70 years on: Looking forward with hope for young people's mental health

Anna Freud ©Freud Museum London

In 2022, here are five reasons to be cautiously hopeful about the future of young people’s mental health:

1. Schools are now aware of the problem

Young people’s mental health is firmly on the agenda of schools, with a clear recognition that they play a pivotal role in providing support. Working closely with the Centre’s Schools Division, Jess Deighton (Director of Applied Research and Evaluation) remembers a different attitude from schools at the beginning of her career 15 years ago. “I think the school culture was really different at that point,” she says. “There was a sense that quite a few school staff felt mental health wasn’t their remit – that they were there to teach and mental health went on elsewhere. They felt there were specialists for this kind of thing, it wasn’t part of what they should be thinking about. That view is much rarer these days. On the whole, schools are much keener to support the mental health of their students now.”

2. There’s more legislation and training

With better recognition of the scale of the problem, there has been a drive to develop legislation and training that supports young people’s mental health. In 2017, the Government published its green paper, Transforming children and young people’s mental health provision. “This was really encouraging,” says Jaime Smith, Director of the Schools Division. “The Government has started to put mental health and wellbeing at the heart of education policy. The green paper recommended that every school have a Senior Mental Health Lead, who will implement a whole school approach to mental health across their setting. We’re delivering this DfE funded training and see huge uptake.”

Andrea King, Director of the Clinical Division, agrees: “We’re now really seeing children’s mental health as a strategic national priority. We’re seeing that reflected both in policy and in funding.” This is a move in the right direction, but there is still some way to go. Jaime Smith adds: “At present, it’s not mandatory to have a Senior Mental Health Lead, and they’re often not given any extra time or resources for the role. For our schools to be mentally healthy, I would also like to see mental health content in initial teacher training and ongoing CPD for education professionals. This is not about teachers being mental health professionals, absolutely not. It’s about having basic knowledge, mental health literacy. Spotting signs and symptoms, and knowing how to start a conversation.”

3. It will become easier to access support and treatment

To avoid pressure on school staff to become mental health professionals themselves, they need to be able to refer young people quickly and easily to the appropriate services. A potential solution is Educational Mental Health Practitioners (EMHPs). These professionals are part of a new workforce – partly trained at the Centre – sitting within Mental Health Support Teams in schools. They conduct one-to-one and group work with young people who have mild to moderate problems, particularly anxiety, low mood and some behavioural difficulties. They can provide a bridge between education and mental health professionals. However, it has been acknowledged that it will take years to embed these teams in schools across the country.

Beyond schools, there is a similar drive to train more people to support those with milder mental health difficulties. “What works often doesn’t need someone to have a PhD or to be a clinical psychologist,” says Peter Fonagy, the Centre’s Chief Executive. “Actually, it’s much, much simpler than that. It’s really about making interventions that are evidence-informed, are based on good psychology, behavioural science and neuroscience, and that are accessible to the broadest group who are in routine contact with young people. It’s about translating down the essence of what is effective.” So far, the evidence is promising. Child Wellbeing Practitioners, who have the equivalent of six months’ training, are effective at treating mild to moderate anxiety, low mood and behavioural difficulties¹.

4. Research is focusing more on prevention

An ambitious research agenda is starting to gather pace: that one day we might be able to prevent mental health problems before they begin. To do this, we need to understand what increases the risk of mental health problems – and a key example is trauma.

“Historically, we have tended to wait until mental health problems emerge before we offer support and help,” says Eamon McCrory, Director of Education and Training. “That needs to change. Childhood abuse and neglect are the biggest environmental risk factors for mental health problems. Brain imaging research has shown that, following adverse experiences, it’s possible to identify what we call ‘latent markers of vulnerability’ – changes in the brain that can increase risk of mental health problems, even many years later.” Work is now underway to understand exactly how these brain changes increase risk, including how they impact social relationships, so young people at risk can be better supported.

5. Co-production is fast gaining momentum

Co-production is a way of working that involves individuals with lived experience collaborating with those across services and disciplines, with the goal of improving the quality and effectiveness of what they do. As is often said by those involved in co-production, ‘Nothing about us without us.’ As the co-production movement gains momentum, and all sectors and disciplines recognise its credibility and importance, the hope is that more young people, parents and carers will contribute and be heard.

It’s particularly important to hear the voices of vulnerable young people who are disproportionately affected by mental health problems. Andrea King explains: “We need to hear from children living in poverty, children with the whole suite of protected characteristics who are experiencing exclusion and harm in wider society. We also need to hear from those for whom mainstream school is just not working, and children who are neurodiverse.” Current approaches often fail to support these young people, and co-production can help. In terms of research, Eamon McCrory adds: “This really involves researchers and young people working together to create forms of help that are accessible and non-stigmatising, that meaningfully address young people’s needs. This is key if we are to avoid self-selection and drop-out, which continue to be a real problem and challenge.”

As the Anna Freud Centre takes stock after 70 years, it is helpful to look to the future. But clearly, the signs of cautious hope need to be translated urgently into better practice on the ground. There are many young people and families who continue to suffer right now, and who need help much faster than they will get it. In schools, clinics, communities and research labs, we need to push hard for more money, legislation and support.

Anna Freud herself pioneered the approach that, to support children’s mental health, we must recognise and respond to each individual’s developmental needs – that a child doesn’t grow out of their problems, but they grow with and through them. Her vision drives our work today, and will do so in the years to come.

¹Fuggle, P., & Kurina, A. (2021). Clinical Outcomes for the Education Mental Health Practitioner (EMHP) Programme for Children, Young People and their Parents/Carers: Update Report April 2021. London: Anna Freud National Centre for Children and Families.