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The voice of Scotland’s vibrant voluntary sector

Published by Scottish Council for Voluntary Organisations

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Next steps for mental health care in Scotland

This opinion piece is about 1 year old

Martin Crewe calls for a "massive investment" in whole-family support services across Scotland

I am sure that many will have heard of Barnardo’s, but you may not be aware of the scale of operations of our charity. We are a UK-wide organisation and bring learning from across all four nations to the work we do. Focusing specifically on Scotland, we deliver more than 125 community-based services supporting around 16,000 vulnerable children, young people and families.

We work in more than 400 schools, provide family support and early intervention, support care-experienced young people in the transition to adulthood, help hundreds of young people into employment, provide foster care and residential care to more than 200 children and young people, and help families affected by drug and alcohol use. Across this wide diversity of services, we see two disappointingly consistent themes: the impact of poverty and examples of poor mental health and wellbeing.

We are lucky in Scotland that we have a great deal of knowledge around what is needed for children and young people to enjoy good mental health. We need a whole-family approach and trauma-informed interventions. We need to identify problems early and intervene to prevent them from escalating. We need collaboration and partnership working across different agencies, including health services, local authorities and third-sector organisations. We need a skilled and well-supported workforce to deliver high-quality mental health services.

These are the common themes across numerous policy documents including Denise Coia’s review of mental health services published in 2017 and The Promise report produced at the end of the Care Review in 2020. Undoubtedly, the Scottish Government’s new ten-year Mental Health and Wellbeing Strategy to be published next month will echo these themes once again.

If we look at current mental health provision for children and young people then the focus is often on waiting lists for CAMHS services. Unfortunately, our experience is that the majority of children and young people who make it to the top of the CAMHS waiting lists do not then meet the referral criteria to receive a service. We work closely with CAMHS colleagues, and they would acknowledge that their endeavours are only one small part of the picture for children’s mental health.

Our schools are dealing with a huge range of mental health issues, many of which have become more severe as a result of the pandemic. We see high levels of anxiety and increased prevalence of eating disorders. Schools are struggling to create inclusive learning environments that respond to the needs of neurodiverse children and young people with autism, ADHD and dyslexia.

Schools are also having to respond to an increasing number of children and young people who do not conform to traditional gender roles or who identify as transgender or non-binary. Other key mental health challenges include transitions to adult mental health services and the impact of social media.

There are pockets of good practice in mental health services to children and young people now, but the overall picture is of too little, too thinly spread. There is a gap – or probably more accurately a chasm – between policy and implementation, or, to put it more bluntly, between rhetoric and reality.

The focus at Barnardo’s is on next steps for mental health care in Scotland. The big question for children and young people is: ‘How can we make a step change in our current provision?’

To conclude, I would like to make three recommendations:

  1. Firstly, we need a massive investment in whole-family support services across Scotland. We know from the Sure Start programme in England that investing in early years delivers savings for many years to come.
  2. Second, we need whole-school approaches where everyone is committed to relational, trauma-informed engagement with students and there is adequate funding to give everyone the support they need.
  3. Finally, we need to take a genuine children’s rights approach to promote positive wellbeing and use a ‘no wrong door’ policy in our support to families.

Martin Crewe is director of Barnardo’s Scotland