News

Brent Centre makes Green Paper submission to the Secretary of State

In the middle of the winter’s worst blizzard, the Brent Centre wrote to the Secretary of State regarding the government's recent Green Paper on young peoples’ mental health.

The response was written in response to concerns raised across the psychoanalysis field in the run-up to the final hours of the consultation deadline on March 2nd.

Here is our letter submitted as a result:

The Quick Read

Whilst the Brent Centre welcomes the government's renewed attention to youth mental health and supports the principle of early intervention, we also wish to raise several concerns regarding the content of the proposals. 

The main concerns expressed in the letter to Jeremy Hunt MP and Damian Hinds MP were that:

  1. Working with vulnerable young people in schools presents risks - especially when it comes to undiagnosed severe mental illness. The government must make sure of its priorities when trialling proposals which have the potential to backfire.
  2. Psychoanalysis has in the past been cited as impracticable due to ‘cost constraints’ when in fact, psychoanalysis is evolving with varying types of intervention including short-term. In an example of this, short-term interventions have been trialled and rolled out by the Brent Centre for Young People in 10 local schools, working with around 300 teenagers and children a year.
  3. Evidence demonstrating the efficacy of psychoanalysis and child psychoanalysis vis a vis other NHS modalities such as CBT / medication have so far been overlooked in the Green Paper research framework or proposals.

Most importantly, we felt it vital to emphasise the Brent Centre’s long experience with working with teenagers and mental health on the ground – five decades of working with up to 600 teenagers a year – which was recognized this year by receiving the International Association for Child Psychoanalysis’ Annual Award for Excellence.

This pioneering experience of work on the ground with teenagers in mental health is a ground-breaking clinical and research resource unparalleled in the UK, which the Brent Centre hopes the government will take note of.

 

 

 

Full letter text below:

 

Brent Centre response to Green Paper consultation on child and young people mental health                                                   

March 2018

To:

The Rt Hon Damian Hinds MP

Secretary of State for Education

MINISTERS@education.gov.uk

 

The Rt Hon Jeremy Hunt MP

Secretary of State for Health

mb-sofs@dh.gsi.gov.uk 

 

Dear Mr Hinds and Mr Hunt,

We are writing in response to the Green Paper consultation on young people’s mental health.

As an award-winning and highly-respected organisation working on the front-line in Brent, battling every day to save lives as the only organisation besides CAMHS to which suicidal teens are referred to in a crisis, we would like to draw your attention to the scientific evidence on the most effective treatment for those suffering from more severe mental illness.

We are concerned that the framework of research cited in the Green Paper does not sufficiently take into account the strong evidence basis that shows that psychotherapeutic and psychoanalytic interventions are more effective than other short-term-modalities, when dealing with severe mental health cases.

The Brent Centre is an essential part of the pipeline for saving lives every day on the front line in Brent, and as a professional body with over 50 years' experience, and with an internationally–recognized reputation, we feel it is essential to provide the 'voice of clinical experience' to the Green Paper consultation, as well as point out newly established research that highlights psychotherapeutic interventions as the most effective in the field of mental health.

The NHS relies on the Brent Centre for Young People, which sees over 600 young people a year, to save young lives daily. If a young person gets turned away from CAMHS as a young person aged 16-24, then suicidal teens are turned directly to us.  

The Brent Centre also works directly in ten local Brent primary and secondary schools with over 280 young people a year. So we remain reliant in practice on what works and research that demonstrates significant results.  To do otherwise would be to risk lives.

While there is no doubt that short term interventions by practitioners who have had limited training can successfully address some mental health conditions in children and young people, there are many whose conditions are too serious to be successfully treated in this way. Short-term interventions with short-term trained staff can include CBT, and can also include other varieties of approach, such as “mentalisation” therapy or training.

However, there also need to be services, whether in CAMHS or voluntary sector providers such as the Brent Centre, the Brandon Centre and Open Door in Haringey, which can offer treatment to young people with more deep-seated and intractable conditions (severe depression, acute anxiety, self-harm, anorexia, risks of suicide), for whom standardised packages of short-term interventions provided by inexperienced practitioners are not effective. At this point, psychoanalytic and psychodynamic interventions have to be focused on patients at the more severe end of the mental health spectrum, for whom more superficial treatments are often found to fail.

Research demonstrating psychotherapeutic and psychoanalytic interventions versus other modalities can be more effective in more severe mental health cases include: the large-scale 2016 IMPACT study of severe adolescent depression conducted by the University of Cambridge, UCL and the University of Manchester [1]- and the recent Tavistock Clinic Adult Depression (TADS) Study.[2]

Of particular note is the recent TADS study on adults which proved conclusively that long-term psychoanalytical therapy for long-term depression was significantly more effective compared with NHS treatment as usual (according to national guidelines). Patients got considerably better as a result of psychotherapeutic interventions, whilst those patients who underwent other modalities alone - standard treatment prescribed on the NHS - achieved less significant results.

