Child and Adolescent Psychotherapy in an Unequal World

The Association of Child Psychotherapists has been working to improve the mental health of children and families since 1949. On World Mental Health Day 2021 the world of children and young people is very different to what it was 72 years ago. This blog looks at what Child and Adolescent Psychotherapists are doing to adapt to changes in society and to best meet the mental health needs of the populations we serve.

An unequal world leads to poor mental health

The theme for World Mental Health Day 2021 is 'Mental Health in an Unequal World'. The ACP is a UK-based organisation, accredited by the Professional Standards Authority, but we do have members living and working across the world, in South Africa for example. Our Journal of Child Psychotherapy has a wide international reach. However, we know that major inequalities exist even in prosperous countries such as the UK. The Marmot Review 2020[1] showed that the social factors that lead to poor mental health, such as lower educational attainment, low-quality employment, poverty and income inequality, are persisting or getting worse.

Acting early to make a difference

Marmot also identifies the scientific consensus that giving every child the best possible start will generate the greatest societal and mental health benefits. Taking action to improve the conditions of daily life from before birth, during early childhood, at school age and during family building provides opportunities to improve population mental health and reduce the risk of mental disorders that are associated with social inequalities. There is compelling evidence[2] that the period from pregnancy and the first two years of a child's life lays the foundation for every child’s future health, wellbeing, learning and potential.

Child and Adolescent Psychotherapists bring their expertise in early social and emotional life to direct work with infants and families. They also offer training and supervision to a wide range of professionals and agencies in the early years' field. Therapeutic interventions at this early stage are often highly effective[3] and can reduce the likelihood of problems becoming chronic, and far more difficult and expensive to address.

Providing treatment when problems escalate

But we also know that, often due to the impact of our unequal world, family relationships can break down and parents can suffer from mental health problems and addictions. Children may be taken into care because they have suffered abuse or neglect. An important part of the work of Child and Adolescent Psychotherapists is with children and young people who are looked after and have suffered trauma and other adverse childhood experiences. This includes refugee children.

Where the difficulties of children are not sufficiently addressed this can result in the development of severe, complex and enduring mental health problems. These can put young people at risk of self-harm and attempted suicide. As well as the terrible effects on the individual and their families, high-risk adolescents can use a lot of healthcare resources. The availability of regular psychotherapy sessions provides depressed and self-harming children and young people with a containing structure for their very intense emotions, meaning they are less likely to lean heavily on other services.

Changing as the world changes

These are some of the areas where members of the ACP work across the health, social care, education and justice sectors. The ACP’s commitment to public service was consolidated in the 1970s when child and adolescent psychotherapy became a core profession within the NHS. Since then we have continued to develop and adapt our practice to meet the changing needs of children and young people, and the society they live in.

Over the last year, we have entered a new phase of growth and change as we align ourselves to the ambitions and priorities of public services. Mental illness in children and young people is recognised as a major public health concern with evidence of rising prevalence, exacerbated by COVID-19[4]. The NHS in all parts of the UK has committed to additional funding for child and adolescent mental health with ambitions to develop comprehensive multi-disciplinary services through an expanded and more diverse workforce.

Addressing unequal access to services

The provision of child and adolescent psychotherapy in the UK is significantly unequal with disparities across English regions and the devolved nations. The NHS long-term plan aims to create a sustainable workforce of Child and Adolescent Psychotherapists that is both equitably spread across the country and representative of the diversity of the communities it serves.

In England, support from NHS England and Health Education England has led to a 25% year-on-year increase in child and adolescent psychotherapy training places.  In Northern Ireland, Wales and Scotland we are working with colleagues to address areas that lack child and adolescent psychotherapy and increase access to training.

Improving equality and increasing diversity

As well as geographic differences, the ACP is working to address the unequal representation of Black, Asian and minority ethnic communities in the profession. Funding has been provided to the child and adolescent psychotherapy training schools to offer bursaries as part of an equality, diversity and inclusion programme. This is an opportunity to become a multi-cultural profession that meets the needs of all those who seek our services. Our work takes places within a social context where racism, anti-Semitism, or discrimination related to sexuality, gender and other aspects of identity, interact with and exacerbate socio-economic inequalities.

Looking above and below the surface

As Child and Adolescent Psychotherapists we approach all our work from a psychoanalytic perspective which seeks to look beneath the surface of difficult emotions, behaviours and relationships to help children, adolescents and their families to understand themselves and their problems. Increasingly, this must include the effects of an unequal world.