Counselling Services For Young People


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Counselling Services For Young People

  1. 1. highlight no. 239 Counselling services for young people Introduction Promoting the mental health and emotional well-being of individual, in terms of prolonged ill health and poor adult children and young people in the UK is a key aim of the outcomes, and for society in terms of costs related to health current national policy agenda. In recent years, this has been services, social care and the criminal justice system.1,5 For marked by an increased interest in the use of psychological young people in particular, mental well-being affects both therapies and in how to improve access to such educational attainment and stability in relationships with interventions. others, both of which are essential foundations for a healthy and happy adult life. Costs to society were the central theme Psychological therapies are known to be effective for of a report by Layard in 2004, which described mental treating many mental health conditions and are preferable health as ‘Britain’s biggest social problem’ and called for a to drug treatments for people under the age of 18.1 significant expansion in provision of psychological They cover many different ways of working including therapies, noting that: psychodynamic, art-based, drama-based, group analysis and systemic approaches.2 ‘Patients’ biggest complaint of the service is the lack of psychological therapy, and partly for this reason there is Counselling, which can fall within any one of these more discontent about mental health services than almost approaches, is recognised by the Department of Health any other aspect of the NHS’.6 (DH) as a form of psychological therapy, and accepted as a therapeutic approach in the range of interventions for Policy context children and adolescents. With evidence of its effectiveness with anxiety and depression, the Department’s report The current policy context is supportive of the development Treatment Choices in Psychological Therapies and of counselling services for young people. In England, such Counselling gives the following definition: policy includes: Youth Matters, the youth green paper,7 Youth Matters Next Steps8 and guidance for the ‘a form of psychological therapy that gives individuals an development of Targeted Youth Support,9 all of which are opportunity to explore, discover and clarify ways of living closely connected to the cross-governmental children’s more resourcefully, with a greater sense of well-being. services strategy, Every Child Matters (ECM), and indeed Counsellors practice within the… therapeutic approaches… can be seen as vehicles through which the five outcomes of (for example) CBT, humanistic, art therapy, existential, the ECM programme will be delivered.10 drama therapy, personal construct and interpersonal therapy…’.3 Cross-cutting these, is the National Service Framework (NSF) for Children, Young People and Maternity Services11 A further definition, given by Youth Access specifically in and in the education arena, policy initiatives such as relation to counselling for young people, is as follows: National Healthy Schools, extended schools and the ‘an activity voluntarily entered into by a young person who Targeted Mental Health in Schools project (TMHS).12 These wants to explore and understand issues in their lives, which initiatives provide a clear platform for extending and may be causing difficulty, pain and/or confusion. The developing the range of support interventions, including boundaries of the relationship are identified and an explicit counselling, to be offered to young people in education. contract agreed between the young person and the The commissioning of counselling provision is also counsellor. The aim is to assist the young person to achieve congruent with various commissioning frameworks that a greater understanding of themselves… to create a greater have been issued recently by the DH. These include the Joint awareness of their personal resources and of their ability to Planning and Commissioning Framework for Children, affect and cope with their life’.4 Young People and Maternity Services,13 which emphasises Alongside the recognition of the importance of joined up provision, early intervention and prevention. The psychological therapies, it is apparent that the availability of work of the DH’s Third Sector Partnership Team and the this provision is limited on the NHS, with wait times of over Third Sector Commissioning Task Force add further a year being commonplace.1 support. The ‘third sector’ can be described as the range of organisations that sit between the State and the private The costs of not offering appropriate and timely mental sector including small local community and voluntary health interventions are considerable both for the
