MAC-UK responds to Government's Children and Young People's Mental Health Green Paper The UK government has launched a consultation on their proposals for provision of mental health support for children and young people. The core proposals involve incentivising schools to train a Designated Mental Health Lead who will oversee the school's approach to mental health and wellbeing; linking schools and colleges locally with specialist NHS services; and piloting reduced waiting times for NHS services for the children and young people who need specialist help. While MAC-UK welcomes the ambition for more accessible mental health provision through schools, we are concerned that these proposals do not meet the needs of excluded young people or address widespread health and social inequalities. At MAC-UK, we have worked to address the mental health inequalities of young people affected by serious youth violence in their communities and with other at-risk groups, such as care leavers and looked after children, for nearly 10 years. We have also worked alongside some of those young people to develop our response to this consultation. Response Young people were clear that the education system is not a place they felt valued or where their skills were valued. All said that they would be very unlikely to access therapy through school. They thought it was likely that the mental health leads and teams would quickly become a stigmatised service. This is especially true for young people from BAME communities, who are less likely to access conventional statutory therapy because current service offers are rarely culturally sensitive and in can reinforce stereotypes. (See the Up My Street report by the Centre for Mental Health about young African/Caribbean young men's experiences.) For example, young people affected by serious youth violence in their communities are at a much higher risk of experiencing psychological distress. They need reaching with the emphasis on engagement and relationships, through co-production and wrap around holistic support in their communities. They then can be supported in creating change to their social environments, as well as individual change (Durcan, Stubbs & Zlotowitz, 2017). Evidence There is clear, robust evidence that key determinants of mental health include “social, cultural, economic, political and environmental factors such as national policies, social protection, standards of living, working conditions and community support” (WHO, Purdie, Dudgeon and Walker, 2010). Poor mental health and low wellbeing are consistently strongly associated with social context factors, such as levels of unemployment and security of employment, inequality and low income (Melzer, Fryers and Jenkins, 2004; WHO 2014). By attending to wider life circumstances and conceptualizing an individual’s difficulties in social and environmental terms, practical support can be developed, which can lead to positive health outcomes (Smail 1994). Solutions We would like to see much more emphasis on the mental health inequalities of excluded young people and a transformation of the mental health offer for them. This would mean addressing their psychological distress through a wider choice of interventions to create social change, as well as individual therapy. This requires resources to work in partnership with community agencies for example, the voluntary sector, residential units and youth workers to co-produce solutions. MAC-UK’s multi-agency projects work hard to co-produce systemic change that reduce the risk factors in the social environment, as well as the individual. These solutions need appropriate and sustained resources. For this reason, much more of the resourcing needs to be put towards a community outreach offer from NHS specialist services, which is co-produced with young people and intervenes at the individual, peer group and community level, to prevent future adverse childhood experiences. You can read our full response to the CYP Mental Health Green Paper consultation, here. If you would like to hear more from MAC-UK about mental health policy or service design, consider signing up to our newsletter, below.