Sophie Pilgrim, Director of Kindred, member of the SCSC, writes for Friends of the Scotsman on why Scotland's mental health strategy is intelligent and far-reaching.
All of a sudden, it is glamorous to campaign for mental health. The young royals have been in the news promoting their charity, Heads Together, with the help of Lady Gaga. Heads Together aims to tackle stigma, raise awareness and provide help for people with mental health challenges.
Princes William and Harry deserve credit for choosing a campaigning issue which is much neglected and is not generally popular with the public. No wonder this evoked memories of Princess Diana reaching out to patients who were dying of AIDS. Prince Harry spoke very movingly about the impact of childhood bereavement on his own life as an adult. No matter how privileged, mental health touches all our lives at some point.
So what is hopeful about Scotland’s new Mental Health Strategy? Of course, we can all worry and complain that there’s not enough money. But the new strategy is intelligent and far reaching. There is recognition of the need to tackle stigma, and to redress the imbalance of care which has resulted in such low levels of support for children and young people. There is an understanding that mental health affects us all in one way or another, and that many problems are preventable and almost all are treatable. The Strategy acknowledges all those many voices calling for prevention and early intervention. This must surely add up to a commitment to a meaningful investment in Child and Adolescent Mental Health Services (CAMHS).
Many families of children and young people with significant mental health needs are supported by the organisations which make up Scottish Children’s Services Coalition (SCSC). Our organisations specialise in supporting care experienced young people, in providing specialist education and residential care, and in providing information and support for parents of children with additional support needs. The children and young people that fall under our remit are at much higher risk of mental health challenges.
Child and Adolescent Mental Health Services are constructed like a pyramid with four ‘tiers’. Tier 1 is universal services at the base and available to all children, and Tier 4 at the apex is the very specialist services including inpatient psychiatric care and community intensive treatment teams. Children who require services at the top of the pyramid are likely to have several conditions. For example, some have a combination of learning disability and Autism Spectrum Disorder, and bi-polar disorder. Children and young people with learning disability account for 14% of the total child and adolescent psychiatric morbidity and yet the prevalence of learning disability is only 1 – 3% in the population. In other words, if you have a learning disability you are many times more likely to have a mental health problem.
These conditions are difficult to diagnose especially where children are affected by more than one condition. Horizon have produced an excellent documentary about comedian Rory Bremner’s self-referral for a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). It is moving to see his reaction to getting a diagnosis and his realisation of the impact on his whole life of ADHD but particularly the impact on his childhood.
Mental health problems in childhood often occur because of the lack of appropriate support and provision. We know this because you can take a child and move them from one school to another school, or from one psychiatric hospital to another and they can be transformed overnight. Getting the right environment for children with learning disability and other additional needs is hugely important to their mental wellbeing.
We are lucky in Scotland to have coherent educational policies which prioritise wellbeing, including Getting It Right for Every Child (GIRFEC), Curriculum for Excellence and the Additional Support for Learning legislative framework. We have made great advances in our understanding of mental health. This means that we can make progress which will not always be costly. The mental health strategy champions the role of parenting classes, of counselling in school, support to teachers and effective use of specialist CAMHS. We need to acknowledge these effective interventions so that they can be prioritised by our statutory services.
In an uncertain world, we have a meaningful mental health strategy for Scotland. And that is something to feel good about.