  2. 2. highlight no. 239 groups, small and large charities, and a growing number of Youth Information, Advice, Counselling and Support social enterprises and cooperatives. Services (YIACS) are the largest provider of young people’s counselling services across the UK. Often operating from Specifically in the field of mental health services for young people, the planning framework Improvement, Expansion high street-based premises, and based on the ‘under one and Reform14 gave considerable impetus to the development roof’ or ‘one-stop’ model, these services provide free of new services. This set out the expectation that so called counselling via many different routes for young people aged ‘comprehensive’ Child and Adolescent Mental Health 13 to 25 years. Services (CAMHS) would be available in all areas of the Findings from a survey commissioned by Youth Access in country by 2006. It was acknowledged that this did not 2005 as part of the a2c Project provide a comprehensive mean that all services would be in their final configuration picture of the counselling offered by YIACS.17 (a2c, Access or available in every locality by that date. However, where to Counselling, is a DH funded project which aimed to local provision is: improve young people’s access to mental health services by ‘not appropriate or possible, commissioners will need to set enabling voluntary and community sector counselling out the collaborative arrangements that will ensure that organisations to be integrated into the strategic planning there is an agreed pathway to meet the specific needs from and commissioning of local services). The current an alternative service; i.e. a clear and comprehensive limitations in counselling provision were highlighted – in network of services’.15 some parts of the country, YIACS are working effectively on a partnership basis with CAMHS, whilst in others Voluntary and youth sector counselling services for young relationships are either non-existent or very limited. Fifty people can play a crucial role in ensuring a continuum of three per cent of the survey respondents reported that services from the community primary care level through to there were: more specialist mental health services, and with an emphasis on acceptability, availability and easy access. ‘young people in their area not able to access counselling services either because no provision is available or because The NSF,11 published in 2004, is a ten-year programme for of factors such as location, opening times, counsellor improvement in children’s health and well-being. Its key aim capacity, lack of outreach, funding boundaries’. is to achieve a situation where: The survey revealed considerable variations in the size and ‘multi-agency services, working in partnership, promote the structure of YIACS counselling services: mental health of all children and young people, provide early intervention and also meet the needs of children and • over two thirds of the counsellors work as volunteers/on young people with established or complex problems’.15 an unpaid basis The NSF links to, or can be seen as sitting within, the ECM • supervision and training is offered internally in some, programme. This endorses multi-agency and collaborative whereas in others, this is provided by external agencies approaches and calls for the improvement and integration of • 87 per cent of counsellors are trained at certificate, universal services. It also promotes the reconfiguration of services around the child, young person and family in one diploma, masters or other level; the remainder are place (i.e. the ‘one-stop’ model) and a shift from typically final year students on diploma and other intervention to prevention. recognised counselling courses Thirty Public Service Agreements (PSAs) were published as • the length of time counselling is offered varies from part of the government’s Comprehensive Spending Review periods of six weeks to over a year and in most services, 2007. PSA 12, to improve the health and well-being of follows an initial assessment session children and young people, sets out the government’s vision • 69 per cent use some form of counselling outcomes tool for improving the physical, mental and emotional health of (for example, the Clinical Outcomes Routine Evaluation all children for the next three years. One of the key tool (CORE), Teen CORE and YPs CORE or the Health indicators on which progress towards the vision will be of the Nation Outcome Scale for Children and monitored is improving emotional health and well-being, Adolescents (HoNOSCA)) and CAMHS. • user feedback is one of the frequently used tools for Counselling provision for young people - an measuring the effectiveness of counsellor’s practice. overview Self-referral and referral by GPs are the most common Voluntary sector provision is a key component in the routes into these counselling services. However, referrals on provision of counselling services for young people, with to, and from CAMHS appear to be growing. With regard to voluntary organisations increasingly involved in providing partnership working with CAMHS and other agencies, the in-school services (for example Place2Be) as well as survey findings revealed a very mixed picture of operating from their own community-based premises, where development. Just under 14 per cent of YIACS reported they typically focus on a slightly older age range.16 some form of contractual arrangement with their local
