How to improve children's mental health services - Sarah Brennan of YoungMinds

Children and young people's mental health services are too few, too poor and too stressed, causing untold suffering to children and their families. There are government inquiries, reviews and a new taskforce under way to address the issues, but what would services look like if they were working well?

Young people's mental health services would be embedded in the heart of communities. This doesn't mean ivory towers with big signs on the front of the building saying "mental health services" (we know how mental health stigma builds walls for young people who need help), but places that are young people-friendly, informal and welcoming.

They should be one-stop shops that offer other services like sexual health and youth services. Places where they can just walk in and not have to be referred by a doctor, where they don't feel intimidated and they wouldn't have to wait months for help. Places like the Well Centre in Streatham, a great example of a youth health centre that has drop-in counselling services for young people.

Services would be wide-ranging – some delivered as structured therapy, some peer-to-peer support or group work. There would also be a range of digital services, along with face-to-face support, helping young people to take care of themselves and reaching out to those who don't have the confidence to ask for it themselves.

At 18, if a young person needed to move on to adult services, this would be simple – there would be no more falling off the edge of the "transition cliff" as is now a common occurrence. Children and teenagers need very different services, so support would be age-appropriate – neither patronising to teenagers or overly complex for children.

If children and young people are suffering from serious mental health problems, community outreach teams would be by their side to support them. Sussex children and young people's mental health services run an urgent help team – experienced mental health workers who support young people in crisis and their families, whether in the community or on an inpatient basis near their homes. This kind of model is very successful: there is evidence that early intervention when a mental health crisis first occurs reduces the severity of the illness and the improves the ability of young people and their families to manage it.

Schools should adopt whole-school approaches to building emotional resilience – everyone from the dinner ladies to the headteacher needs to understand how to help young people to cope with what the modern world throws at them. Preventing mental health problems arising in young people is just as vital as acting swiftly when they arise. Schools should also pay for mental health services to be available to all pupils if they need them. Working closely together with other schools and healthcare services would mean streamlined support and reduce silo working.

When children and young people are in distress, it is also a difficult time for parents and carers, who can feel guilty, powerless and overwhelmed. They need places where they find out what they can do to support their children and get support themselves. The YoungMinds parents helpline takes thousands of calls each year from worried parents and careers – another example of a service that works.

Lastly, all of the above needs resources. Children and young people's mental health gets a paltry 6% of the NHS mental health budget. This derisory amount is simply not enough.

Sarah Brennan is chief executive of the charity YoungMinds. This article was originally published on The Guardian website.

Can online CBT overcome diabetes distress?

Diabetes distress is a term used to describe the sense of frustration, anger and disillusionment that can lead to a reduction in a person’s ability to manage the condition over time and this neglect can have serious implications for the person’s health.

Although diabetes distress is very common, it is often not recognised by Diabetes Nurse Specialists (DNSs) or GPs for a number of reasons.  Firstly, there is not enough time in an appointment to ask a patient how they are feeling or if they are coping; secondly, many DNSs have said that they feel ill-equipped to cope with the response.

Coming to terms with the implications of life with diabetes takes a considerable adjustment; symbolically it can be equated to being given care of a baby that is never going to grow up.  However, there is little psychological support available for adults newly diagnosed with this condition.

If low mood and depression are detected some are referred to the Improving Access to Psychological Therapy programme, but as the therapists are not medically trained they cannot integrate the psychological care with the diabetes care.  So there are few places for DNS to signpost patients for psychological support.

To address this PsychologyOnline has secured Small Business Research Initiative for Healthcare (SBRI Healthcare) funding to see how its approach to cognitive behaviourial therapy (CBT) can be used to treat diabetes distress.

The collaborative project aims to improve glycaemic control and psychological wellbeing through integrated care.  It is led by Ann Hayes, chairman of PsychologyOnline, alongside Professor Khalida Ismail, who leads the Diabetes and Mental Health clinical service at King's College Hospital and Bruce Hellman, founder of uMotif, a health and wellbeing app.

Previous research at KCH has shown that specially trained DNSs delivering face-to-face CBT can help patients improve their blood glucose management.  So Prof Ismail, a specialist in liaison psychiatry, is very interested in the potential for online CBT.

She says that around a third of patients have psychological issues interfering with their confidence to manage their diabetes: “Living with diabetes requires lifelong skills in calculating insulin doses and carbohydrate portions, taking into account physical activity. It is therefore understandable that some people may need psychological support from time to time to help them build their confidence towards effective blood glucose control.

“On the other hand, people with diabetes also have busy lives so trying to find the time and money to travel and attend face-to-face therapy sessions on top of the diabetes appointments is not always possible.

“I am very interested to investigate how online CBT integrated into usual diabetes care delivered by a specialist nurse can be used to provide an effective intervention.”

Online CBT is very effective at treating anxiety conditions such as those developed during diabetes distress and PsychologyOnline’s Thinkwell service is available without a GP referral.