Response 15940285

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1. Our framework sets out 8 priorities for a new Mental Health Strategy that we think will transform mental health in Scotland over 10 years. Are these the most important priorities?

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If no, what priorities do you think will deliver this transformation?
About Place2Be Place2Be is a leading provider of school-based emotional and mental health services operating in Scotland, England and Wales. Founded in 1994 (and operational in Scotland since 2001) Place2Be has school-based teams, comprising of over 150 paid clinicians and 1200 counsellors who volunteer their time in over 282 schools, supporting 116,000 children. It offers a flexible menu of services that extend its reach to a further 369 schools. Place2Be seeks to improve the prospects of children aged 4-14 years, by tackling the complex social, psychological and emotional challenges that result in educational disadvantage. Place2Be works in schools providing early intervention tier 1 and tier 2 mental health support, without stigmatising children, young people, families, carers or schools and at a point when they need it most. It effectively removes the emotional barriers to learning and prevents the downward spiral that can lead to low aspirations, poor educational achievement, truancy and exclusion from school and subsequent social and health problems. By helping improve children’s classroom learning and academic progress and building their resilience, Place2Be provides children with brighter prospects and hopeful futures. Because it is an integrated school-based service supporting children, parents, carers, teachers and school staff, Place2Be becomes a trusted part of the school and the wider community. Its core services are delivered by its clinical staff and highly skilled Counsellors who volunteer their time for Place2Be. It measures and evaluates the outcomes of its work, demonstrating the positive impact of interventions. Place2Be offers on-site support, advice and workplace learning to teachers and school staff building capacity from within the school to engage with and support families effectively. It is a leading provider of specialist training and university-validated professional qualifications to those who work with children, helping to build capacity in families, schools and local communities. In addition to school based work, Place2Be ensures there is a strong multi-agency approach to its service delivery (developing strong relationships with school nurses, educational psychologists, CAMHS (Children and Adolescent Mental Health Services) professionals, social workers and other specialist staff) in order that a joined-up package of care is in place and onward referrals to specialist agencies, such as CAMHS can be made as and when appropriate. In essence, by offering school-based therapeutic and emotional support to children, we are able to reach 50-60% of the school population with an embedded, no-stigma approach to mental health issues, as well as providing on-site consultancy for teaching staff around psychological and therapeutic approaches. Our whole school approach ensures that we can reach parents and carers and their children as early as possible and with the greatest chance of engagement with our service. Introduction Place2Be welcomes the opportunity to respond to the Scottish Government’s consultation on the new Mental Health Strategy. As our focus and expertise is in early intervention and prevention with children and young people we will focus our response on providing our view on these aspects of the strategy. We agree with the way in which the strategy is set out in life stages: starting well, living well and aging well. Our evidence demonstrates the impact that early intervention has for children, young people and families. By providing easily accessible, non-stigmatised mental support for children and young people we can reduce the likelihood of mental health problems occurring in later life and the wider costs to society. For this reason, we believe early intervention and prevention should have a central role in the vision for what our mental health services look like in 10 years. Funding is critical to realising the Scottish Government’s vision for mental health – and ambition to achieve true parity between physical and mental health. The Scottish Children’s Services Coalition recently reported that less than 0.5% of the NHS budget is spent on child and adolescent mental health services. Parity will be very difficult to achieve if we cannot fund both our statutory and third sector agencies effectively. This is essential if we are to have any meaningful impact on mental health and wellbeing in Scotland, particularly for our children and young people. The new Strategy must have clearly defined outcomes that measure how we are progressing in achieving this vision, and truly improving health and wellbeing across all life cycles. We can learn from the previous Scottish Government Mental Health Strategy 2012 – 2015, and establish where we made progress towards those targets and where we need to do better. 1. Are the 8 priorities identified the most important? While we broadly agree with the 8 priorities identified by the Scottish Government, we strongly believe that early intervention and prevention (Priority 2) should form a core component of the Mental Health Strategy. Three children in every classroom have a diagnosable mental health condition. Half of those with a lifetime mental health issue first experienced symptoms by the age of 14; and we know that children are less likely to suffer from serious mental health difficulties later in life if they receive support at an early age. By starting well and improving the mental health and wellbeing of our children and young people, we can reduce the associated financial burden on statutory services. We also query whether Priority 8 should be a priority or rather a guiding principle that underpins the Mental Health Strategy. All agencies working within mental health have a duty to ensure that human rights are central to the way in which services are delivered.