  3. 3. Counselling services for young people CAMHS – with an established or contractual relationship flexibility, providing a holistic and diverse range of interventions, being seen to benefit young people’s access to counselling and with a commitment to giving young people a choice, can and other mental health services – and 22.8 per cent successfully work alongside and complement CAMHS and reported receiving some funding from CAMHS to provide other public services for young people. It can also play a vital counselling. However, 39 per cent reported no or a limited role in engaging with young people who may not choose to relationship with CAMHS and cited factors such as a lack approach formal mental health services, and can improve of time and resources, and a more widespread lack of geographic access through the development of satellite services voluntary sector involvement, as barriers to the or the delivery of provision in other settings typically used by development of a working relationship with CAMHS. young people. In addition, a number highlighted a reliance on short-term Conclusion and one-off funding as hampering their ability to fully develop their services. Similarly, limitations in their The provision of counselling services for young people can administrative infrastructure had restricted their analysis make an important contribution to the policy agenda to and use of outcomes data, although this was being improve the mental health and emotional well-being of addressed, with the available data indicating positive children and young people. Hard ‘evidence’ in terms of outcomes. outcomes data specific to counselling for young people is limited, but growing. Overall, there is an increasing Different approaches in voluntary sector recognition of the importance of psychological therapies, and counselling services improving access to these therapies is a current DH initiative. The wide range of provision, the different therapeutic The ways in which these services are delivered appears to be interventions offered, and the flexibility in the ways voluntary a particularly important part of their success. Defining ‘good sector counselling services for young people are delivered, is practice’ in service provision is a complex task and definitions evident in a number of recent reports. In Commissioning abound. Maxwell, in a much cited work,19 suggested that the Counselling Services for Young People,16 a series of case studies quality of care could be measured by six dimensions: access to describes the array of provision, which includes: services; relevance to need (for the whole community); effectiveness (for the individual); equity; social acceptability; • extended opening hours including evening and weekend and efficiency and economy. opening Further support comes from the growing literature about • emergency counselling, brief/short-term counselling and what works in supporting children and young people with longer-term support mental health and emotional problems, and in promoting • satellite and mobile services well-being. This encompasses both the perspective of which • training and support for volunteers in listening skills, in peer treatment options bring positive individual clinical outcomes20 counselling, anger management, management of self-harm and increasingly, the perspective of young service users and in dealing with bullying themselves in terms of what services they find acceptable and are therefore more likely to use.21,22,23 Much of this • groups and individual work in local schools and other information highlights the importance of the style of delivery agencies such as Connexions, youth centres, YMCAs and of services. Young people want ready access and are easily community drug and alcohol services deterred by long wait times and complicated professional • advice and advocacy, sexual health advice, work with family referral routes. Furthermore, it lends considerable support to and relationship issues, work with bereavement, substance the ‘one-stop’ or ‘under-one-roof’ model - and the use of misuse advice and treatment informal, non-medical settings that are the trademark of many voluntary sector services including YIACS.3,24 • group-based post-counselling support Support to develop voluntary sector counselling services fits • telephone and text-messaging support especially well with the national policy agenda of addressing • fast tracking arrangements into CAMHS the needs of young people in the transition between childhood and adulthood since many services, most notably YIACS, • Primary Care Trust (PCT) and/or local CAMHS span the 13-25 age range. This is known to be a time when commissioned provision including psychotherapy and work serious mental health problems can emerge and various targeted on meeting the needs of young people from black reports, in the main focused on the 16-25 age range, have and minority ethnic communities. highlighted the considerable barriers to support that can face this age group. These include Breaking Down the Barriers,4 A similar diversity of provision is revealed in the report Listen Sidelined,25 Turned Upside Down26 and the report by the up! Person-centred approaches to help young people Social Exclusion Unit Transitions: Young Adults with experiencing mental health and emotional problems. 18 Both Complex Needs.27 The latter makes particular reference to the reports demonstrate how such provision, with a focus on ‘wide consensus amongst service providers’ as to the
