holistic approach to children and young persons mental health, including failing to mention the role played by paediatric specialist teams.

Our response

  • The green paper does not go far enough in encouraging and understanding the vital importance of a holistic and multidisciplinary approach to mental health for children and young people. The green paper focuses on CAMHS (child and adolescent mental health services) and schools, when evidence shows us that youth clubs, charities, nurseries, GPs and children’s centres are all part of the system, which is currently fragmented. The green paper also fails to address this fragmentation.
  • Specialist paediatric services deal with a huge amount of mental health issues in children and young people, but don’t get mentioned in the green paper. Forty per cent of all paediatric outpatients seen by children’s outpatients have a mixture of both physical and mental health problems, and there is often need for mental health assessments of children presenting in Emergency Departments.
  • In our view, any reform that ignores this vital cog in the system is incomplete and will not lead to the transformational change required. Future in Mind recognised that children and young people’s mental health services depend on a whole system approach. If schools and colleges are to meet the challenges set in the green paper then this will only be feasible if the rest of the system of support is also functioning well, and continued investment in local and community CYPMHS (children and young people's mental health service) is therefore imperative.
  • The unacceptable amount of waiting time for CYPMHS is the most common concern raised by RCPCH members when asked about the challenges they experience accessing CYPMHS. This can commonly lead to early discharge or unnecessary admission, and can result in pressure on Emergency Departments when a later crisis point is reached, or when parents seek further help as they are waiting for their CAMHS appointment.
  • We believe the Government should be setting out a clear vision and strategy for promoting mental health in childhood: we need better quality research on what population interventions may be able to influence outcomes across a gamut of mental health problems, and independent analysis of how interventions might be put into place. 

Our recommendations

  • We recommend that consideration is given for placing responsibility for mental health and wellbeing on a par with safeguarding, and ensuring that everyone shares responsibility in a whole-system approach. This could include trialling a system of training for people working with young people at risk of mental health problems that is analogous to the level of safeguarding training that is required for all health care staff (both clinical and non-clinical).
  • We recommend evaluation of the established local offer programme for SEND (special educational needs and disability) and how this has increased access to services for children with SEND. This is with a view to developing a similar local offer for mental health services to support Mental Health Support Teams in accessing the appropriate local services. This is something the RCPCH would welcome the opportunity to discuss further and support the development of.
  • We recommend that the local CYPMHS network are collectively responsible for achieving SMART (Specific, Measurable, Accountable, Responsive, Time-specific) outcomes defined in collaboration with the young person and their family, and that achieving these outcomes is the primary focus. It is important that support for children does not become limited by the school gate or by school term times, nor limited by the extent of the influence that schools are able to have on other important factors in a young person’s life, including their housing and other social needs.
  • In relation to consulting children on their views on mental health we recommend that children are consulted in their local, familiar environment (eg schools or youth clubs). This ensures you engage with all children, not just those confident enough to put themselves forward. We suggest involvement of charities use to carrying out work like this, such as YoungMinds.

You can also see our response to the inquiry into this green paper.

We respond to a wide range of consultations to ensure that the College’s position, and ultimately children’s health, is represented. Members can get involved in current consultations by contacting the Health Policy team: