Early behavioural problems are still not widely recognised as a marker for poor mental health

Lorraine Khan, Associate Director, Children and Young People Programme

The Children and Young People’s Health Outcomes Forum has published its report to the Department of Health setting out the standards services in England should meet.

The report has much to recommend it. It advocates early intervention and a life course and holistic approach for children. Children and parents’ voices have been central to its development, rather than outcomes being shaped by professionals and the systems that they work in. It recognises that poor mental health is a significant impairment in a child’s life chances and that a range of health, social and educational partners play crucial roles in supporting improvements to wellbeing.

The report includes a commitment to integrate information systems across agencies as well as improving and tracking children’s progress across five year age bands as they mature, to support evaluation of children’s progress against international comparators. It also recognises the importance of tracking the proportion of mothers with mental health problems, including postnatal depression, in order to support improvement in child mental health.

However, some important areas are under developed in this outcome framework. There is insufficient acknowledgment in the framework itself, in the outcomes and in most of the supporting documents, of the significance of early severe behavioural (or conduct) problems as a marker for poor future outcomes. Early starting behavioural problems are still not widely recognised as a marker for poor mental health and severely compromised life chances.  We would like to see routine tracking of all children’s behaviour not just via early developmental pre-school tests but also during other key educational transitional stages (such as key stage 1-2 and transfer to secondary school using a validated tool such as the Strengths and Difficulties Questionnaire (SDQ). Using this, we would like to see a reduction in the numbers scoring in the top 20% of the SDQ (and particularly the top 5% meeting the criteria for mental health diagnosis), and an increase in the numbers of evidence-based parenting programmes made available for parents in the top 20% and 5% brackets.

There is now clear evidence that well implemented evidence-based parenting interventions have the potential to support improvements in children’s behavioural problems through helping parents with positive parenting techniques. Yet the importance of these evidence based interventions, and how well they are implemented, is overlooked in this document. The Centre is publishing a report later this year that will examine these issues in greater detail.

While the forum recognises the important part played by agencies other then the NHS in helping achieve improved health outcomes for children, there is little mention of the importance of local authority early years and parenting teams or of the voluntary sector. There is also only passing mention of school commissioning which is vital to the delivery of improved mental health outcomes for children. Most parents with children with very early mental health problems (i.e. severe behavioural problems) do not present to the NHS, but present in schools seeking help and advice. The framework should therefore measure how long people wait for support from wherever they have sought it, not from the point they make contact with health services.

The forum’s report can be found here: http://www.dh.gov.uk/health/2012/07/cyp-report/