The pandemic has had a disproportionate impact on the mental health and emotional well-being of children and young people, according to academics.
They were giving evidence to a Senedd committee which found that many children and young people have experienced stress, anxiety and loneliness.
You can read more on this work in our previous article: Living with COVID-19: are we in the endgame?
Data on mental health problems in children and young people in Wales is limited. Commonly reported UK statistics include:
- an estimated three children and young people in every classroom (or one in eight overall) has a diagnosable mental health condition; and
- half of all mental health problems manifest by the age of 14, with 75% showing by the age of 24.
The statistics show a consistent increase in the incidence of mental health issues, even before the COVID-19 pandemic. So why are governments across the UK still failing some children, young people and their families when it comes to mental ill health? Part of the answer is that as a society we’re still mostly reacting rather than preventing.
This article focuses on prevention and looks at:
- the current mental health landscape for children and young people; and
- what the Welsh Government is doing to reverse the mental health epidemic as we recover from the pandemic.
We’ll publish a further article looking at the impact of the pandemic on specialist Child and Adolescent Mental Health Services (CAMHS).
There’s clear ambition within Welsh Government to focus on prevention
The Welsh Government doesn’t lack ambition when it comes to prevention.
This isn’t about mental health awareness – our awareness of mental health issues is definitely greater than it was a decade ago. While this is really important, prevention is about helping children and young people to cope with the ups and downs of life. It’s about building resilience, self-esteem and well-being from a young age.
We're starting to see that cultural shift, particularly through the Welsh Government’s whole school approach. It focuses on equipping children and young people with skills to look after their own mental health and helps to teach them how to build their emotional resilience.
It’s also helping teachers to better support children and young people who experience anxiety, low self-esteem and other low-level mental health issues.
The new Curriculum for Wales, which primary schools will be required to implement from September 2022, features health and well-being as one of the key areas of learning. Well-being is also woven through the other curriculum areas.
The Welsh Government introduced new statutory guidance in 2021, requiring all schools to embed a whole school approach towards mental health and emotional wellbeing in everyday practice. Schools and colleges can decide what mental health support they want to fund and provide themselves.
Examples include school counselling services, teacher training, emotional literacy support assistants (ELSA), and intervention programmes.
Around £320m is now invested in mental health services each year, more than any other service in NHS Wales.
Despite this funding and policy ambitions, the long-standing criticism of Welsh Government is its inability to translate these actions into practice. At times, the Welsh Government has struggled to implement some of its priorities set out in its 10-year strategy ‘Together for Mental Health Delivery Plan’.
In a whole-school approach, wellbeing and mental health are everyone’s business
The whole-school approach has been championed for a number of years. The Fifth Senedd’s Children, Young People and Education Committee published its influential Mind over Matter report in 2018 - and its follow up Mind over Matter: Two years on.
Both reports emphasised the importance of prevention when it comes to mental health issues in children and young people.
The first report highlighted that while there was an established system in place for children and young people presenting with a diagnosable mental health issue (i.e. for them to be referred by the school or their GP to CAMHS), there was very little support in place when the issue was low-level, or in the early stages.
The Committee questioned why children and young people had to get so ill that they needed a specialist before support was provided.
The Together for Children and Young People Programme has been responsible for driving change
In 2015, the Welsh Government set up Together for Children and Young People (T4CYP), a multi-agency programme designed to improve mental health services for children. The programme was extended until March 2022 with three Programme priorities:
- early help and enhanced support - NYTH NEST Framework;
- working with Regional Partnership Boards (RPBs); and
- neurodevelopmental services.
Despite the T4CYPP ending on 31 March 2022, further legacy work is continuing until September.
Over to Regional Partnership Boards – ensuring momentum isn’t lost
In February 2022, the Children’s Commissioner published ‘Making Wales a No Wrong Door Nation - how are we doing?’ The Commissioner called for young people to get the help they need wherever they ask for it – so they aren’t told they’ve knocked on the ‘wrong door’.
The NEST/NYTH framework includes No Wrong Door as one of its key principles.
The Commissioner’s report says that every RPB has a plan for children’s provision, and has begun to make changes towards a No Wrong Door approach. But it also says “children and young people are still, every day in Wales, being told they have come to the wrong door when they reach out for support with their mental health, emotional or behavioural needs”.
One area of specific concern is waiting times for an assessment for a neurodevelopmental condition (for children with suspected Autism, ADHD and other similar conditions) .
The Senedd’s Health and Social Care (HSC) Committee is currently running an inquiry looking at mental health inequalities. Neurodiversity is one of the key focus areas.
Circumstances such as persistent poverty are risk factors that can lead to children developing serious mental health problems
The HSC Committee’s inquiry is a reminder of the importance of a whole family / whole system approach to tackling the epidemic around mental health in children and young people, including the role of society and communities. The different causes of poor mental health in children and young people are complex.
A study published in the British Journal of Psychiatry says one in three adult mental health conditions relate directly to adverse childhood experiences (ACE). Research has found that for every 100 adults in Wales, 47 suffered at least one ACE during their childhood and 14 suffered four or more.
Additionally, our research article Poverty and mental health: it’s a two-way street considers the impact of poverty on mental health. It is estimated that around 30% of children in Wales live in relative poverty.
In her evidence to the HSC Committee on mental health inequalities in March, the previous Children’s Commissioner, Sally Holland, said that not all RPBs are yet in a position to confidently deliver the interventions children and young people need to build resilience, self-esteem and well-being.
This takes us back to the implementation gap and the perceived problem the Welsh Government has in making sure it can deliver its ambitions. Clearly there are other systemic issues holding back progress.
Article by Sarah Hatherley, Senedd Research, Welsh Parliament