2. The table in Annex A sets out a number of early actions that we think will support improvements for mental health.

Are there any other actions that you think we need to take to improve mental health in Scotland?
We will focus our response on Priority 2 – focus on prevention and early intervention for infants, children and young people. We agree that it is important to examine and develop evidence-based programmes to promote good mental health based on prevention and early intervention. Place2Be is one a number of third sector agencies already well established in providing evidence based mental health support to children and young people. In 2014/15 Place2Be delivered therapeutic services to over 30 primary schools in Scotland and a further 4 secondary schools. Approximately 3500 children and young people accessed a drop-in session (Place2Talk) to discuss a range of issues including friendships, bullying, bereavement and family issues. Our direct work with children is measured using Goodman’s Strengths and Difficulties Questionnaires, pre- and post-intervention. We worked with nearly 400 children and young people in one-to-one counselling across the academic year. We know that of those children who started counselling in the abnormal clinical range 64% of teachers felt the children improved post intervention; and 80% improved according to parents. As we have stated in our previous response to the development of this strategy, by providing our service in a school setting we do not suffer the non-attendance rates experienced by CAMHS services in Scotland, currently at around 13% of all first time appointments. Place2Be school projects managers are able to reach out to parents/carers and build trust, helping to improve relationships between parents and children. But this requires more than an appointment-based service. To reduce stigma and become truly embedded within a school, Place2Be staff on on-site 2.5 days a week, offering consultation to school staff as well as counselling to parents where required. Our experience suggests that it is vital that mental health services are provided to users in a way that meets their needs, in an accessible non-stigmatised way. Providing our service in a place where parents and children visit every day has the additional benefit of reducing transportation costs to users. It also means we are well placed to help the Scottish Government deliver in their commitment to ‘Ask Once, Get Help Fast’ as we can signpost families to other types of support to meet their need. In developing the 10 year Strategy the Scottish Government must consider the full contribution the third sector make to the promotion of good mental health and wellbeing, and how we fit within the wider landscape. For instance, Place2Be estimates that model of in-school counselling provision provides voluntary positions to approximately 100 volunteer counsellors each year in Scotland. Each volunteer receives an exceptionally high level of continued professional development, training and therapeutic experience which helps individuals with onward career opportunities. This brings wider economic benefits to the health care sector in Scotland. The new Strategy must also focus on developing frameworks for statutory and third sector agencies to share best practice to develop the range of programmes needed to work with individuals in different life stages. Child and Adolescent Mental Health Services The consultation identifies the need to address waiting times and issues in CAMHS. The most recent Scottish Government statistics show that only half of Scotland’s Health Boards successfully met their CAMHS targets. The number of children seen by CAMHS rose by 30 percent in the last quarter, and demand for access to mental health support is increasing. Place2Be works closely with NHS Boards and Local Authorities who commission our service to share our outcomes, contributing to wider health goals, with the ultimate aim of reducing the number of Tier 1&2 referrals to CAMHS. Delaying access to support has huge implications not only for the individual but also in the wider cost to society as a whole. In Scotland, SAMH estimate that the total cost of mental health in Scotland amounts to £10.7 billion. Statutory services and the third sector should be encouraged to develop partnerships and shared pathways, to improve access to mental health services and reduce the pressures on CAMHS services. Education & Attainment We know that children with more severe mental health issues experience lower levels of attainment. At Place2Be we work with children to build their resilience, improving their ability to deal with the difficulties life throws at them. By improving children’s mental health and wellbeing we reduce the barriers to learning in classrooms. Teaching staff have a vital role to play in identifying mental health issues in children and helping them to access support. Existing teacher training courses do not adequately address this issue, and often fail equip teachers with the skills and confidence to support children’s emotional health and wellbeing. This was one of the findings of the recent Scottish Youth Parliament report ‘Our Generations Epidemic’ – young people reported that teachers didn’t understand or know enough to be able to provide mental health support. The Talented Teacher Programme was developed by Place2Be to help bridge this gap. Recently independently evaluated by NatCen, the report found that the Talented Teacher Programme increased teachers’ ability and confidence when identifying and supporting pupils with mental health needs. Participating teachers had greater confidence when working with parents and reported increased self-reflection, enhancing their overall wellbeing. The new Mental Health Strategy should articulate the need to provide teaching staff, especially early phase teachers, with the skills and confidence to understand the emotional wellbeing and mental health of children. We also believe every school in Scotland should have access to programmes of support to help Senior Leadership Teams shape their own mental health strategy. There is a role for third sector mental health agencies to share their experience and expertise to help create mentally healthy school communities. Place2Be has developed its own programme for Mental Health Champions in Schools, to support a key staff member in any school to become the go-to individual to co-ordinate mental health and wellbeing approaches within the school, as well as gaining an overview of external, relevant, mental health services.

3. The table in Annex A sets out some of the results we expect to see.

What do you want mental health services in Scotland to look like in 10 years' time?
All children in Scotland have the right to grow with prospects and hopeful futures. Mental health support needs to be accessible and children and young people should feel confident about seeking support when needed. The new Mental Health Strategy must bring the third sector and statutory services together, to take a more joined up flexible approach to support that places user needs at the centre. There have been recent reports in the media that the Scottish Government will consider a plan to give all secondary schools in Scotland access to a qualified counsellor. The Welsh Government has a similar statutory requirement on local authorities to provide ‘reasonable provision’ of independent counselling services. Anecdotal reports suggest that in practice, this has led to patchy coverage as counsellors often cover a number of schools and have limited time to provide counselling services. We question whether this leads to a sustainable lasting improvement on individual school communities’ health and wellbeing. A statutory requirement in Scotland to provide access to counselling services in schools would be a welcome and necessary development, however this must be considered in terms of access and quality of the service provision. As stated earlier, the embedding of a counsellor-based mental health intervention within the school ensures that the simple act of talking about problems, and exploring ways forward in addressing them becomes normalised. To this end, it seems to us vital that children get to know the mental health team – counsellors etc – in the same way that they get to know their teachers. External referral, or counsellors parachuted into a school on a needs-only basis work against normalisation in our opinion. By investing in mental health support early, we can ensure that future generations of children and young people in Scotland feel empowered and in control of their own mental health and wellbeing. With the best possible start, we can give young people the opportunity to live well and age well and reduce the damaging cost of mental health issues to our communities.