This study showed quite clearly a positive outcome for patients, and serves an additional indicator to the much-larger IMPACT study on adolescents comparing CBT, short-term psychoanalytical psychotherapy and brief psychosocial intervention (psychiatric treatment and drugs), which found child psychotherapy to be equally as effective as the other modalities, in terms of both treatment and cost-effectiveness.

Unfortunately, whilst the IMPACT study has been taken into account in forming NICE guidelines, the results of the recent TADS study - which have been received in the field as highly significant  - have so far been ignored. Child psychotherapy is mentioned in the NICE guidelines, but the evidence of its efficacy has so far been overlooked.

In terms of our in-house research, here at the Brent Centre we are dealing with the spectrum of young people aged 8 to 24 that fall in between ‘mild depression and anxiety’ to borderline clinical cases. This is a unique niche which only a handful of other organisations work to address, but a critical one to prevent less severe problems from getting worse – and also at preventing significant mental health relapse and breakdown to both teenagers and later in adulthood.

Our unique Adolescent Exploratory Therapy – which offers short-term to two-year interventions for those who have not yet reached the Severe / Borderline Clinical category of mental illness - has achieved highly significant results with young people, including 100% reduction in suicidal attempt and 80% improvement in suicidal ideation.

Please contact us for specific research findings.

 

Conclusion 

Whilst the field of psychoanalysis and psychotherapy recognizes that there are limitations on the length of treatment that can be offered due to cost-constraints  - constraining its ideal vision of unlimited treatment for those with severe mental health issues – the field is addressing this with experimenting with new more short-term interventions that are still based on psychoanalytic and psychotherapeutic theory and practice.

With 50 years experience of saving young lives every year, our concern is that the existing evidence on what works in saving young lives must be consulted in providing solutions to the widely-recognised youth mental health crisis, especially when considering sending in newly-trained clinicians to schools where they will inevitably be confronted with undiagnosed severe mental health cases of self-harm, suicidal attempt and ideation and borderline depression and anxiety. 

Experienced clinicians who save lives every day here are horrified by proposals to send in people who have had only three months training to deal with a suicidal teenager. 

Overall, we would like to highlight the psychotherapeutic field’s concern with more severe or borderline clinical cases in vulnerable young people – of which we have seen a 25% rise in the last year. We are concerned the wider debate on mental health may become too overly focused on drug and ‘innovative’ interventions which have been proven to also only work in the short-term – thereby creating a 'sticking plaster' solution to mental illness – the equivalent of putting a plaster on a broken leg. 

Our comments come in the context of currently having significantly high numbers on our waiting list after many years of not having a waiting list, and battling to see as many suicidal teens as we can daily who CAMHS no longer have the capacity to see. Our suicidal referrals have doubled in the past year from 2016-2017.

We urge the government to carefully consider what its priorities are with this Green Paper consultation.  We hope the Green Paper consultation will not be based on an ill-informed and 'partial' evidence picture – and even worse, could be accused of making a deliberately vague and distorted picture in order to provide 'quick fix' solutions. 

We write as part of a wider group of psychotherapeutic organisations who have been consulted in the run-up to the formation of this submission, which include: the Institute of Psychoanalysis, the Association Child Psychotherapist and the British Psychoanalytical Society, all of which are highly concerned that evidence is being ignored in the run up to the end of the Green Paper consultation, and consequently, young lives are being put at risk. 

Yours sincerely,

 

Dr. Maxim de Sauma

CEO and Clinical Director

 

2017 Awards: –

  • Brent Charity of the Year
  • International Association for Child Psychoanalysis – Annual Award for Excellence 2018

[1] (Goodyer et al (2016) Cognitive behavioural  therapy and short-term psychoanalytical psychotherapy versus a brief psychosocial intervention in adolescents with unipolar major depressive disorder (IMPACT): a multicentre,  pragmatic, observer-blind, randomised controlled superiority trial. Lancet Psychiatry   November 30, 2016 http://dx.doi.org/10.1016/

[2] (TADS) ( Fonagy, P. et al. (2015)  Pragmatic randomized controlled trial of long-term psychoanalytic psychotherapy for treatment-resistant depression: the Tavistock Adult Depression Study (TADS) (World Psychiatry  2015;14:312–321

 

UPDATE:

The government has responded! – an encouraging early response noting the Brent Centre’s ‘breadth of experience’.