Despite recent initiatives there are few signs that the growing crisis in UK mental health provision is abating. Now mental health charities are saying the fightback should start in our schools.It’s a painfully familiar story and one I might have missed had Suzanne Lakie not been a special educational needs co-ordinator.
The 48-year-old mother of three taught at Harpur Hill Primary School in the Derbyshire spa town of Buxton. A colleague described her as ‘always bubbly and full of fun’. Photos show Suzanne smiling to camera flanked by her children and on a trip to Paris with her boyfriend, James.
Beneath the surface, however, Suzanne was far from serene.
In 2009 her younger brother David had taken his own life. Seven years later Suzanne was still struggling to come to terms with his death. Her marriage had ended and she had found solace in alcohol. Pressures were mounting and the binge drinking was beginning to impede her work.
On 4 July last year she rang in sick one final time before taking an overdose of prescription pills washed down with alcohol. The coroner’s verdict — that she had committed suicide while the balance of her mind was disturbed — was poignantly delivered in Mental Health Awareness Week (8-14 May 2017).
According to the latest Samaritans Suicide Statistics Report 6,188 suicides were registered in the UK in 2015 — a one per cent increase on the year before. But this small increase masks some worrying trends: male suicides are in decline whereas female suicides — like those of Suzanne Lakie — are on the rise. The current rate of the latter is the highest it’s been for a decade.
A similar uptick is also evident among young people. In 2015 the rate of suicide among 10- to 29-year-olds was 10.6 per 100,000, up from 9.9 in 2014 and 9.8 in 2013. According to the charity Papyrus, suicide is now the biggest killer of young people — male and female — under 35 in the UK. In 2015, 1,659 people in this age group took their own lives.
Suicide is, of course, only the tip of the iceberg. Many other young people attempt to kill themselves and fail, while others self-harm, battle with depression or seek escape from the challenges of everyday life through self-destructive behaviours such as alcohol and drug abuse.
In March 2017, the Mental Health Foundation commissioned NatCen to conduct a survey amongst its panel members in England, Scotland and Wales. The aim was to understand the prevalence of self-reported mental health problems, levels of positive and negative mental health in the population, and the actions people take to deal with the stressors in their lives. In all 2,290 interviews were completed — 82 per cent online and 18 per cent by phone.
The headline findings are stark. Only 13 per cent of interviewees reported living with high levels of good mental health whereas over 40 per cent reported experiencing depression at some time. The responses also suggested a link between good or poor mental health and household income and economic activity. Equally stark were the differences between age groups.
While 58 per cent of people aged 55 and over reported experiencing a mental health problem in their lifetime, for the 35-54 age group the comparable figure was 68 per cent and for the 18-34 age group 70 per cent. In part this may be explained by a greater reluctance of older people to disclose a mental health problem, as the report says. However, the research also found that people aged 55 and over were also more likely to be living with positive mental health (19 per cent) compared to those aged 18-34 (7 per cent) and 35-54 (10 per cent), and less likely to be living with negative mental health (10 per cent) compared to the 18-34 and 35-54 age groups, each of which scored 20 per cent.
The worrying trend among young people is what primarily concerns the mental health charity YoungMinds. WiseUp, its latest report published with the National Children’s Bureau, is part of a growing campaign to persuade politicians that the mental health of young people deserves parity with their physical health when it comes to policy initiatives and funding.
WiseUp brings together a plethora of evidence to illustrate the crisis in mental health among young people. This includes that suicide is the most common cause of death for boys aged between 5 and 19, and the second most common for girls of that age, and that around 1 in every 12 young people deliberately self-harm, though this may rise to almost 1 in 3 for girls aged 15.
The case for specifically addressing the mental health needs of young people is also unassailable. A 2010 position statement from the Royal College of Psychiatrists — No Health without Public Mental Health: The Case for Action — noted that:
Half of all lifetime cases of diagnosable mental illness begin by age 14 and three-quarters of lifetime mental illness arise by mid-twenties.
