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Reviewing whole system delivery of children’s services across Portsmouth
In Wessex, the model of bringing Directors of Children’s Services and their leadership teams together with leaders from local CCG groups to think whole system mental health transformation for children has been really successful, Andrea King explains how.
We know that one in ten of all 5-16 year olds are thought to have a mental health disorder, with 50 per cent of lifetime mental illness starting by age 14, and 75 per cent by the mid-20’s. We know that inequality and adversity lie at the heart of children’s emotional ill health. Children from low income families are at greatest risk, three times more likely to suffer from emotional or mental health difficulties than those from the highest economic groups.
Although we are increasing the support by the NHS for children and young people with mental health problems schools and colleges tell us that they are frustrated that help does not come quickly enough. They can see the problems, spot the difficulties, but accessing effective and timely help and support for children and young people affected by emotional ill health is a constant struggle.
Is this a challenge for those of us leading children’s services alone, or is it a wider problem requiring system leadership for those working across all ages? The Five year Forward View for Mental Health sets out the legacy of emotional and psychological problems into adulthood.
With mental illness as the single largest cause of disability in the UK, with each year about one in four people suffering from a mental health problem this is an issue that concerns us all. As well as the human cost to individuals and their families and friends, the economic costs are high and estimated to be around £100 billion annually – roughly the cost of the entire NHS.
Physical and mental health are closely linked – people with severe and prolonged mental illness die on average 15 to 20 years earlier than other people – one of the greatest health inequalities in England.
How do we enable a whole system, from schools, to GPs, to our colleagues in the voluntary, community and faith sectors, to not just spot the signs, but more importantly know how to respond – what to say, what to do – that will help our children? We know those initial responses in the first few months when a need emerges make all the difference.
How do we enable our whole system to have the confidence, skill and insight to play an active role?
Portsmouth’s senior leaders, across the Local Authority Children’s Services and Clinical Commissioning Group leadership team are a fantastic example of how to grip this significant problem and deliver tangible change. The leaders instinctively understand the relevance of embedding early intervention in emotional health and well-being in all that they do together.
You will find emotional health and well-being as a priority in the Children & Young People’s Plan, school improvement strategy, in the early help strategy, in behaviour intervention and inclusion strategy, in social care statutory planning.
As a combined leadership team, on a sunny day in June, local authority and clinical commissioning group systems leaders sat together, to understand each other’s perspectives about children’s emotional well-being. They took time to understand the risks evident in the system. They modelled a restorative principle of ‘seeking first to understand’. The conversation quickly identified crucial dependencies in the system, where investment to enable effective intervention is crucial – like the Harbour School, an alternative education arrangement, holding many of the city’s most vulnerable children with hidden and often unmet emotional health needs.
What defines Portsmouth’s systems leaders is an unequivocal focus on understanding the child’s lived experience. Rather than making assumptions about how children access support first in the local community and then onto the more specialist services, they modelled appreciative enquiry.
Working jointly, leaders asked children and young people to describe their experience of asking for help and receiving support, recognising that the next step is to progress to meaningful co-design of the mental health system with children and families.
This rich qualitative information was supplemented by interrogating quantitative data with systems leaders analysing indicators of children’s emotional health need, gathered from education, criminal justice, social care and the health economy – providing insight into the welfare of the whole child; the inter-dependencies between needs and risks; the potential of community assets and strengths.
‘Children with emotional health needs,’ become ‘our children’ in this conversation. We each can see our part in the system, the relevance of what we do and oversee, and the potential to change and transform our landscape emerges. Resources are always limited, so by working together to adapt what we currently have available to us, we can make the system more coherent. Portsmouth’s leaders metaphorically model how to hold their resources and services in an open hand, rather than a closed fist, enabling decisions to be taken in the best interests of children, maximising the chances of spotting the signs of additional needs early.
Over the next few months we will follow this journey of local authority and clinical commissioning group leaders in Portsmouth to see what we might learn from their experiences.