Its time to stop mopping and turn down the taps – taking prevention seriously in child mental health

There is a well-used analogy for health systems that are under pressure due to high demand as being like 'overflowing sinks' (Burkitt & Trowell, 1981).

In the terms of this metaphor ill health is like the water cascading out of the sink onto the floor, and although all our energy and resources may go into trying to mop the floor more effectively the water still keeps pouring.

The well documented crisis in mental health services for children and young people in this country, coupled with the lack of financial resources, has led to many different strategies to try to improve this "mopping".

One of the latest strategies is the plan to increase the availability of psychological therapies through new training programmes for therapists and improving the availability of therapy to individuals, families and groups.

However, increasing efficiency, effectiveness and availability, whilst valuable in themselves, will not change the rate of flow, a flow which represents high levels of distress and suffering in our children and young people, with long term consequences for them and for our society.

So, should we not be investing in supporting families and nurturing young people in order to prevent that distress?

Ultimately more effective solutions come when the system works at preventing these problems from starting in the first place - by 'turning down the taps'.

However, 'turning down the taps' does not mean denying help to those in need, or leaving them until the difficulties have become entrenched and complex (as so often happens now in our over stretched services), but it does mean reducing the demand for services by working to keep children and young people healthy and by focussing on the risk factors that lead to psychological problems

In recent years we have learnt a great deal about the risk factors which contribute to the development of psychological difficulties, and about the protective factors which help build resilience and psychological wellbeing.

But, despite the research evidence, most policy making and commissioning still seems to proceed by applying models of individualised therapeutic work once problems have developed.

Prevention is better than cure however, and reducing demand can be best achieved by investing in primary prevention - for example interventions that address poverty and social inequality, social isolation and bullying, trauma and maltreatment - health promotion, for example in schools or maternity settings -  and early intervention.

Community psychology can also be extremely beneficial, by encouraging whole communities to shape their own environments to be psychologically safe, building resilience and promoting healthy lifestyles for children and young people, and ultimately leading to better and sustained psychological wellbeing.

In our recent publication "What good could look like in integrated psychological services for children, young people and their families: preliminary guidance and examples of practice", we argue that we need to rethink psychological services to better nurture our children and to improve their emotional health and wellbeing. This will require changes and transformations to provisions that are focused on integration and prevention.

The publication also addresses issues of capacity and argues for new ways of thinking about how we can develop the potential of those people closest to children – their families, their teachers, and their local communities – so as to further support their psychological development.

It seems like a daunting task, especially when everyone connected to the child mental health agenda is operating under unreasonable pressures, yet we have already found places where integrated preventative services are being developed and have identified a range of existing resources which can be used.

We hope these can serve as both inspiration and practical guidance and that more people will help us reduce the need for mopping by turning down the taps.

Find out more about Place2Be and the importance of children's mental health.

About the author

Julia Faulconbridge is a Consultant Clinical Psychologist who works primarily with children and young people.

As a Chartered Member of the BPS she acts as the Child Lead for the Division of Clinical Psychology, and has previously served as Chair for the Faculty of Children, Young People, and their Families.