Unlike other health problems such as cancers and heart disease, most mental illness begins early and may persist over a lifetime, causing disability when those affected would normally be at their most productive. Approximately 11 million people of working age in the UK experience mental health problems and about 5.5 million have a common mental disorder. A significant proportion of the population experience sub-threshold symptoms, which, although not meeting criteria for diagnosis of mental illness, have a significant impact on their lives.
Despite the mountain of evidence of the huge personal and societal costs resulting from mental illness support for young people remains woefully insufficient. State of the Nation, the April 2016 report of the CentreForum Commission on Children and Young People’s Mental Health, found that child and adolescent mental health services (CAMHS) are, on average, turning away nearly a quarter (23 per cent) of children referred to them for treatment, often because the access criteria they use are the ‘antithesis of an early intervention approach’. CentreForum — now the Education Policy Institute (EPI) — also uncovered that the median of the maximum waiting times for all providers was 26 weeks for a first appointment and nearly ten months for the start of treatment.
So what can be done?
Sarah Brennan, Chief Executive of YoungMinds, says schools need to rebalance by giving similar weight to wellbeing as to academic performance:
Students need education to include how to understand and look after their mental health — just like we learn how to look after our physical health. By shifting the focus to preventing mental health problems and building resilience we can do so much to improve the lives of so many. Good wellbeing on leaving school has a much greater impact on life outcomes than exam success.
In the hothouse atmosphere of today’s schools this will seem to many like wishful thinking. As the CentreForum report notes only 0.7 per cent of NHS funding is spent on young people’s mental health, and only 16 per cent of this funding is on early intervention.
Back in 2015 the Conservative/Lib Dem coalition government published Future in Mind, a plan to transform mental health services. This was to be accompanied by £1.25bn investment over five years ‘to increase access to the right treatment, in the right place, at the right time’. Two years on the EPI has published a new report looking at the progress that has been made using evidence from NHS England’s new ‘Mental Health Five Year Forward View Dashboard’. Among its findings are that almost three quarters (73.2 per cent) of Clinical Commissioning Groups (CCGs) failed to meet NHS England’s own benchmark for improving services and that CCG’s planned spending per head varied significantly, The latter, they say, suggests ‘that there is a postcode lottery in children and young people’s mental health care’.
Meanwhile in schools there is growing evidence that far from mental health provision improving matters are getting worse. Polling evidence collected by YoungMinds in February 2017 and cited in WiseUp reveals that 82 per cent of teachers said that the focus on exams has become disproportionate to the overall wellbeing of their students and that 73 per cent of parents would prefer to send their child to a school where children are generally happy, even if the school’s previous exam results have not been good. As for young people themselves, 81 per cent felt that their school cared about their grades/results whereas just 61 per cent felt that they cared about them being happy.
Yet the case for change is compelling and there are some signs that campaigners are making headway.
Earlier this month an online petition to make mental health education compulsory in primary and secondary schools garnered 103,554 signatures despite being closed early because of the forthcoming General Election. The UK parliament considers all petitions that get more than 100,000 signatures for a debate.
An initial Government response says that,
Schools should decide how to teach pupils about mental health developing their own curriculum to reflect the needs of their pupils’ but adds that if re-elected the Government ‘will be developing a new green paper on children and young people’s mental health to be published later in the year with new proposals for both improving services and increasing focus on preventative activity.
In late April, 10,000 people signed an open letter to Prime Minister Theresa May calling on her to act on the five recommendations contained in the WiseUp report. These are to:
- Update existing legislation to enshrine wellbeing as a fundamental priority of schools.
- Establish mental health and wellbeing as a central part of school improvement, by strengthening the focus on wellbeing provision within the Ofsted framework.
- Develop, trial and establish a wellbeing measurement framework by 2020.
- Embed an understanding of wellbeing, mental health and resilience in all teacher training.
- Provide schools with designated funding to resource wellbeing provision.
As WiseUp states:
We are calling on the Government to rebalance the education system so that the wellbeing of students is considered as important as academic attainment.
We encourage the Government to adopt these five key recommendations to put student wellbeing at the very heart of the education system. We believe these changes are needed to ensure that all schools help their students to build resilience, look after their emotional wellbeing and go on to thrive in adulthood.