The increasing prevalence of serious mental health issues in children and young people has been thrust into the national spotlight recently as Childline revealed it receives contact from a young person with suicidal thoughts every 30 minutes.
Children and young people struggling with suicidal thoughts contacted Childline 19,481 times last year, more than double the number five years ago. The NSPCC’s Childline service offers free, confidential support, day and night, to young people under the age of 19. They can receive support via a freephone helpline, by email or via one-to-one online chat. Each communication with a young person is recorded as a session. The service carried out an average of 53 counselling sessions a day about suicidal thoughts last year. Children as young as 10 told Childline how desperate and hopeless they felt as detailed in the service’s annual review 2015/16 - ‘It turned out someone did care’ (NSPCC 2016).
The government insists it is investing in children’s mental health services. However, a new report by the Education Policy Institute’s Independent Commission on Children and Young People’s Mental Health says this promised funding is not making it through to frontline services. This, in turn, is putting the planned transformation of services at risk, it says. The Institute’s new report, Time to Deliver, found specialist mental health services are, on average, turning away 23% of the young people referred to them for treatment.
Reaching crisis point
As the Time to Deliver report identified, access to support is a key issue. Childline’s annual review highlights that this lack of support is leading children to reach crisis point. There was an 87% increase in counselling sessions with young people who were experiencing difficulties with accessing local support services – and a 34% increase in young people expressing dissatisfaction with these services. Many told Childline they were singlehandedly dealing with problems and blamed lengthy waiting lists, lack of information and refusal of help. “The chronic shortage of support is forcing many children to wait until they reach crisis point, when they feel the only place they can turn to is Childline,” the report said. The number of counselling sessions that resulted in a referral to external support agencies such as CAMHS increased by 11% during 2015/16 – 61% of these referrals were suicide-related.
Childline said it often hears from young people who are desperate and reaching out for support and help because suicide seems to be the only option left for them. One young person told the service: “I don’t know what to do. I am feeling numb and the urges to overdose are crazy. I fantasise about my own suicide every day and I don’t want to feel this way. I know I am destroying everyone around me but I can’t stop feeling like this. I just want it all to go away.”
“We have to understand why so many children are reaching such a desperate emotional state that they feel they have no option but to end their lives,” says Peter Wanless, the NSPCC’s chief executive. “As a society, we cannot be content that a generation of children feel so worthless, alone and cut off from support. It is up to all of us to help them feel that life is worth living. What is most worrying is that almost 20,000 of the counselling sessions Childline delivered were for young people who were thinking about or planning suicide – the highest levels we’ve ever seen. We must listen to them, find out what is troubling them and help them overcome their problems.”
It is well documented that abuse can trigger serious mental health issues. Other key triggers outlined in the service’s review were turbulent home life, school pressures, mental health conditions and the rise in young people struggling to access professional help. One young person, Ava, 16, described how unhappy and desperate she feels. “I really want to end my life and have been feeling this way for a few weeks now. My dad is violent towards me and my mum, and he touched me in a wrong way. I am just scared I will try and end my life because I really want to. I just feel like things are never going to get better.”
Childline found girls were six times more likely to be counselled about suicidal thoughts and feelings than boys. One in three Childline counselling sessions about suicidal thoughts took place at night. Additionally, the review identified the preferred method of contact for young people in crisis. Four out of five counselling sessions took place online. Young people said they found it easier to talk about these issues in an online environment.
“There has never been a greater need for children and young people to have access to professional support locally, especially for mental health problems,” says Wanless. “But the feedback we are getting is that for the vast majority this help is simply not available which in turn is placing more pressure on teachers and social workers who are left to try and pick up the pieces.”
School and college support
The Association of School and College Leaders found Childline’s review echoes the findings of a schools survey they carried out earlier this year. Eight out of ten respondents reported a rise in self harm or suicidal thoughts among students.
“All schools and colleges provide a wide range of emotional health and wellbeing support to their students,” says Anna Cole, the Association’s specialist parliamentary adviser. Examples of the wide-ranging support offered to students include: PHSE lessons dedicated to mental health and wellbeing awareness, support with completing referral forms, contacting referral services and booking appointments. Many schools promote external organisations offering mental health and wellbeing support and invite guest speakers to talk to students. School leaders also reported promoting mental health and wellbeing through advice leaflets, via small group work and via school assemblies dedicated to mental health awareness.
“Schools are finding it increasingly difficult to access specialist support services when they have identified a young person that needs professional help,” says Cole. “The cuts have led to a broken pathway. We are finding only the very serious cases (tier three) are being dealt with as the thresholds to access specialist support have been raised so high. Waiting lists are so long that schools are ending up taking children to A&E to get professional help.”
Schools can also access support from local organisations and charities such as Place2Be which provides emotional and therapeutic services in primary and secondary schools around the country, advises Cole.
Recognising the signs
Another recommendation by the commission outlined in the Time to Deliver report was for Ofsted to pay more “specific attention to mental health and wellbeing” when inspecting schools. The report also suggested that teachers should be given better training to identify children in need of support.
The NSPCC offers guidance on the signs and symptoms of mental health issues to look out for in children and young people. Common signs include:
- • becoming withdrawn from friends and family
- • persistent low mood and unhappiness
- • tearfulness and irritability
- • worries that stop them from carrying out day to day tasks
- • sudden outbursts of anger directed at themselves or others
- • loss of interest in activities that they used to enjoy
- • problems eating or sleeping
Advice for social care professionals
CareKnowledge spoke to Karen Goodman, professional officer at the British Association of Social Workers (BASU) for advice on how best to proceed with a young person in crisis.
“It’s a case of assessing how high up the scale of seriousness the situation with a child or young person reaches and acting accordingly,” Goodman says. “If it is at the serious end – if you have a situation where a child is describing suicidal ideation, has started to self harm or is threatening any form of self harm, there is no doubt about it – the case requires a psychiatric referral. Social workers would also need to do an assessment under Section 47 of the Children’s Act 1989 as to whether this is a child protection matter. Children or young people may need protecting either from what is going on around them or indeed from themselves. If a young person is displaying self harm behaviour, social workers must consider the whole range of reasons for this during the assessment processes.”
Referral is the next step to escalate a case but Goodman admits this poses an issue for social care professionals. “CAMHS are operating in the most desperately difficult circumstances”, she says. “They are under resourced, under financed and there is a huge shortage of consultants. This presents social workers with a real problem as we know referrals need to be made even though young people could face long waiting lists and delays.”
Goodman recommends signposting young people to charities that can provide dedicated help and support such as YoungMinds and Sane. Local directories of resources can also be helpful for signposting young people to local support networks such as voluntary organisations.
For people working in social care that are non-social workers, Goodman advises speaking to an experienced social worker or the community mental health team if you have serious concerns about the mental wellbeing of a child or young person. “If you are worried about a child or young person, don’t be afraid to ask. Escalate your concerns up the chain,” Goodman advises.