On Thursday, Scotland faces an important – to decide who we want to lead us through the next phase of our country’s future and growth.
I’m already fairly sure that I know who I am voting for – given the fact I have a monthly direct debit to one of the political parties would suggest that my vote is fairly secure. There’s something though that always always eats away at me when I am doing my 3am insomnia battle with myself;
“What the hell do we mean by early intervention and how do we fix it?”
After a particularly rough few months, culminating in a stressful bank holiday weekend, I decided to explore the manifestos of the parties that are asking us to put our faith and trust in their ability to lead us forward, as well as current policy in a bid to understand just what early intervention is, and where exactly it is being delivered. I wanted to know what national policy says the criteria is and whether or not we are achieving that.
I quite literally googled ‘early intervention in Scotland’. First up was the Early Intervention Framework for Children and Young People’s Mental Health and Wellbeing – super. This is a brand new resource, literally launched in March 2021. The opening blurb is great, full of the fact that relationships are key – which they are. Crucially it stated that “children and families need the right help at the right time“. I mean if it does what it says on the tin – offering a trauma informed approach to help support GIRFEC keeping in mind that we love the UNCRC then this is surely gold standard right? It did also make me wonder if this is why my local authority is currently recruiting for a educational researcher to figure out what interventions work and why. Which is great idea, but might have helped if they had employed that person before the cluster wide Mental Health Youth Workers that are already rolling out varying degrees of intervention across the county.
An educational researcher would be an ideal post, if the organisation behind the employment was in any way trauma informed or indeed had any consideration of access to education for those with additional support needs or who have faced trauma – but alas, it seems we are a way away yet from delivering GIRFEC here.
Ok so – a quick flick through this shiny new framework suggest that in order for it to work there needs to be the establishment of an implementation team within each organisation to support and oversee systematic change to being trauma informed –> trauma skilled –> trauma heroes. Let’s say that in the ideal world that we apparently live in that that happens – it then goes on to say that they need to then divert staff from current roles to solely focus on delivering strength based interventions. It’s a lot of words for essentially highlighting that this is going to be absolutely impossible to deliver. Mostly because the staff in their roles have jobs to do? And who would do that while they’re off delivering new interventions?
Back to google and I came across the policy statement on Early years and early intervention. It was written in 2008 which is a long time ago in the face of the ever changing approach to intervention and prevention. Almost poetic in the fact that it was the year my eldest was born. Let’s see what it says; so they want to focus on prevention, risk identification and early intervention (that’s the governments role) and when we look at what that actually means it seems to suggest that it will take the form of more differentiation and personalisation of services, with an emphasis on identification of risk, need and resilience (sounds like victim blaming to me) and providing an appropriate intensity of support at an individual/family level.
Ok super, so depending on the individual/family everyone is going to get a personalised, differentiated amount of support that’s focus lies in prevention, risk identification and early intervention.
But I am still unclear as to what early intervention is? Or when it should be deployed? Plus I’ve written loads of words and am now boring myself.
Who identifies the risk? Is there joined up thinking? What if there is risk but no capacity for intervention?
Lets look and see what the parties are going to do if elected shall we…?
- There is “no health without mental health” (cool phrase Labour). They want to introduce ‘earlier’ intervention, quoting this will be less than the average 18 week wait that people currently face. 18 weeks is a JOKE of a statistic. Try 12 MONTHS.
- Oh so this is spicy – every child and young person who needs help will get it at the first time of asking. WHAT IF THEY DON’T ASK FOR HELP THOUGH?! WHAT IF THEY NEED IT BUT DON’T WANT HELP OR ASK FOR HELP?! WHAT THEN LABOUR?!
- A mental health A&E in every local authority health board. This won’t happen.
- An increase from 8.5% spending on Mental Health to 11%.
- Want to increase spending to 10%
- Mental Health First Aid to everyone in the public sector – BOLD STATEMENT. Realistically unachievable. What level? 1? or 6? Who is going to deliver it?
- 1% of spending to CAMHS – with an underlying message of ‘ask once, get help fast’. Again – WHAT IF NO ONE ASKS?! CAMHS have an average wait time of a year. A YEAR. That isn’t ask once, get help fast. That’s ask once, try and not die in the meantime.
