The Failure To Deliver Quality Child Mental Health Services

Children and adolescents are failed not only by an underfunding of services  ( see The Guardian, Sunday  December 3rd) but by an aping of models based on IAPT for adults.

I have just seen a 10 year old who had 8 counselling sessions, completed a wide range of psychometric tests, mum was allowed to attend the first ‘assessment’ session. At the end of treatment the agency declared that he had made ‘excellent progress’ and the child thought treatment was ‘fine’. But the reality is that the only disorder he was suffering from before counselling was separation anxiety disorder, when I re-examined him with his mum after treatment there had been no significant change in his diagnostic status. He was happy to chat about anything other than being separated from mum. Inspection of the counselling notes  mentioned working on self-esteem, work with play dough and breathing techniques. Mum had felt excluded from treatment and reported his recent ‘melt down’ when she briefly lost him coming out of a cafe.

Unfortunately neither a diagnostic competence nor ensuring fidelity to an evidence based protocol figure anywhere in IAPT and when agencies ape it, it is no surprise that the results are very poor. Appointing a counsellor in every school sounds good in that the child does not have to go to a mental health establishment and teachers could act as reality checks that ‘treatment’ is making a difference.  But the ‘caseload’ and training remain to be determined. In principle working in a school gives the opportunity  for the counsellor to engage in preventative work, but we have no hard evidence that this works. Nobody it seems has yet addressed the question of the right balance between preventative work and treatment. I can foresee a situation in which the counsellor becomes overwhelmed by the volume of work and redefines their role in a Citizen’s Advice Bureau manner acting primarily as a signpost, doubtless labelled Step 2 making no real world difference

Dr Mike Scott

Leave a Reply