Anne Clarke
Anne Clarke was the Director of HeadsUpScotland, the National Project for Children and Young People’s Mental Health, from 2004 to 2007. She now works in the Public Health Department at NHS Ayrshire and Arran.
Having come from a background of working in health improvement for many years (including mental health), my aim was to bring that perspective to the provision of services to support the mental health of children and young people. The recommendations of the SNAP report (Scottish Needs Assessment Programme, Report of the mental health needs of children and young people, 2003) had already said the same thing: that children and young people’s mental health is the responsibility of everyone who works with them.
Those who do not have specialist training in mental health have the task of building confidence and self-esteem, of helping young people acquire resilience (skills such as problem-solving, mastery, assertiveness, dealing with emotions appropriately, getting along with people etc contribute to the development of resilience). Those who have done some further training can help those young people who might be vulnerable to mental health difficulties – and those groups can be easily identified from the national data. Lastly, there are those specialist mental health staff who have a role both in maintaining and improving mental wellbeing, but also treating and caring for those who are unwell. My vision was fourfold:
- To help develop the understanding that inequalities and adverse life circumstances affect mental health in the same way they affect physical health
- To help people understand that there is a difference between mental wellbeing and mental illness
- To help everyone who works with young people recognise the potential contribution they have, whether part of the wider workforce or as part of the specialist mental health services
- To provide a range of resources/training to help people be more confident to embrace these roles
The tools to help this happen are all now in place – more or less – but there is still a considerable way to go to help people in the wider workforce understand that what is being asked of them is not any different to what good practitioners are already doing. There is an anxiety that this is a specialist area of work and that somehow there is the danger of doing harm, which is not the case. The specialist services feel overwhelmed at the aim to have them adopt a training and development role with their non-specialist colleagues. Clinical demands dominate their working lives.
Having said all this, I was inspired by the commitment of people to this agenda. The participation of the statutory and voluntary sector working together to achieve the same outcomes was inspiring; the wide range of voluntary sector agencies setting aside their necessary reserve with each other to address this agenda collectively was one of the best experiences; the commitment of folks developing the range of resources and training packs was utterly humbling as people worked well beyond the call of duty; the support of professional bodies and their embracing of the vision without being threatened. Actually seeing people begin to take the policy and work with it was also inspiring.
Frustrations included the marginalised nature of the work – both mental health and children and young people are not really mainstream. Not quite belonging to anyone’s agenda – neither fully owned by “children’s services” nor by “mental health” was a double-edged sword. It meant there was the chance of two bites at the cherry but it also sometimes meant that the issue fell between the two.
Frustrations also include a lack of understanding of the full breadth of the issue – it’s not just specialist services, but for everyone. Lastly, there is no doubt that the issue of lack of resources is a real, pertinent and almost insurmountable challenge for this agenda.
On a wider scale, I would say that much of what the National Programme did was good stuff, but I always felt that we should have been doing much more about promoting mental health for the whole population, rather than only addressing the remaining three aims about those with already established mental health problems. I understand why it happened, because trying to address a broad agenda like that is very challenging.
Although I no longer work specifically with just children and young people, the mentally flourishing Scotland agenda fits exactly with the vision that I have had throughout my time working in mental health improvement. I am happy to support this approach and continue to take this forward on a local level.
Three most important actions:
- Mandatory inclusion in Single Outcome Agreements
- Performance management requirement for the NHS
- Resources ring-fenced within Fairer Scotland funds specifically for mental wellbeing
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