01.12.12
Tackling mental ill-health among children and adolescents
Source: National Health Executive Nov/Dec 2012
There is a major issue of under-diagnosis and under-treatment of mental health problems among children and adolescents. NHE speaks to Dr Raphael Kelvin about a new e-portal giving mental health advice and guidance for anyone who works with young people, aimed at tackling this problem.
A consortium of professional bodies and medical royal colleges with an interest in young people’s mental health and development are launching an educational e-portal to improve mental health outcomes and speed up diagnosis and intervention.
The £2.2m advice and information resource, funded by the Department of Health, is aimed ultimately at everyone who works with or spends time with children and adolescents, especially NHS staff, early years’ professionals, teachers, social workers and police. It goes live in spring 2014.
Dr Raphael Kelvin is the clinical lead for the consortium and helped get the idea off the ground. He told NHE: “We’re being ambitious here. Any adult who has any responsibility for a child or young person is among the potential audience for this e-portal. Whether that’s a youth worker, a football coach or sports teacher, or a member of the clergy, or a GP or a paediatrician or a psychiatrist…
“We’re targeting people involved in healthcare and not, statutory and non-statutory: any adult. We want to upskill people and give them the ability to upskill themselves within their organisational framework and within their personal interest.”
It is hoped the information within the e-portal will help with earlier diagnosis of mental health issues in children, ensuring people can spot warning signs, and ensure messages given out are concise and consistent
Dr Kelvin said: “We’re aiming for this portal to meet those people’s needs and for them to be able to tailor what they take from the e-portal to their individual context, needs and requirements.
“A police officer, for example a custody sergeant, may have an interest because he or she’s getting 14-year-olds coming in and wants to understand more about self-harm in adolescents who are offending. They will probably want to use the portal in quite a different way to, for example, a special needs co-ordinator in a school or a paediatrician who works with lots of disturbed young people daily. The custody sergeant will deal with disturbance but of a different sort.
“We want to make it as user-friendly as possible, as feasible as possible and as context sensitive as possible.”
The Consortium is in partnership with a CYP mental health e-learning for school and college counsellors programme, led by Professor Mick Cooper, which together were granted £3m (£2.2m for the Consortium and £0.8m for the BACP-led development). They will develop the e-portal in close collaboration, with the same over-arching developmental principles and goals.
A focus on mental health
Dr Kelvin referred to a number of recent documents that detail the context in which this e-portal is being developed, from the Government’s ‘No health without mental health’ strategy, to the recent ‘How mental illness loses out in the NHS’ paper from the LSE. Professor Lord Richard Layard, Professor Clare Gerada of the RCGP and Professor Simon Wessely of King’s College London noted after the release of that paper that “a major expansion of psychological therapy would more than pay for itself in savings on physical healthcare”.
Around three-quarters of people with mental illness are not having treatment for it, including the 700,000 children with problem behaviours, anxiety or depression. A 2010 RCGP survey suggested that 78% of GPs could only “rarely” get specialist psychological therapy for children who had emotional or conduct problems within two months.
These statistics helped push the Government to launch the Children and Young People’s IAPT programme, upgrading the existing CAMHS to provide more evidence-based treatment and better outcomes.
Dr Kelvin told us: “We do need to better address the needs of children and young people with mental health problems: that’s been clearly identified. There is a big need out there and it’s pretty clear that need isn’t being met as well or as fully as it should be.”
He said there is clear evidence across England of under-diagnosis, under-detection, underreferral and under-treatment of children and young people with mental health problems.
E-portal development and content
Dr Kelvin praised the strong ministerial support for the project, initially from Paul Burstow and Andrew Lansley, and latterly from Norman Lamb and Jeremy Hunt. The genesis of the e-portal, he suggested, was an innovative mix of bottom-up pressure from clinicians and other health professionals, and top-down policy aims from the Department of Health.
He said: “From the bottom up, there was a wide range of people over many years asking for improved content on e-platforms for learning, knowledge and understanding of mental health from across the field.”
The e-portal funding is linked to, but separate from, the £32m, four-year CYP-IAPT programme, under clinical lead Professor Peter Fonagy and project lead Kathryn Pugh, which Dr Kelvin has also been involved with.
