Real stepped care

Ellie Kerry – a Psychological Wellbeing Practitioner at Great Ormond Street Hospital – writes.

My mum recently asked a question I have heard many times since starting as a PWP in Great Ormond Street Hospital (GOSH): ‘why is it that children seem to have worse mental health these days?’.

I answer: ‘Well, I think there are multiple factors such as increased awareness, reductions in stigma, and yes mum, social media might also be playing a part’. ‘Ahh’, she says, ‘it must be social media because we were fine in my day’, and the other parts of my answer fall on deaf ears.

And this is the issue – we, not just my mum, but even seasoned mental health professionals, are quick to underplay issues in children which have always been a problem, like conduct, anxiety, depression or attention deficit which are extremely common, treatable and in some cases preventable. Why is it then, that there is not a child equivalent to the adult IAPT system, when we know that more than half of all mental ill-health starts before the age of 14 (Future in Mind, 2015)? Steps have been taken with initiatives such as The Children and Young People’s Improving Access to Psychological Therapies (CYP IAPT) programme, but this service is situated within CAMHS, a service which is impenetrable by families who are ‘functioning’, whose children still attend school, have no diagnosis, and have not ‘yet’ had suicidal thoughts. The majority of families with children with treatable conditions, cannot receive the support they need.

The solution is a real stepped care system for children and young people. At GOSH, we are researching the acceptability of such a system, with step one a ‘mental health drop-in’, delivering low-intensity interventions for families who might otherwise slip through the proverbial healthcare net. To my surprise, my experiences so far have not only brought me in contact with families experiencing mild to moderate conditions, but also those who have been deemed too complex for some services and too mild for others. The result is a sad lack of any meaningful input, with lots of waiting and let-down at the end. But the story brightens, as our service has been able to provide some simple evidence-based guidance and signposting, which in one family’s words, gave them the skills to cope whilst waiting to be seen by CAMHS.

So, to return to my call for a real stepped care system. With fantastic growing ambitions to provide support for children at earlier stages, for example within schools (Green Paper, 2017), we must remain mindful that there is still a big gap and a poorly designed net between first presentation and specialised support. Let’s think together about how we can add steps and prevent untreated cases resurfacing later in the adult mental health system.

Ellie Kerry
Psychological Wellbeing Practitioner
Great Ormond Street Hospital

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