The Mental Health of Children and Young People: A Framework for Promotion, Prevention and Care

2. Policy Context

2.1 The Scottish Executive is committed to ensuring that every child has the best possible start in life and is able to reach their full potential. Scottish Ministers expect children and young people in Scotland to be valued by ensuring that they are:

2.2 These principles apply across agency, service and professional boundaries and are consistent with the principles enshrined in the United Nations Convention on the Rights of the Child ¹⁸. They all impact on, and are influenced by, children's and young people's mental health and wellbeing.

2.3 The Framework should be considered within the context of a range of strategic policies and initiatives which aim to ensure that children and young people have the best possible opportunity to achieve their potential. It sits alongside several other important initiatives to support children's development and welfare, all of which seek to:

• Promote a step-change in Scotland's public health through implementation of Improving Health in Scotland - The Challenge¹⁹, the work of the National Programme for Improving Mental Health and Wellbeing ²⁰, and implementation of Being Well - Doing Well²¹, supported by implementation of the school nursing framework ²².
• Achieve seamless and more effective support for children, young people and their families through implementation of For Scotland's Children²³ and new proposals for improving children's services (see below).
• Redesign assessment and support for children through implementation of the Education (Additional Support for Learning) (Scotland) Act 2004 ²⁴ and the Integrated Assessment, Planning and Recording Framework (see below).
• Improve protection for children and young people at risk of abuse or neglect through a programme of child protection reform ²⁵, informed by It's everyone's job to make sure I'm alright²⁶, the Framework for Standards²⁷ and the Children's Charter²⁸ for all agencies involved in protecting children and young people.

Integrated children's services planning

2.4 The Scottish Executive has published new guidance for the preparation of integrated children's services plans ²⁹. This is intended to support rationalisation of local planning activity and encourage agencies to agree consistent improvement objectives and delivery strategies across universal and targeted services for children and young people. As indicated earlier, planning for implementation of the Framework should be part of the new integrated children's services planning arrangements.

2.5 The Scottish Executive is developing a quality improvement and inspection framework to support integrated children's services planning and delivery, and will be consulting on proposals in 2005.

Health for All Children 4 (Hall 4)

2.6 The Framework links strongly with implementation of the fourth edition of Health for All Children³⁰ (known as Hall 4) in Scotland. Hall 4 recommends a holistic approach to child health screening and surveillance with an emphasis on health promotion, primary prevention, and targeted active intervention with vulnerable families. It emphasises the need for enhanced health promotion work to inform and educate parents about their child's development and needs so that they can seek the right help when they need it. Hall 4 also highlights the need to draw more effectively on the range of regular contacts that children and families have with other professionals, in childcare and education, supported by clear routes for liaison, consultation and referral to health professionals when there are concerns. The Scottish Executive published guidance ³¹ in April 2005 to support implementation of Hall 4.

Improving support systems for children in need

2.7 The first phase of the Scottish Executive Review of the Children's Hearings System ³² raised concerns that at present, children are not receiving support when they need it, and that many are referred to the Children's Reporter when more effective local action would have been more appropriate.

2.8 Like the SNAP report on children's and young people's mental health, the first phase of the Children's Hearings Review found that professionals want to spend more of their time on actually helping improve things for a child or young person. This means spending less time on processing children and families through systems, and more time tackling concerns.

2.9 The Scottish Executive has developed and consulted on proposals to improve support systems for children ³³, including options to strengthen individual agency and collective responsibility for identifying and addressing children's needs, building on approaches developed in respect of child protection. The proposals are based on the principle that mainstream services (for example, nurseries, schools, family centres) should ensure that children, young people and parents get the learning and support they need to do well. The proposals also suggest that agencies should take responsibility and do all they can, with the help of others, to support the child before referring to another service. This fits with the SNAP report recommendation that children's mental health and wellbeing should be "mainstreamed" ( see Section 3).