He said: “We have got very close working links, and some elements of this crossover with that.”
We also asked Dr Kelvin about progress on formulating the content for the e-portal.
He said: “It’s a complex task. From the start, we’ve been working with a very wide group of stakeholders and we’re bringing in more as we go through the scoping process to develop the over-arching curriculum – the ‘A-Z’ of the field. For that A-Z, authors will provide content on a quality-assured, peer-reviewed basis.
“Its content is going to be best evidence based; either NICE, or best evidence approved information where NICE-based information is not present. It’s got to be focused on outcomes, and it’s got to be informed by the needs of users – meaning both the children and their parents using services, but also the adults who are going to use the site.
“Not any old content is going to get in there.”
Multi-disciplinary team
The e-portal will be open-access, and Dr Kelvin said its scope and ambition were unique, though it has drawn on the knowledge and skills of people involved in the e-learning for health programmes, such as the work of the RCPCH on the Healthy Child and Adolescent Health programmes.
The project team is also learning lessons from work done by Royal College of Psychiatrists and the British Psychological Society.
Dr Kelvin explained: “What we’ve put together here is a multi-disciplinary, multi-professional, multi-agency consortium, which includes royal colleges but also relevant professional associations and representatives of children, young people and parents and non-health organisations through the NCB.”
The project also has cross-governmental buyin, with support from relevant ministries like the Department for Education, Department for Communities and Local Government, Ministry of Justice and Home Office. This widespread support, especially from the non-health sector, would help ensure the e-portal is well-used by everyone who would benefit from it, Dr Kelvin suggested.
Early intervention
Dr Kelvin praised the ‘No health without mental health’ strategy, and said: “Local decision makers, chief executives and boards really should be referring to the strategy as a cornerstone of their approach to mental health.
“All the evidence tells us that getting to children as soon as possible makes both common sense and financial sense in the medium and long term.”
He cited work by Julia Kim-Cohen and colleagues from 2004 suggesting that half of all mental disorders an adult might have at any time can be traced back to their first onset at the age of 14, and 75% can be traced back before the age of 21.
Dr Kelvin said: “Clearly if we can intervene in the earlier stages, we’re going to mitigate and moderate the consequences later in life.
“Mental health issues can fundamentally affect your ability to have relationships and your ability to work.
“The scale of the problem is worth reminding people about. 10% have diagnosable mental disorders, and a further 10% of children may not have a diagnosable disorder but they do have behaviours and symptoms that put them at risk of a subsequent disorder. “This project is all about pulling together all the relevant forces on behalf of children and young people.”
Dr Raphael Kelvin is National Clinical Lead for the Children and Young Persons Mental Health e-portal development based with the National Consortium of Professional Bodies and CYPs stakeholders, and a Consultant and Associate Lecturer in Child & Adolescent Psychiatry in Cambridge, Cambridgeshire and Peterborough NHS Foundation Trust & University of Cambridge, where he undertakes his clinical, teaching, training and research work.
From 2009-2012, he was seconded to the DH as National Professional Advisor for CYP mental health, and was a lead in the bidding for and development of the CYP IAPT national service change programme, PBR for CAMHS and had a key leadership role in the development of ‘No health without mental health’ (DH 2011) and the Child Health Outcomes forum and strategy to follow.
A high-quality learning resource
RCPCH vice president for education, Dr Alistair Thomson, said: “This electronic portal will provide a high-quality learning resource to enhance the knowledge, skills and confidence of the multitude of professionals that work directly or indirectly with children and young people with mental health problems.
“It will help identify children and adolescents with mental health issues at the earliest possible stage thereby not only directly improving children’s health and other associated benefits like improving their educational achievement, but thanks to early intervention, preventing conditions worsening when that child moves into adulthood.”
The consortium
Royal College of Paediatrics and Child Health
Royal College of Psychiatrists Faculty of Child and Adolescent Psychiatry
Royal College of Nursing
Royal College of General Practitioners
British Psychological Society
National Children’s Bureau
Children’s charity YoungMinds
The British Association for Counselling and Psychotherapy (BACP) will deliver the counselling-related e-learning materials.