Ok, that’s about it actually from the SNP. Underwhelming.
- Ok the first party to actually commit to a number on increased spending – £235m per year on mental health.
- An extra £161m on CAMHS
- Doubling the community mental wellbeing services budget to £30m
- Expanding access to CBT, Exercise referral schemes and peer support
- SAME DAY access for substances misusers when people present for help.
- Ok, I might have missed it. There was clear plagiarism from the Greens plan to expand on CBT and exercise referral schemes but aside from that there is NOTHING AT ALL ABOUT MENTAL HEALTH OR CHILDREN.
- 15% of funding to Mental Health services
- Doubling the number of psychiatrists for children – Hmmm are we suggesting that all poor mental health is medicalised? Hope not. However, at 3am this morning the on call psychiatric nurse wasn’t ‘trained’ to speak to our 12 year old so they had to phone someone else so this might actually be a good thing. Imagine if the police or social work said ‘oh sorry, not my thing kids’. OUTRAGE
- More school counsellors. £5k grants for everyone who wants to train up. Strong. Definitely worthwhile. I reckon you might need 2-3 per school to cover all the referrals though.
- Abolishing rejected CAMHS referrals by integrating into a system of multi-disciplinary support. Again – like this. Something similar is rolling out in my LA and it sort of works *sometimes but doesn’t reduce wait times which is shit*
Lots of talk about early intervention. Lots of talk about prevention. Lots of talk about providing support when it is first asked for. Lots of suggestions of what could be done better. Lots of money from the magic money tree.
No real tangible idea of how this will be delivered.
No real talk of how we reduce waiting times or inequalities in access to services.
If you can afford to though, you can pay £2k privately to have your child assessed for various additional support needs. Or…you can wait over a year, sometimes much much longer, for our underfunded, under staffed, over pressurised local authority services to do something. Which even then might not be the right thing. And it isn’t even their fault. No one in CAMHS wants to be not seeing kids for a year. No one in social work wants to say ‘sorry can’t allocate this there is no space’. No one in the Police wants to say ‘sorry we aren’t going to IRD because despite attempting to take their life they aren’t at risk at home’.
No one wants to fail at this. But if you don’t have money then you are at the bottom of the heap.
That is the issue. Money and privilege. You can have early intervention – if you can pay.
But what is early intervention? Because honestly, I’m still not sure.
Today, I was told by police, that any out of hours referrals to Social Work that come from within my local authority go to another Local Authority. And that their criteria for whether or not that was need for intervention is ‘whether or not the child is at immediate risk’.
What is immediate risk? Who gets to decide?
You can’t get seen by emergency Mental Health services if you don’t have an active suicide plan. Sometimes, you also have to have attempted to take your own life as well, a lot of the time you have to have tried more than once.
That isn’t prevention. That’s repair.
That isn’t prevention. That’s ‘let’s cross our fingers that when we have a space that this young person is still alive’.
Access to services when someone asks for help is a GREAT starting point. The time frame for someone asking for help and then changing there minds again is about 6 hours – so whatever any government implements needs to be fast acting.
On call school counsellors in every school in Scotland – might be a start. Lots of them.
But that is just one thing.
What about those who don’t ask for help and cant access what is offered? What about those that want help but can’t talk. What about those who have additional needs. What about those who don’t tell anyone and just carry on? What about those kids?
About 5000 words ago we read that we offer individualised support for all.
As long as you want to talk about your feelings that is. Because otherwise, there isn’t any support. All we do is wait until your ready. Or dead. Or an addict.
Because we don’t do anything to help.
Why? Because we can’t. There isn’t any money. There isn’t any support. The ones who are out there day in day out trying to make a difference (and believe me they are there) are swamped by paper work and red tape and poor wages and are sacrificing their own mental health and social lives and work/life balance to prop up a system that is broken.
How can we start to intervene and support and prevent ongoing issues and concerns for our children and young people when the system is broken?
Maybe, we need to start thinking about that.
Because otherwise we are hurtling towards a generation of hurting adults who we try to repair.