Integrated Assessment, Planning and Recording Framework

2.10 With the proposals for improving support systems for children in need, the Scottish Executive has consulted on a draft Integrated Assessment, Planning and Recording Framework ³⁴ ( IAPRF). As children grow and develop they routinely have contact with numerous professionals in health and education. Some children and young people have particular health, learning, or social needs which require assessment and support from a range of different services and agencies.

2.11 The IAPRF is intended to ensure the consistency and quality of assessments by introducing a common structure for assessing the needs of children and young people. It will provide a means by which all services for children - universal and specialist - will be able to gather and share appropriate information, assess needs, plan and coordinate services for individual children. The IAPRF will support the integration of a range of information and assessments from different professionals and agencies into a coherent view of a child's strengths and needs.

2.12 Children are already assessed in a variety of ways within universal and specialist services. The difference will be that all professionals will be working to the same frame of reference - the IAPRF - and will be required in their assessments to take account of the child's life in the context of the families and communities within which they live. This will mean that a child will not have to be subjected to repeated assessments if he/she moves from one geographical area to another, as the assessment information will transfer with the child and be able to be built on and updated in the new area. When children and young people move at key transition stages in their lives, for example from primary school to secondary, or at school leaving age, important information can go with them.

2.13 The IAPRF will ensure that the child's experience is maintained at its centre and that account is taken of strengths, achievements, and the personal resources of the child and family as well as needs and risk of harm. It will:

• Set out common standards and processes for recording and decision-making
• Set out what assessment involves
• Define the information to be taken into account when assessing the "whole" child or young person
• Provide guidance on when multi-agency assessments should be undertaken
• Provide guidance on using information to establish an assessment and action plan
• Set out requirements for the electronic sharing of information
• Set out clear guidance for information sharing and in what circumstances information should not be shared
• Ensure that parents, children and young people have clear information about safeguards for information, about giving consent to share and identifying circumstances in which some information which they might prefer to keep private might need to be shared

Community Health Partnerships

2.14 The Framework is published at a time when Community Health Partnerships ( CHPs) are beginning to take shape across Scotland. CHPs are intended to provide a focus for service integration for local communities and a vehicle for addressing local inequalities ³⁵. Guidance on the establishment of CHPs, for example in relation to mental health services ³⁶, is pragmatic. On the one hand, a number of universal qualities are stated, including the importance of working in partnership with those who use services (a recurrent theme within this Framework). On the other hand, the need for flexibility of form within partnerships is recognised and endorsed, since these are practical arrangements whose success will be reflected in delivery of their aims.

2.15 In relation to the mental health services for children and young people, CHPs will want to develop arrangements which best promote:

• "Horizontal" integration with children's service partners, for example in education, social services, youth and community, justice and voluntary sector children's services
• "Horizontal" integration with health service partners, for example in primary care, community health and secondary care
• "Vertical" integration with specialist mental health services, through local, regional and, where necessary, national networks of service

2.16 Whilst the specific arrangements in each area may vary significantly, each of these strands should be evident in every case. CHPs should consider identifying an individual within the team with a specific role to have an overview of the range of services and options available which support children's and young people's mental health.

Learning disability and autistic spectrum disorders

2.17The same as you?³⁷, the report of the national review of services for people with learning disabilities, was published in May 2000. A key objective of its implementation is for mainstream services to meet the needs of children, young people and adults with learning disabilities and/or autistic spectrum disorders wherever possible, supported by specialist services for those who need them. Policy and practice developments for all children and young people should, therefore, consider and address the needs of these children too.

2.18 The Public Health Institute of Scotland (now NHS Health Scotland) needs assessment reports on autistic spectrum disorders ³⁸ and learning disability ³⁹ explore the ways in which the health care needs of these client groups can differ from those of the rest of the population, and identify the need for appropriate interventions for co-morbid conditions, such as mental health problems. They also highlight the need for multi-agency approaches in providing appropriate health care.

