{"id":38179,"date":"2017-01-17T14:47:02","date_gmt":"2017-01-17T13:47:02","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=38179"},"modified":"2017-01-17T14:47:02","modified_gmt":"2017-01-17T13:47:02","slug":"miranda-wolpert-we-must-set-realistic-expectations-for-outcomes-in-child-mental-health","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2017\/01\/17\/miranda-wolpert-we-must-set-realistic-expectations-for-outcomes-in-child-mental-health\/","title":{"rendered":"Miranda Wolpert: We must set realistic expectations for outcomes in child mental health"},"content":{"rendered":"

\"\"The secretary of state for health, Jeremy Hunt, identified Child and Young People\u2019s Mental Health Services as \u201cthe biggest single area of weakness in\u00a0NHS\u00a0provision at the moment<\/a>.\u201d Hardly a day goes by when there is not another story in the press about children and young people failing to get access to or needing to travel huge distances for treatment. Professionals and lobby groups call for more funding and greater access<\/a>.<\/p>\n

I want to be clear that I absolutely endorse the need for more funding and the calls for better access. However, I am concerned that, because of the strength and urgency of the focus on funding and access, consideration and discussion of the limits of treatment is being lost. The fact that not all provision is helpful is rarely discussed; perhaps partly out of concern that, if it were raised, what limited resources are already available would be cut further. I have argued elsewhere that this silence on the limits of treatment has potential negative consequences<\/a>; in particular it can leave therapists and patients alike feeling bewildered and blamed for a lack of progress and can limit any motivation to genuinely review outcome rates and make improvements in the light of that review. \u00a0<\/p>\n

Understanding and improving outcomes<\/strong><\/p>\n

As a trainee clinician I was trained extensively in the best means to assess (formulation vs diagnosis) and treat (e.g. cognitive behavioural therapy vs psychodynamic therapy). When \u201coutcomes\u201d were discussed, the focus was on differential effectiveness (i.e. treatment A is better than treatment B) rather than overall impact (i.e. x% of children treated by treatment A or B are not \u201cbetter\u201d at end of treatment). No training was provided on how to end therapy if the problems were not resolved. As a practising clinician, I became increasingly frustrated by not having any means of knowing if the children, young people and families I was seeing were making the best progress they could. This frustration was shared by others and was the motivation for establishing the Child Outcomes Research Consortium (CORC)<\/a>\u00a0over a decade ago; a learning collaboration which has grown to include the majority of those working to support the mental health of young people in England and beyond, and\u00a0which shares a desire to understand more about what outcomes are being achieved in services and how we might improve them.<\/p>\n

\u00a0<\/strong>The data<\/strong><\/p>\n

In December 2016, CORC published a report<\/a> on child- and parent-reported outcomes and experience from children and young people\u2019s mental health services, based on routinely collected data from 2011\u201315, across England. The report \u00a0found that of those children and young people who completed relevant self-report measures (n=5,896 ):<\/p>\n