According to The Children’s Society, in the last three years, the likelihood of young people in the UK having a mental health problem has increased by 50%. In a classroom of 30 children, five are likely to have a mental health problem.
In 2019-20, only 391,940 children in England received treatment for problems with their mental health – just a quarter of the more than £1.5 million children estimated to need treatment. Those children who did access services often had to wait weeks or months for treatment, and only 20% of children referred to services started treatment within four weeks.
The Mental Health Implementation Network aims to address this gap in treatment and services by supporting interventions designed to increase access to a range of psychological therapies for children and young people.
The project will build on the approach developed by the NHS’s Improving Access to Psychological Therapies (IAPT) programme. Since it began in 2008, this IAPT programme has transformed the treatment of adult anxiety disorders and depression in England – providing millions of adults with access to talking therapies to help overcome their depression and anxiety.
IAPT-style interventions could help to meet the needs of children experiencing adverse childhood experiences (ACEs) – such as neglect, poverty, losing a parent, or living with a parent with severe mental illness – and children living with their own mental health difficulties. Access to therapies can help to identify children experiencing difficulties, refer them for treatment if needed, and provide a range of support through interventions delivered at school.
Interventions delivered in school to support mental health have been shown to help build resilience and wellbeing in children, address problem behaviours, and support positive family relationships. These interventions usually include a combination of interactive educational and psychosocial-based activities delivered by teachers at a low-cost.
The aim of this MHIN project is to expand access to mental health care for children and young people using IAPT-style services, especially by increasing available support in schools.
In expanding the availability of IAPT-style services, we aim to:
Supporting the priorities in the NHS national transformation programme, the MHIN selected an intervention to implement parent-led cognitive behavioural therapy (CBT) to help address child anxiety. They focused on two intervention sites: working with mental health support teams on the Northwest Coast and primary school support staff in the East of England to support interventions co-developed with clinicians, researchers, children and families.
Anxiety is one of the most common mental health difficulties in childhood, with 50% of anxiety cases beginning before the age of 12. But access to evidence-based treatments is limited with long waiting lists for support. If left untreated, anxiety can severely impact social development, education attainment, and wellbeing.
Therapist-guided parent-led CBT is a brief intervention for children aged 5-12 with anxiety. It has been shown to improve access to anxiety treatments, taking less therapist time to deliver, without compromising child outcomes or parent satisfaction.
In the Working on Worries MHIN project in the East of England, primary school support staff in Norfolk were trained to help families access parent-led CBT.
The intervention can be delivered in a book format or online (pictured below).
Using a ‘train the trainer’ model, 220 pastoral and school staff across 130 primary schools in Norfolk were trained by external children and young people's mental health practitioners to be able to work with parents in schools using CBT approaches.
There was high engagement from schools in rural and socioeconomically deprived areas, where there is less access to mental health support. Around 230 families accessed the intervention, the majority choosing the online version, with promising results.
Overall, the team found that the intervention was effective in reducing child anxiety. It helped to build positive relationships between schools and parents, provide support to children quickly and reduce onward referrals to specialist mental health teams.
It has been really good. We have definitely seen a change in our daughter. We understand how to deal with her anxieties and how to support her in future. Family life is less stressful
The MHIN team evaluated the facilitators and barriers to successful implementation.
Facilitators included:
Barriers included:
Following the success of this intervention, the MHIN team have secured an agreement in principle to sustain parent-led CBT delivery in Norfolk for the next school year.
