Local Government’s role in supporting children and young people’s mental health

Purpose of report

For discussion.

Summary

This report sets out the key findings and recommendations from the Isos Partnership’s report into the role of local government in children and young people’s mental health and emotional wellbeing. Members are asked to reflect on the key findings and recommendations of the report, and to discuss where the LGA could best focus its efforts to bring about positive change to enable local government to better support children and young people’s mental and emotional wellbeing. These recommendations will be incorporated into the information the cross-board steering group has to help it finalise its recommendations for the LGA’s position, priorities and work programme on children’s mental health and emotional wellbeing.

Recommendations That the Board notes the key findings of the research report. That the Board provides comment to inform the children and young people’s mental health cross-board steering group’s work on the LGA’s position and priorities. Actions Officers will take the views of the Board to the cross-board steering group to help inform their recommendations.

Contact officer:	Abigail Gallop

Position:	Senior Policy Adviser

Phone no:	0207 664 3245

Email:	Abigail.gallop@local.gov.uk

Local Government’s role in supporting children and young people’s mental health

Background

After discussion with the LGA Children and Young People’s Board, Community Wellbeing Board and Safer Stronger Communities Board; the LGA commissioned Isos Partnership to investigate the role local government plays in supporting children and young people’s mental health and emotional wellbeing, and to identify good practice in this area.

The Boards also approved the establishment of a cross-board steering group to help develop the LGA’s position and priorities on children’s mental health and emotional wellbeing. The group is working towards a refreshed Children’s Mental Health Campaign as part of the LGA’s Bright Futures Campaign and a ‘Green Paper’ on children and young people’s mental health for the LGA Annual Conference in July 2020.

The Isos Partnership report was published during Children’s Mental Health Week on 3 February 2020. The report is published as an independent LGA-commissioned research report. As such, the recommendations in the report are those the consultants are making to the LGA, and not LGA’s agreed recommendations. The next phase will establish the LGA’s position and priorities, which will be developed through the cross-board steering group and then brought back to each Board.

This report outlines the main findings and recommendations of the report and an outline proposal for the Green Paper. An earlier draft of the Isos Partnership report was reviewed by the Children and Young People’s Board at their meeting during the National Children and Adult Services Conference (NCASC) in November 2019.

Issues

The report highlights that despite increased investment and focus on mental health services for children and young people, particularly the £1.4bn investment through “Future in Mind”, the number requiring support is going up, thresholds for accessing support remain high, waiting times are long and there is significant difference in provision between different local areas.

The report concluded that more children were requiring support, not just as a result of increased prevalence, but as a result of the pressure on core universal service provision as a result of the long and significant reduction in local resources. As budget cuts have had to be made to pastoral support staff in schools, targeted youth services, children’s centres, health visitors, school nurses, and so on, the collective capacity for universal services to provide additional support for children and young people experiencing turbulence in their lives and emotional distress has been diminished.

The research highlights three areas for change, beyond the issue of underfunding, that were impeding the most effective use of the resources and workforce. The first is that the complexity and fragmentation of the system means that it is difficult to see a clear national direction. The second is the lack of capacity and poor wellbeing of those delivering mental health support, reflecting both staff shortages in key professions such as educational psychology and children’s psychologists, the lack of join up between these professions, and the reduced capacity of staff in universal services such as schools or health visiting.

The final issue frustrating the more effective delivery of mental health and wellbeing support for children and young people was identified as the lack of focus on early support and intervention. The report argues that the orientation of the whole system, from where funding is directed, through how clearly responsibilities are described, to the targets that are set, incentivise a set of behaviours that prioritise specialist and complex treatment at the expense of earlier intervention and prevention. In particular, all the national targets which relate to children’s mental health revolve around access to specialist treatment rather than outcomes experienced by children and young people.

However, despite the very challenging national context for supporting children and young people’s mental health and wellbeing, the report’s fieldwork in eight contrasting councils shows just how much local government, working closely with its key partners, can do to mitigate the effects of some of these challenges and deliver better outcome for children and young people.

Nine key themes recurred in the research as critical elements in establishing an effective partnership-based approach to supporting children and young people’s mental health, which in turn contributed to three overarching ways of working. Where these were securely in place, local areas felt that they were able to deliver better and more timely access to support, earlier intervention and prevention and more efficient use of resources.

The nine key enablers the report identified are:

Leadership and vision

Self-reflective partnerships

Integrated commissioning to enable bolder decision making and total investment

Working with young people

Promoting good mental health for all children and young people

Developing the children’s workforce

Embedding CAMHS within the delivery of other key services

Supporting families

Creative solutions to managing risk in complex cases

The report also argues that there is a limit to what local government and its partners can do unaided. Improving the support for children and young people’s mental health is not solely about making more funding available, although that undoubtedly is needed, but about Government making the most of the resources currently in the system.

LGA next steps

Building on the work of Isos Partnership and the cross-board steering group, it is proposed that the LGA develops a ‘Green Paper’ on children and young people’s mental health. This paper will emphasise the key role of councils, absent in the December 2017 Government’s Green Paper on Children’s Mental Health, in creating mentally healthy childhoods, supporting children, young people and families and the whole-person support that is needed to improve outcomes for children and young people with multiple and complex needs.

It is proposed that the paper explores the following underpinning issues:

Funding, co-commissioning and accountability, particularly via Health and Wellbeing Boards

Co-production and the views of children, young people and families/carers

Support and development of the workforce

It is proposed that the paper sets out how children and young people’s mental health and emotional wellbeing can be better supported through:

Building on the role of councils in enabling mentally healthy childhoods through influencing the determinants of good mental health and in the provision of universal services.

Public health interventions for good mental health, particularly through the provision of broad mental health support programmes including resilience, pre and peri-natal, early years, working with schools, and alongside other public health priorities such as obesity, smoking cessation and drugs and alcohol misuse.

Providing early pre-emptive and non-medical support for children and young people and their families who are experiencing difficulties and where children and young people may be at greater risk. This would include:

Unaccompanied asylum seekers

Adverse childhood experiences (ACEs)

Learning difficulties and autistic spectrum disorder

School exclusions

Young carers

Domestic abuse in families

Homelessness

County Lines

Gangs

Young offenders

The provision of wrap around support before and after clinical diagnosis and treatment where this occurs. This includes support for carers, continuous education, and a whole-person and whole-family approach.

Specific and age-appropriate interventions to support young people transitioning into adulthood.

An integrated, outcomes based and trauma-based approach to supporting children and young people with complex and high needs.

Members of the Board are asked to reflect on the Isos Partnership report and the proposed outline of the ‘Green Paper’, and to discuss where the LGA could best focus its efforts to bring about positive change to enable local government to better support children and young people’s mental and emotional wellbeing. These recommendations will be incorporated into the information the cross-board steering group has to help it finalise its recommendations on the LGA’s position and priorities on children’s mental health and emotional wellbeing.

Implications for Wales

Children and young people’s mental health is a devolved issue in Wales.

Financial Implications

This report has no financial implications. The financial implications of the proposed LGA priorities and work programme that will be put forward by the cross-board steering group will be outlined as part of their future report.

Next steps

Officers will put forward the recommendations from the Children and Young People’s Board to the cross-board steering group.

The cross-board steering group’s recommendations on the LGA’s position, priorities and work programme on children and young people’s mental health and emotional wellbeing will be put before the Children and Young People’s Board, the Community Wellbeing Board and the Safer Stronger Communities Board for final approval.