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Children and Young People's Mental Health: A Framework for Promotion, Prevention and Care

2. POLICY CONTEXT

2.1 The Framework should be considered within the context of a range of other 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 an action plan for health improvement, Improving Health in Scotland - The Challenge⁸, which includes a focus on intervention in the early years and at points of teenage transition.
• Achieve seamless and more effective support for children, young people and their families through implementation of For Scotland's Children⁹ and the Integrated Early Years Strategy¹⁰.
• Support delivery of integrated children's services through national roll-out of Integrated Community Schools, with every school becoming a Health Promoting School by 2007, supported by implementation of A Scottish Framework for Nursing in Schools¹¹.
• Redesign assessment and support for children through implementation of the Education (Additional Support for Learning) (Scotland) Act 2004¹².
• Improve protection for children and young people at risk of abuse or neglect through a programme of child protection reform¹³, informed by It's everyone's job to make sure I'm alright¹⁴.

2.2 The Framework also links strongly with implementation of the fourth edition of Health for All Children¹⁵ (known as Hall4) in Scotland. Hall4 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. Hall4 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 has consulted on draft guidance¹⁶ to support implementation of Hall4 and will be publishing finalised guidance by the end of 2004.

Mental Health (Care and Treatment) Scotland Act 2003

2.3 The Mental Health (Care and Treatment) Scotland Act 2003¹⁷ 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.

2.4 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.

2.5 NHS 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 April 2005. Joint management, joint resourcing and joint delivery are intended to be at the heart of this.

Integrated Children's Services Planning

2.6 The Scottish Executive has published new guidance for the preparation of integrated children's services plans¹⁸. 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.

Integrated Assessment Framework

2.7 The Scottish Executive will shortly be consulting on a draft Integrated Assessment Framework for Scotland's Children. 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 other needs which require assessment and support from a range of different services and agencies. The Integrated Assessment Framework is intended to ensure the consistency and quality of assessments by introducing a common structure for assessing the needs of children and young people.

2.8 The aim of the Integrated Assessment Framework is to 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. Core information collected for all children will connect with specialist assessments necessary to meet the needs of those children and families requiring additional support. The Framework 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.

Community Health Partnerships

2.9 This 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 inequalities¹⁹. Guidance on the establishment of CHPs, for example in relation to mental health services²⁰, 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.

2.10 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; and
• "vertical" integration with specialist mental health services, through local, regional and, where necessary, national networks of service.

2.11 Whilst specific arrangements developed in each area may vary significantly, each of these strands should be evident in every case.

The National Project for Children & Young People's Mental Health

2.12 HeadsUp Scotland, the national project for children and young people's mental health, is part of the National Programme for improving Mental Health and Wellbeing²¹. It was established by the Scottish Executive 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 and young people's mental health.
• Develop and improve the capacity of the workforce to support more appropriate interventions.

2.13 The Project aims to facilitate the integration of children 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.

2.14 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 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

2.15 The Department of Health and the Department for Education and Skills in England have recently published a National Service Framework for Children, Young People and Maternity Services²². 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)

2.16 The Welsh Assembly has also published a draft Service Framework for Children and Young People and Maternity Services in Wales²³ for consultation.

2.17 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.

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