THE PANEL
Andy Bell, chief executive, Centre for Mental HealthAndy has been with Centre for Mental Health since 2002 and became chief executive in 2023. He has worked for more than 25 years in the voluntary sector, and was the driving force behind the Commission for Equality in Mental Health, established to investigate inequalities in mental health.
Will Snell, chief executive, Fairness FoundationAfter several years at the Department of Health and then the Department for International Development, Will left to set up a skills mentoring programme for entrepreneurs in Kenya. He joined Global Witness in May 2020, before becoming the founding ceo of the Fairness Foundation in April 2021.
Laura Bunt, chief executive, YoungMindsLaura joined YoungMinds in March 2023 after three years as deputy chief executive at With You, a national charity providing support to people experiencing issues with drugs, alcohol or mental health. She has skills in digital transformation, research and influencing, strategic design.
THE DEBATE
What does research tell us about the links between poverty and children’s mental wellbeing?
Andy Bell: We have looked extensively at why it is we’re seeing an increase in mental health difficulties among children and young people because it has been a very stark increase over the last decade. There are multiple causes but the one thing that’s become very clear is that poverty and financial difficulty are a major cause of mental distress among children and young people.
We’ve identified that poverty is a risk factor in and of itself, and the reasons for that are many and complex, but in some ways it is simply the stress, the anxiety, the day-to-day grind of living in poverty in a society where you can’t afford the basics and things you perceive everyone else has.
They wear away at your wellbeing, and that particularly seems to affect children, even where parents have done everything they can to shelter them children from the effects of poverty, it’s nonetheless there
Rising poverty and austerity have put more children at risk, and the sudden increase we saw in levels of diagnosable mental ill health and referrals to mental health services since 2020 would suggest that the pandemic and the lockdowns and school closures pushed a lot of children to the point where they needed help – but they were probably already vulnerable to that.
Will Snell: The Education Policy Institute did a literature review in 2018 which we’ve cited in our report in July on the key drivers of the disadvantaged gap. It’s a list of 25 or so different ways in which deprivation drives educational disadvantage. The first three or four, are physiological impacts of poverty on the development of the foetus, the levels of nutrition and stress of the mother, and whether or not the mother smokes, which has a link to poverty and deprivation. They all have a huge impact on the cognitive development of the unborn child.
There’s a litany of ways in which growing up in deprivation negatively impacts a child’s development, physically and mentally. All these impacts are multiplying and compounding over time, before the child has even entered preschool. So, it’s no surprise that when you look at the disadvantage gap in terms of educational attainment, that that’s already several months wide before children even start formal education.
It feels like there’s an obvious read across between educational attainment and both physical and mental wellbeing.
Can poverty undermine interventions designed to address mental health problems?
Andy Bell: I’m not sure we have the research that would tell us the answer to that. I would say that with good mental health support, children can recover and enjoy better mental health. That doesn’t take away the risk factors if you’re still living in poverty, in a home which is damp and mouldy, sharing a bedroom with two or three other kids and you don’t really have your own space to do your homework in. Mental health treatment can help you to cope with those things, but it can’t make those risk factors go away. That’s not to denigrate the importance of mental health support – no matter where a child is and where a young person is, if they need mental health support, then it should be available.
For young people and young adults particularly, support with practical issues – such as dealing with difficulties at school or college, getting started in a career, having enough money to live independently – is just as important as the therapeutic input.
Support for children and parents for their mental health is fundamentally important because it can at least mitigate the effects of poverty and financial difficulty.
One of the things we found in our recent research is the impact of benefit sanctions and the growing tightness of our social security system – which was designed to alleviate the stress of poverty, but, in some instances, is making it worse, because parents are being subject to assessments of whether they are disabled or not, which are sometimes demeaning, and wrong, particularly when it comes to mental health difficulties.
Laura Bunt: We’re seeing referrals into child and adolescent mental health services (CAMHS) going up every month and more young people referred into crisis care.
The system is really under pressure and we hear from young people and families waiting months, years sometimes, to get seen after having an assessment.
If you live in poverty that can create a barrier for young people being able to get support.
Young people from racialised backgrounds are also more likely to experience poverty. There’s a dual impact because often it’s young people in marginalised and racialised communities that face additional barriers to accessing mental health support, whether that’s through knowing where to go to get help or barriers in the system.
We hear from children and young people about whether CAMHS itself is fit for purpose. You may have six to eight cognitive behavioural therapy sessions you are entitled to and then treatment ends. That doesn’t really address the fundamental context that a young person is growing up in which we know materially impacts their mental health and wellbeing. We need interventions that address the drivers of the crisis in young people’s mental health rather than [just] treating the individual in terms of what they can do.
What specific measures from the government would tackle poverty and improve children’s mental health?
Will Snell: We are calling for three things: first, make sure you get cross government coordination right, so they are joining up the dots and not working on individual issues in policy silos.
Second, we need to raise more revenue and reduce levels of wealth inequality. The key way to achieve that is to start taxing wealth more. We saw some steps towards that in the Budget, but there is more the government can do to put a dent in wealth inequality. We can’t pretend we’re going to make any significant progress on improving children’s mental or physical wellbeing without getting rid of the two-child cap as a basic starting point. I’m hopeful that the [promised] child poverty strategy will not only look at that but conclude it’s a prerequisite for progress.
Third, we need regulatory levers that can help to break down barriers to opportunity outside of the education system. For example, ending no fault evictions and improving the quality, security and affordability within the private rented housing sector, alongside, investment in social housing, and moving away from homes as assets to homes as homes. We’ve also got the whole agenda around employment rights, low pay and secure work.
So, there’s a lot on the agenda that feels promising on trying to tackle some of those barriers, but there’s more to do. If we can make progress in those areas, that could have a significant impact on children’s mental health.
Laura Bunt: We need to be bolder around this agenda from the government. A report earlier this year used the phrase “dual crisis” to describe the need to tackle the young people’s mental health crisis alongside child poverty.
We need a social security system that prioritises the mental health of parents and carers and young people. If you are feeling constantly like you don’t have enough to live on in the current cost of living environment alongside the punitive approach to welfare, this can be damaging for mental health and create stress and pressure on families.
We need a system that gives families enough and recognises young people’s mental health is an economic priority, if not a social and ethical one. It makes financial sense to ensure that young people are provided for in their early years of life, and that poverty doesn’t hold young people back.
In terms of specific policies, we’d like to see the two-child benefit cap lifted – that would lift 500,000 children immediately out of poverty.
It’s essential that young people are able to get early access to support and are not waiting months and years, and that support is more holistic.
We need greater investment in young people’s mental health but we can’t treat our way out of the crisis – we need to address the fundamental issues that are driving the mental health crisis.
We’ll be advocating for an investment standard around children and young people’s mental health to ensure that CAMHS are funded appropriately and designed around the needs in the local area.
We also need a fundamental look at how the system shifts from analogue to digital, from hospital to community, and from treatment to prevention.
FURTHER READING
Special Report: Children’s Mental Health
link