  4. 4. highlight no. 239 Highlight No. 239 © National Children’s Bureau 2008. ISSN: 1365-9081. Highlights may be reproduced by NCB members for non-commercial circulation within their own organisation, subject to acknowledgement of source. Contact the Library for further information. National Children’s Bureau, 8 Wakley Street, London EC1V 7QE. Tel: 020 7843 6000. Fax: 020 7278 9512. beneficial effects of counselling for young people. It also notes for Children, Young People and Maternity Services. London: that the evidence that young adults benefit from counselling DfES. when they receive it, is supported by National Institute for 14. Department of Health (2002) Improvement, Expansion and Health and Clinical Excellence (NICE) guidance on the Reform. London: DH. treatment and management of depression.28 15. Department of Health (2004) Report on the Implementation of There is clearly recognition of the importance of counselling Standard 9 of the National Service Framework for Children, on a wide range of fronts. However, it is apparent that Young People and Maternity Services. London: DH. significant and more stable investment is needed if current geographic variations and service limitations are to be 16. Street, C (2007) Commissioning Counselling Services for addressed. Additionally, as the report We Need to Talk notes,1 Young People: A guide for commissioners. London: Youth more rigorous research, alongside the development of Access. inspection and audit structures, is needed if a situation is to be 17. Young, K (2006) Youth Access to Counselling (a2c) reached where much more is known about what works for YIACS/CAMHS Survey. Quorn: Harrington Young different groups of children, which will in turn support a Organisation Development Consultants. more strategic commissioning of counselling services for young people. 18. Garcia, I, Vasiliou, C and Penketh, K (2007) Listen Up? Person-centred approaches to help young people experiencing Dr Cathy Street mental health and emotional problems. London: Mental March 2008 Health Foundation. 19. Maxwell, RJ (1984) ‘Quality assessment in health’, British References Medical Journal, 288, 6428, 1470-1. 1. Bird, A (2007) We Need to Talk: The case for psychological 20. Fonagy, P and others (2002) What Works for Whom? A critical therapy on the NHS. London: Mental Health Foundation. review of treatments for children and adolescents. London: Guilford Press. 2. Department of Health (2004) Organising and Delivering Psychological Therapies. London: DH. 21. Street, C and Herts, B (2005) Putting Participaton into Practice: A guide for practitioners working in services to 3. Department of Health (2001) Treatment Choice in promote the mental health and well-being of children and Psychological Therapies and Counselling. London: DH. young people. London: Young Minds. 4. Wilson, C (2002) Breaking Down the Barriers. A strategy in 22. Kurtz, Z (2005) Minority Voices: A guide to good practice in development. London: Youth Access. planning and providing services for the mental health of black 5. Scott, S and others (2001) ‘Financial cost of social exclusion: and minority ethnic young people. London: Young Minds. follow-up study of antisocial children into adulthood’, British 23. Mumby, C (2001) Building User Involvement: A step-by-step Medical Journal, 323, 7306, 191-3. guide to involving users in youth information, advice, 6. Layard, R (2005) Mental Health: Britain’s biggest social counselling and support services. London: Youth Access. problem? 24. National Children’s Bureau (2005) Children and Young People’s Views on Health and Health Services: A review of the 7. Department for Education and Skills (2005) Youth Matters. evidence. London: NCB. London: TSO. 25. Howarth, C and Street, C (2000) Sidelined: Young adults’ 8. Department for Education and Skills (2006) Youth Matters: access to services. London: New Policy Institute. Next steps. London: DfES. 26. Smith, K and Leon, L (2001) Turned Upside Down: 9. Department for Education and Skills (2007)Targeted Youth Developing community-based crisis services for 16-25-year Support. London: DfES. olds experiencing a mental health crisis. London: Mental Health Foundation. 10. 27. Office of the Deputy Prime Minister (2005) Transitions: Young 11. Department of Health (2004) National Service Framework for adults with complex needs. London: ODPM. Children, Young People and Maternity Services. London: DH. 28. National Institute for Health and Clinical Excellence (2005) 12. Department for Children, Schools and Families (2008) Depression in Children and Young People: Identification and Targeted Mental Health in Schools Project. management in primary, community and secondary care. Clinical guideline 28. London: NICE. 13. Department for Education and Skills and Department of Health (2006) Joint Planning and Commissioning Framework