High integrity mental health services for children: focusing on the person, not the problemBMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1500 (Published 03 April 2017) Cite this as: BMJ 2017;357:j1500
- M Wolpert, professor in evidence based practice1,
- P Vostanis, professor of child mental health2,
- K Martin, director3,
- S Munk, children and young people mental health and resilience strategic lead, 4,
- R Norman, school improvement adviser5,
- P Fonagy, professor of contemporary psychoanalysis and developmental science1,
- A Feltham, adviser3
- 1Research Department of Clinical, Educational, and Health Psychology, UCL, London, WC1E 6BT, UK
- 2University of Leicester, Leicester, UK
- 3Common Room, London, UK
- 4London Borough of Newham, UK
- 5London Borough of Lambeth, UK
- Correspondence to: M Wolpert
- Accepted 22 March 2017
Around 1 in 10 children and young people worldwide have mental health difficulties that substantially affect their lives. Even in high income countries only a small minority of these people access specialist support, which has led to demands for more mental health specialists.1 We support these calls but think that focusing exclusively on the need for more healthcare professionals is not enough. We need to move away from approaches led by professionals that focus on problems towards care that is person centred and focused on progress.
In England some specialist provision is available from the NHS—publicly funded, free at the point of access—but the focus is increasingly on schools as key locations for provision (as is the case in many other high income countries), and on developing resilience in the community (as is the focus in many low and middle income countries). We can learn from the situation in England (box 1) as well as emerging international examples (box 2).
Box 1: Provision of mental health services for young people in England
Around a quarter of a million young people (up to age 24) and their parents or carers are seen in NHS specialist services for mental health across England each year. The numbers of young people accessing other forms of support are not available.
The most common difficulties for those accessing NHS services are family relationship difficulties, depression, and anxiety. Many have experienced abuse or trauma, and dedicated services exist for those in the care of the state, who are recognised to have particularly high levels of need and who may find it hard to engage with services. Most people who access services have more than one difficulty, and some are considered at high risk of harm from …