From We need to talk about Children's Mental Health
Throughout my twenty year career as a psychologist working in Specialist Children’s Mental Health Services (SCAMHS) two frequently repeated mantras have been amongst the biggest sources of frustration for me:
“It’s a social problem, not a mental disorder” and “the child needs to be stable to access therapy”; the latter often responded to with the helpless reply “but the child need’s therapy in order to be stable”. Indeed, much of the tension between Health and Social Care can be boiled down to these two themes.
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.... Adverse Childhood Experience’s (ACEs) evidence base provides a wake up call to radically overhaul how our services are designed. According to the ACE studies, what happens in our childhoods makes a difference to our mental and physical health, and impacts on the rest of our lives. Our environment and social context affects us in significant ways, and is inextricably linked with our physiology. The research is extensive and unequivocal, and amongst the most robust in the field of health and social care. As such it ‘trumps’ NICE guidelines for specific disorders which has been adopted as the primary domain of children’s mental health. The SCAMHS model has, historically, been developed along an adult mental health model of service provision which focuses on the individual, and relies on children engaging in the process and being supported by the adults in their life to achieve this. I will argue that clinic based, ‘within child’ models of service provision do not take into account the complexity of children’s lives; the impact of adverse childhood experiences, and the powerlessness of children to make changes in the systems that surround them.
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