Elaine Bennett, a BACP member, organised the inaugural Norfolk Children and Young People’s Mental Health Summit, ‘Looking Forward’, at the East Coast College in Great Yarmouth in September 2017. The aim was to bring together practitioners and all those concerned about mental health services for young people. Caroline Jesper, BACP’s Professional Standards Development Facilitator, represented BACP at the event.
We asked Elaine to outline why and how she organised the summit, and to give us some feedback from attendees.
This article, therefore, is a collaboration between Elaine, Chantel Keen – who spoke on the day about her 10-year experience of mental health services as a young person – and Angela Harris, counsellor and BACP member, who reflects on being an attendee.
Organising the summit – Elaine
I am an adult counsellor and child and adolescent psychotherapeutic counsellor with experience of working with young people in educational settings, voluntary agencies and in my private practice. Having moved to Norfolk in 2014, it became increasingly obvious that access for children and young people to NHS and voluntary sector therapeutic services was difficult, if not impossible, for some clients. Timely appointments were mostly not available, due to long waiting lists, and the threshold for CAMHS services was so high that many children and young people (CYP) could not access the services at all. I subsequently learned that only 36 per cent of CYP with mental health issues were able to be seen by the local NHS, although, with some new service developments planned, this target was increased to 55 per cent for 2016–17. School counselling services in Norfolk are also patchy, reflecting the national situation (apart from Wales). Some parents can fund private counselling for their children, whereas others cannot, and I am concerned about this inequality. Additionally, on occasions when I needed to ask a client’s GP to make a referral for specialist support, access often proved difficult, or there was a long waiting time. I also believed there was a need to build a bridge between education and health for young people’s mental health provision.
I decided to write to Norman Lamb, the MP for North Norfolk – he’s not my constituency MP, but is well known nationally as a mental health champion. In the coalition government, he had been Minister of State for Care and Support during the time in which Future in Mind: promoting, protecting and improving our children and young people’s mental health and wellbeing was published. Norman has spoken openly about his son having obsessive compulsive disorder (OCD), and of his sister’s suicide, so is not immune to mental health issues. I asked him if there was scope to ‘think outside the box’ and consider whether services could be delivered differently to better meet the mental and emotional health needs of CYP in Norfolk; possibly even to pilot something.
Prior to meeting him, and to check whether my experiences were shared by others, I contacted local voluntary and statutory agencies, a GP, educationalists, BACP and the Association of Christian Counsellors, and learned that there were common concerns about the availability of CYP mental health services. In one of those conversations, I talked with Stuart Rimmer, Principal of East Coast College, who promotes CYP emotional and mental wellbeing within his national college network. He and I conceived the concept of having a summit. We agreed that if Norman supported it, I would organise it, and Stuart would provide the venue, lunch and printing. Encouragingly, Norman supported the summit, agreeing to be a keynote speaker.
At Norman’s suggestion, I invited a second keynote speaker, Arthur C Evans Jr, Chief Executive of the American Psychological Association, who previously had been the Commissioner of Philadelphia’s Department of Behavioral Health and Intellectual disAbility Service, where he had transformed how services were delivered. Taking a Population Health Approach and a recovery-oriented system of care, clinical care was viewed as just one of the many resources needed for successful integration into the community – and a person’s spirituality, workplace/school, social support, nutrition and exercise, family, housing and peer support were considered to be necessary components. The Philadelphia approach aimed to keep people healthy, to mitigate risk and to offer early intervention for at-risk clients, and to provide effective and efficient clinical care after diagnosis. Dr Evans emphasised the importance of early intervention, especially for children who had suffered trauma and adverse childhood experiences (ACEs) – a message we, as counsellors, have been trying to get across for some time.
I considered who else should be invited to speak. Given the range of agencies and individuals who contribute to young people’s mental and emotional wellbeing, the list of invitees grew. It was obvious from my earlier discussions that the people here in Norfolk were really keen to do their best for their clients, and their contributions needed to be acknowledged. Clinicians at the Norfolk and Suffolk Foundation Trust were also in the process of considering alternative service delivery options to make improvements. What did become apparent, though, was that not everyone knew what each other was doing. I was also keen to highlight the value of counselling.
I divided the summit programme into categories:
- Experiences of mental health services from different perspectives ie young people, the Children’s Commissioner (who wants to see high-quality, children-centric, easily accessible services), Norfolk Healthwatch, the NHS, voluntary sector and political perspective.
- The role of education in prevention, early identification and intervention, which covered work in local schools around attachment needs, particularly of adopted children, and nurture.
- How research contributes to the therapeutic needs of children, covering post-traumatic stress, domestic abuse, the significant evidence base for school counselling, and the need for counsellors working with children and young people to be trained in the BACP core competencies.
