#individualisation

A Summary of Zygmunt Bauman’s ‘The Individualised Society’ – Part Three: The Way We Act

Thirteen – Does Love Need Reason?

Love and Reason will forever fail to communicate… for three reasons.

Reason is about use, love is about value. The world as seen by love is a collection of values, as seen by reason, a collection of useful objects – Value is the quality of a thing, usefulness an attribute of the things’ user. The usefulness of an object stems from a sense of lack in the user – to…

Season planning – part 1 (pleasing everyone!)

Going into each new year, I have to sit down and plan out roughly what workouts I want to do with the club.

What complicates this ideally simple task is the number of different priorities, experience levels and interests in every athletics club. Rarely do we have more than 2 or 3 runners targetting the same race and when we do it is generally ‘by decree’ such as when we tell the membership that…

What is the government’s new green paper on the mental health provision for children and young people really trying to say?

The press keeps no secrets from us regarding the poor state of the mental health of children and young people in the UK. Around 1 in 10 children 5-16 suffer with a diagnosable mental health illness while only approximately 25% of these receive interventions or help from public services. Figures from Public Health England quoted last December suggest a particularly high rate of conduct disorder (68,100 children affected), anxiety (39,500 children affected), ADHD (18,900 children affected) and depression (10,800 children affected). Rumours of investment in mental health services have been hovering around for some time now but what is the government really planning in terms of mental health policy for young people and children?

This year on the December 4th the UK government released a Green Paper, entitled ‘Transforming Children and Young People’s Mental Health Provision’, outlining the latest proposed strategies for improving the mental health of the country’s young people. So, what has been suggested and what does it mean?

To most readers the most striking message of the paper is an increased emphasis of the role of schools in identifying and supporting children and young people facing mental health challenges. The document suggests that every school ought to employ a designated senior lead for mental health, similar but in addition to a special educational needs coordinator (SENCO). This professional would work in collaboration with NHS specialist child and adolescent mental health services (CAMHS) and would, according to the paper, allow children to access the support they need faster and in a less stigmatising manner than the current system of referral to CAMHS directly.

Now that might all sound very lovely until we begin to think about it in even a little more detail.

Firstly, while the green paper states that ‘the school environment is non-stigmatising’ this claim could not be more unfounded. The US adage of ‘high school is hell’ doesn’t come out of nowhere; the Ant-Bullying Alliance explains the bi-directional nature of the relationship between bullying and mental health challenges. Mental health problems make you more vulnerable to being bullied while bullying increases risk of developing mental health challenges. The majority of bullying experienced by children and young people takes place in schools, therefore, a great deal of the stigmatisation around mental health issues in young people also takes place in schools. Already this is not sounding like a ‘non-stigmatising environment’. While individual schools may vary in the extent to which young people facing mental health challenges feel stigmatised the gross generalisation that schools generally are ‘non-stigmatising’ is really introduced into this green paper for the purpose of implying that specialist CAMHS services are stigmatising. In my mind I can think of fewer more effective ways of stigmatising CAMHS services than the government all but labelling them openly as stigmatising environments, bit of an own goal there.

A second concerning statement in this paper is that ‘as the school environment can present triggers for many difficulties (such as social anxiety), it is therefore also a good place to find support to manage them’. This statement seems to run in direct contrast to the previous quotation, describing schools as non-stigmatising, and further confuses the message of the paper. Furthermore, by referring to factors at school as ‘triggers’ as opposed to ‘causes’ the paper assumes a stance which suggests that mental health problems lie like ticking time bombs, or the virus from 28 days later, present in some individuals and dormant until a switch is flipped, and the mental health crisis is released in all its terror. As research has highlighted, over and over again, a large proportion of mental health challenges faced by young people have environmental causes; perhaps experience of early maltreatment or trauma, perhaps prolonged exposure to poverty or conflict, perhaps, even, negative experiences at school. By using language such as ‘trigger’ we individualise mental health problems faced by young people by saying ‘it’s YOU! The problem in YOU and it is part of YOU and the system around you has nothing to do with it’. What we really need is for the systems around young people to recognise their role in the challenged faced by individual children as opposed to pathologizing individual young people.

The paper speaks about ‘children at risk [being] identified and interventions… offered to address problems’. Where is the room in this model for prevention of mental health problems? Again, we come back to the idea of a virus lying unnoticed until, praise the heavens, a specialist mental health professional can identify this toxin. This can be described as ‘professionalising’ mental health work. By suggesting that mental health problems are a specific issue that arises only in individuals and is not related to the world around them we suggest that the only way to deal with them is for a specially trained person to intervene. This runs contrary to a great deal of research that suggests that well thought through changes to the environment, such a school or family, could prevent the development of a mental health problem in a young person even before it became ‘identifiable’.

This paper is just one of the side effects that has arisen, despite many good intentions, from the ‘parity of esteem’ model that we have begun applying to mental health. Parity of esteem originated as the idea that we should treat mental and physical health problems as equally important. I stand by this belief with all my heart. However, this idea has unfortunately been misunderstood by policy makers, journalists and researchers alike to mean that we should treat mental and physical health issues the same as one another. And here in lies the problem. If a person comes to their doctor with a broken leg and they tell their doctor ‘doctor, I have a broken leg’ and the doctor checks it out and says ‘yup, that’s broken’ at the end of this, the leg is still as broken as then the patient came in. However, if someone with social anxiety comes to tell their doctor ‘doctor, I have a problem, I become very anxious in certain social situations’ and they talk this through with their doctor their current experience of their social anxiety may change, for better or for worse, their anxiety may change even before they speak to the doctor when they walk into the room. This is just one simple demonstration of how, while we should give equal respect to physical and mental health issues, we ought not to treat them the same. Mental heath challenges, for adults as well as young people, are affected by context and, therefore, to treat or prevent them we need to look at the context surrounding the person in distress. There is no point providing some wonderful one-on-one therapy for someone if they leave and go straight back into an environment which reinforces their distress.

Once we begin to recognise, as a society and at the policy level, that no child is an island and that mental health issues do not arise in a vacuum but are frequently related to systemic factors surrounding a child we will get closer to truly ‘transforming’ the mental health provision for children and young people.