Mental Health (Care and Treatment) (Scotland) Act 2003

2.19 The Mental Health (Care and Treatment) (Scotland) Act 2003 ⁴⁰ makes a range of provisions to secure benefits for, and protect the rights of, people with mental disorder. "Mental disorder" is defined in the Act as including any mental illness, personality disorder or learning disability, however manifested. The Act's primary objective is to make sure that people with mental disorder receive effective care and treatment. This relates to all people with mental disorder, including children and young people.

2.20 The Act also makes some provisions to protect the specific interests of children and young people. Under section 2 of the Act, accommodation, care and treatment should be provided which best secures the welfare of the child. In addition, section 23 of the Act places a duty on NHS Boards to ensure that, on those occasions when a child or young person under the age of 18 years requires psychiatric inpatient treatment, this is provided in a way that is appropriate to the particular needs of the child or young person. Section 278 of the Act introduces a duty to consider and minimise any potential harm to child-parent relationships where either child or parent is subject to any provisions under the Act or the Criminal Procedure (Scotland) Act 1995.

2.21 Section 26 of the Act places new duties on local authorities to provide or secure the provision of "services which are designed to promote the wellbeing and social development" of people who have or have had a mental disorder. These services should include:

• Social, cultural and recreational activities
• Training, for people over school age
• Assistance in gaining employment, for people over school age

2.22 The Framework endorses the principles of section 26, and in particular, the importance of social, cultural and recreational activities in promoting mental health and wellbeing for all children and young people.

2.23NHS Boards and local authorities have been asked to work with other partners to prepare Joint Local Implementation Plans to ensure that measures are in place to meet the requirements of the new Act from October 2005. Joint management, joint resourcing and joint delivery are intended to be at the heart of this.

2.24 HeadsUpScotland ⁴¹ is the national project for children's and young people's mental health in Scotland, and is part of the National Programme for Improving Mental Health and Wellbeing. It was established in April 2004 to contribute to the range of activity already underway in Scotland to improve the mental health and wellbeing of children and young people. The project's key aim is to support the SNAP report implementation process. Its main activities are to:

• Ensure involvement of children, young people, parents and carers
• Develop and deliver guidance to support local work to improve the mental health of children and young people
• Develop and strengthen partnerships to improve the infrastructure for children's and young people's mental health
• Develop and improve the capacity of the workforce to support more appropriate interventions

2.25 The project aims to facilitate the integration of children's and young people's mental health and wellbeing as a mainstream issue, by supporting local areas in their work. Existing structures, organisations and individuals will, in the main, be the methods through which the project will deliver its aims. This Framework is the first important step in taking this forward.

2.26 One of the functions of the project is to highlight recurring systemic issues and seek to facilitate resolution at a strategic level. The project will therefore:

• Be a central point which provides vision and energy for the future of children's and young people's mental health in Scotland
• Provide a leadership and co-ordination role to support the establishment/consolidation of structures for "mainstreaming" mental health by encouraging and supporting local leaders
• Make a major contribution to the available capacity to support the mental health agenda for children and young people

UK-wide policy developments

2.27 The Department of Health and the Department for Education and Skills in England have published a National Service Framework for Children, Young People and Maternity Services⁴². This includes standards on:

• Promoting health and wellbeing, identifying needs and intervening early (Standard 1)
• Supporting parenting (Standard 2)
• Child, young person and family centred services (Standard 3)
• Growing up into adulthood (Standard 4)
• Safeguarding and promoting the welfare of children and young people (Standard 5)
• Children and young people who are ill (Standard 6)
• Children in hospital (Standard 7)
• Disabled children and young people, and those with complex health needs (Standard 8)
• The mental health and psychological wellbeing of children and young people (Standard 9)
• Medicines for children and young people (Standard 10)
• Maternity services (Standard 11)

2.28 The Welsh Assembly has also published a draft Service Framework for Children and Young People and Maternity Services in Wales⁴³ for consultation.

2.29 Both the English and Welsh framework documents offer helpful guidance, which in many respects would also be applicable in Scotland. Both documents have been considered in the development of this Framework.