- CYP’s spirituality in emotional health and wellbeing, and the role of faith groups in supporting the mental health agenda, a key element of the Philadelphia model.
- An exploration of other mental health approaches, which included the Xenzone/Kooth online and face-to-face counselling service for young people. I was keen to ascertain what could be learned from the Philadelphia model.
Stuart and I jointly agreed objectives for the summit, which were to:
- promote a holistic approach to the provision of mental health and emotional wellbeing services for CYP
- glean Dr Evans’ perspective on Norfolk’s current provision
- promote the role and contribution of education in CYP mental and emotional health
- learn current, relevant, evidence-based research to help meet the needs in Norfolk
- understand the current challenges of accessing services
- share examples of best practice with a view to using this knowledge to offer contributions to the CAMHS Local Transformation Plan and Redesign Project
- highlight the role and potential resources of others to contribute to CYP mental health, such as faith groups, and explore the link between CYP spirituality and wellbeing
- facilitate strategic discussions between the education sector, agencies, professional organisations, faith groups, strategic leaders, local authorities and politicians.
Surprisingly, I learned that the summit was timely, because the CAMHS commissioners responsible for updating the annual Local Transformation Plan were embarking upon a redesign project. One outcome was that attendees were invited to contribute to the consultation for this, and the East Coast College was invited to join the Commissioning Board.
An attendee’s perspective – Angela Harris
I arrived at the summit full of wonder and expectation. It was a privilege to be invited to hear from such a diverse and distinguished group of speakers. Going in, I didn’t know much about the mental health scene in Norfolk. I knew my own personal experiences from a couple of years of private practice, and the general topics (usually complaints) that were often bandied about by colleagues at training events, but I was eager to hear a wider range of perspectives. I was not disappointed.
Most notably, there was Arthur Evans Jr – CEO of the American Psychological Association – who inspired us with tales of the ways in which he and his team transformed how the community of Philadelphia thought about and responded to mental health. Then there was the more local perspective. Elaine had gathered representatives from local and national political bodies, educational professionals in primary and secondary schools as well as higher education, charities, the voluntary sector, the church, research bodies, BACP, ACC, the NHS, and, vitally, young people themselves. By the end of the day, I was saturated – and a bit overwhelmed by the volume of information. But I was also excited.
What quickly became apparent to me was that, although each of these representatives was vital in some way to the provision of mental healthcare to children and young people, many of them had not spent significant amounts of time with one another. The day provided an invaluable opportunity for the politicians to hear from the educators, for the researchers to speak to the young people, for the therapists to share concerns with policy shapers etc. And for all, it was a chance to share harrowing statistics and ask difficult questions.
For example, we heard that only seven per cent of mental health spending goes on care for children, that the number of looked-after children is the same today as it was 30 years ago, that permanent exclusion rates continue to rise year on year, and that the voluntary sector is picking up between 25 and 50 per cent of clients that NHS Wellbeing is having to turn away. We were told that the Department of Education expects primary school teachers to identify mental health problems in children, while the research for how this is best done is non-existent. We heard about how schools are longing for mental health professionals in their midst but do not have the financial resources to employ them.
Perhaps unsurprisingly, the question that was asked, time and again, was: ‘How do we fix these problems?’ It was the question we lobbed at Dr Evans in various guises at the end. ‘With all we’ve heard today, how do we provide the best service for our children and young people?’ The energy had gone out of the room. We were tired, frustrated, disillusioned. The problems seemed a bit too big, the money a bit too tight, the resources a bit too scarce. We’d heard what was wrong; was there any hope of finding solutions?
Dr Evans assured us that perhaps we weren’t as far off as we felt: that across the sectors there was a high level of awareness about what the issues were, and that, despite the difficulty of access to them, the services offered were wonderfully varied. We were starting with more than he had in Philadelphia. He then closed the day by asking us all to consider if our aim was to transform a system or to create allies to build a movement. It was a trick question of course. It takes a movement to transform a system.
Personally, I left with a list of 12 action points – ranging from contacting national bodies to rethinking my personal work-scheduling priorities. I felt empowered to, if not ‘be the change you want to see’, at least do something to initiate change. I’m paying more attention than I was, and asking myself more direct questions about the ways in which I can be part of the solution, rather than feeling despondent about the problem. Change is slow and hard and takes energy and time. Yet this is exactly what I value in my clients each week – the willingness to ask difficult questions and fight for meaningful answers. I’m grateful to be a part of the conversation, even in some small way, and I’m excited to see where movement has begun to happen by our next summit.
