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What really matters in children and young people’s mental health

The mental health and well-being of children and young people has never been of greater concern. Nearly every day a new story breaks: concerns about rising levels of self-harm, eating disorders and depression; concerns from head teachers that schools are struggling to support pupils with mental health problems and are unable to access advice; difficulties in accessing mental healthcare; and fears that the internet acts as a malign force in children’s lives. Perhaps of greatest concern,
however, is the fact that these challenges have persisted despite a series of national reports highlighting the problems and offering well-considered solutions: ‘Just one more report and we’ll get it right’, seems to have been the strategy.

Over the past 5 years major reports from England, Wales, Northern Ireland and Scotland have catalogued concerns and suggested solutions. A little further back, the National Service Framework for Children, Young People and Maternity Services (Department of Health, 2004) set out solutions to many of the same problems. Reports on child welfare and protection have highlighted similar issues.

An important theme that stands out from these reports is the need to consider services for children and young people with mental health problems within the wider system in and by which they are supported: families and communities, schools, health and social care, and the voluntary sector.

This was the key starting point for the Values- Based Child and Adolescent Mental Health System Commission. In taking a whole-system approach we wanted to explore and understand how different values might drive decision-making, behaviours and practice within and between the various components of this wider system.

This is the report of the Values-Based Child and Adolescent Mental Health System Commission. The Commission looked at the children and young people’s mental health system from many perspectives and recommends significant and far-reaching changes. The Commission was supported by the Dinwoodie Settlement, the Faculty of Child and Adolescent Psychiatry of the Royal College of Psychiatrists, the Children and Young People’s Mental Health Coalition and Young Minds.

The Commission aimed to look at the issues through a different lens. While the findings we set out here are broadly consistent with those of our predecessors,
we have adopted an explicitly values-based approach to the issues. In doing so, we have sought to build on earlier reports by considering how a values- based approach can help to achieve our shared aspiration – improvements in the mental health and well-being of children and young people. It is hoped that our recommendations will help to bridge the gap between the challenges consistently identified by other reports, and successful realisation of their recommended actions.

A key challenge for anyone working in contemporary health and social care provision is ‘initiative fatigue’. It seems there is always someone eager to urge us to adopt this or that new approach, with the implication that everything that has been done to date has at best been imperfect, if not wrong altogether. By contrast, values-based practice in the model adopted by the Commission is about empowering both service providers and service users to understand and build on their own and others’ good practice.

The Commission took as its starting point a recognition that tensions within and between stakeholders arise in part, but very importantly, from differences in the values inherent in their working processes and approach. To address these, the Commission drew on the resources of values-based practice.