Sunday, 14 October 2018

Children and young people’s mental health – from prevention to prescription - a case of watch this space?


Greater Manchester has one of the largest student populations in England. There are over 100,000 students studying at one of the four universities (University of Salford, University of Manchester, University of Bolton and Manchester Metropolitan). Last week these four universities and the Greater Manchester Health and Social Care Partnership announced the creation of a dedicated centre to support students with mental health needs. The announcement was made last Wednesday, which was World MentalHealth Day 2018

The World Health Organisations (WHO) took as its theme helping adolescents and young adults develop their own resilience (that word again – see last week’s blog) so as to better look after their mental health and wellbeing. A longside enabling young people to help themselves, the focus is also on better equipping schools, friends, peers and families to more effectively recognise and help young people who might be struggling with mental health issues. 

Now, I never actually went to university to study an undergraduate degree. As such, it’s impossible for me to talk about how it might feel to be away from family friends for the first time. However, I have seen the excitement in many of my students as they start their university journey. But equally, it may also be a challenging time for some young people. Despite there being many other people around, it can feel very lonely. Finances have to be managed, and these days, many students get a job as well as trying to study full time. So good times for sure, but also maybe tough times too. Sadly many students decide university is not for them very early on in their studies and leave. One in five of all 16-24 year olds will experience depression or anxiety, and this new service is aimed at making it easier for students to access help. This may be in the form of services directly provided by the university or more specialist help if that is indicated. 

There were lots of good things said about the new service – ‘we don’t just want our students well-educated; we want them to be well’; developing mental health services that provides support from ‘prevention to prescription’ – I think it is a case of watch this space. 

Coincidently, last Wednesday I also chaired the Wrightington, Wigan and Leigh (WWL) NHS Trust Quality and Safety Committee, which unusually started with a presentation from the local Children and Adolescents Mental Health Services (CAMHS) team. The team were there in response to our concerns over the lack of Tier 4 beds, these are inpatient services for the most unwell children (including those with an eating disorder) whose mental health problems cannot be managed on an outpatient basis. These beds range from open adolescent inpatient units through to medium secure units. There is a national shortage of such placements. 

The presentation drew on the iThrive conceptual model which aims to create locally-driven integrated services rather than simply providing services using the more traditional Tier approach. As a hospital, we want to be part of this integrated approach. For example, when troubled children are admitted to paediatric services at WWL, their behaviour can often be a challenge to deal with, they can pose a risk of harm to themselves and or others, and meeting both their physical and mental health needs can be extremely difficult. Whilst specialist help in the form of RAID (rapid assessment interface and discharge) services have been brilliant at dealing with patients over the age of 18 with mental health symptomology, such services aren’t always available for children and young people. Whilst such services are valuable in ensuring people’s mental health needs are met whilst they are in an acute hospital setting, it is still ‘downstream work’. 

The CAMHS presentation sketched out what might be done better ‘upstream’ and prevent some of the admissions in the first place. We were told of developments such as on-line counselling (Kooth); safe zones (as an alternative to inpatient mental health care) with other early intervention and crisis management approaches being described. I thought it was a hopeful approach, but I think it’s a case of watch this space. 

What we can’t do is ignore the fact that winter is fast approaching and the demands upon our services to meet the needs of children and young people living with both physical and mental health problems will increase. It seems to me that both the university and Wigan community approaches are likely to benefit future generations of children and young people. I think it’s a case of watch this space. Strangely as I was putting together notes for this blog, the postman put the Saturday post through the letter box. There was a loud thump. Opening up the padded letter, out dropped a gold medal. It was my medal for doing a sponsored 10km walk for YoungMinds. They are a great organisation, committed to improving the mental health of children and young people – and for once it’s not a case of watch this space – they are doing it!

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