Young person’s perspective – Chantel Keen
I wanted young people to contribute to the summit. Charlotte Snell, a member of the Norfolk Youth Parliament, explained that the parliament had identified mental health as a priority. So, having met Chantel Keen, a user of mental health services in Norfolk over the past 10 years, I asked her to participate, too. I had been particularly struck by Chantel’s view that relationship was key in the therapeutic process. I think we would agree.
She wrote and presented this poem, which goes through her experience and tells how lack of communication at both ends can cause problems. Chantel has kindly agreed for us to publish her poem.
Ten years of service
15 years old and I feel like I’m breaking down.
They say ‘we’ll work this out’
You see they don’t know me.
How can they fix my difficulties?
I feel like a number...
They see an equation
But I’ve got fingers and skin like them
Emotions so ballistic
Sometimes I bend.
They say communication is instinct.
But every time I go to say something... I rethink.
What if they’re judging me with their pens and paper?
What if they can see I’m useless?
Just full of anger?
17 years old and we’ve made little progress.
They seem to know more
But I know less.
We keep crossing wires and I keep getting scared.
No one tells you about this stuff.
No child is prepared...
19 years old and I’m starting to open up more
But still feel the draught from closed doors.
We are not on the same level.
They pull the brakes and I keep pushing the pedals.
It’s like they say black and I say purple with yellow spots.
Too many times I wished these sessions would stop.
20 years old, funds have been cut and my care team has changed.
But we still seem to be tackling this the wrong way.
I’m starting to lose hope and I think they have, too.
I’ve just shut down so much
They’ve got nothing to use.
Don’t get me wrong...
From time to time there’s been glimmers of light.
We’ve been on the same page, seen things eye to eye.
But it just hasn’t happened enough.
I’m gunna face this alone now
I know the road’s gunna be tough...
23 years old I didn’t last long.
In times I was weak.
In times I was strong.
There’s been another cut I can feel in the air.
I’m gunna see different faces with the same old stare.
...I was wrong
I made a promise,
I’d be honest
From the start to the very end.
This time I communicated my worries, my perspective, again and again.
They seemed to listen and always tried to make sense.
They told me something I was never told before.
‘This is your path, you choose what you use these tools for.’
Finally that barrier came crashing down. Communication was no longer disallowed…
25 years old I’ve left the service.
I deserved this.
I worked hard and they worked harder.
We jumped the hurdles and smashed the barriers together.
I’ve learnt a lot in these past 10 years.
But this has to be my biggest fear.
Some young people they don’t have 10 years for that change and to see the right face.
We’ve got to keep a level of respect and communicate.
Because we are all just people and we all suffer with problems.
Some feel like empathy has been forgotten.
This place is a place where we need to talk more than ever.
Communication is an instinct, something we all should treasure ... thank you.
Concluding comments from Elaine
Organising the summit took a lot of my time, but it gave me a wider and more strategic perspective of the issues experienced across the agencies, and provided networking opportunities for attendees and speakers themselves. I would like to think that it also demonstrated counselling as a key component of service delivery. I was extremely grateful to all speakers for freely giving their time and for funding their own travel, as this enabled attendance, particularly from schools. My reflection on the summit is that there was sufficient material to cover two days, but I was not convinced that busy people would have committed to attending for two days. Attendees were provided with the slide printouts from each speaker, which contained a wealth of information. We received much positive feedback from delegates, and the local press highlighted some of the issues. We hope to continue working together by creating an ongoing multiagency discussion to achieve closer working and delivery of services within our region.
The Commons Science and Technology Committee, chaired by Norman Lamb MP, is now examining the strength of the evidence linking adverse childhood experiences with long-term negative outcomes; the evidence base for related interventions; whether evidence is being used effectively in policy making; and the support and oversight for research into this area.
Norman has invited Elaine and BACP to participate in a meeting with Norfolk representatives and other outside specialists to have a discussion about what we might do here in Norfolk to lead the way.
Elaine Bennett MBACP, BA(Hons) Counselling, MEd (Child and Adolescent Psychotherapeutic Counselling)
Angela Harris MBACP, MA (Counselling)
Chantel Keen, member of Norfolk and Suffolk Foundation Trust Youth Council
Dragon as catalyst
Open article: Dennis McCarthy illustrates how the dragon is an image of unbridled life force in play therapy – and one that appears most frequently in his clients’ play. BACP Children and Young People, December 2017
Identity integration in fragmented families
Free article: Charlie Morse-Brown thinks about the challenges facing young people when trying to integrate a sense of self from within fragmented families. BACP Children and Young People, September 2017
Ghosts in the playroom
Open article: How far do we follow the client? Do they really know best? Henry Kronengold lets us in on a case where music helped a young girl with her anxiety issues. BACP Children and Young People, June 2017