Mental Health in Scotland: Closing the Gaps - Making a Difference: Commitment 13

Children and Young People

Many of the clients with mental health and dependency problems will live in families with children and young people. There will also be some very young parents. Some may be parents or relatives struggling to retain or regain safe care of their children. In many instances there may be additional and associated difficulties for children affected, for example to do with their needs for nurture, safety, health, and education. The impact of mental health and dependency problems on children should therefore be a priority consideration for all agencies in both the public and voluntary sector which provide services for adults and others with these problems, (Reference National Quality standards statement 10).

When there is effective integration of principles, policies and good practice in the delivery of care and support then affected children and family members will:

• know their assessed needs are being addressed;
• experience a co-ordinated, unified approach, which avoids multiple assessment and multiple meeting processes when this can be avoided;
• believe their views are being heard;
• have confidence in using services; and will
• know about the help available to them.

In all cases and especially when there are complex, long term problems, then clinicians, social workers and other professionals should take an holistic perspective - reflecting that no service will ever have the whole answer. Within the constraints of information sharing, children and their families and those who care for and about the children should usually be regarded as partners, and often as leaders in the shaping and resourcing of plans to meet children's needs. Children and young people should be appropriately and sensitively involved in decision making processes which affect them.

Integrated development of services for children affected by mental health and dependency problems may be supported by national policy on quality improvement for and evaluation of children's services; and also by national guidance on Integrated Children's Service Plans 2005-2008. This guidance provides advice for local authorities, NHS Boards and other planning partners (the Police, Scottish Children's Reporter Administration, Voluntary organisations, etc.) on preparing integrated Children's Services Plans covering the 3 year period from April 2005 to April 2008. The guidance is issued within the context of the obligations on Scottish Ministers and local agencies to promote and participate in Community Planning, as set out in the Local Government in Scotland Act 2003.

There is a significant training need to be addressed throughout agencies on the combined impact of parental substance use and mental health problems on children particularly given the poorer outcomes associated with some current interventions. Getting Our Priorities Right and Hidden Harm have led to a considerable development of training and change in attitudes and practice in child protection within substance misuse services working with adults and children. However Aberlour's Think Tank report, A Matter of Substance' identified that agencies tend to set higher thresholds in terms of intervening on children's behalf regarding the use of alcohol by parents than they do for drug use.

The Framework for Mental Health of Children and Young People identifies a need for development of specialist Child and Adolescent Mental Health Staff with expertise in substance misuse Training that addresses both needs, that uses common language and approaches, that is inter agency planned, funded, delivered and attended will help engender the joint approach needed for co-occurring mental health and substance misuse problems in young people. Multi-agency training encourages workers to share/compare their respective roles and promote networking and development of local protocols, particularly in respect of how to respond when children are affected.

It is likely that children living in families affected by mental health and dependency problems will have some sort of caring responsibility. NHS Boards are required to include measures to identify and support children and young people with caring responsibilities in their Carer Information Strategies.

There should be recognition of the impact of adult substance misuse on children and of young people's substance use within CAMHS policy and delivery strategies.

The Framework for Mental Health of Children and Young People offers an interesting diagram which is included for reference purposes. The diagram illustrates a continuum of services concerned with prevention, promotion and care.

Recommendation

6. Progress on this agenda will be monitored through the performance management of the published 2006 commitments and targets for mental health and the work strands associated with the commitments on child and adolescent mental health services.