The long term impact of ‘not meeting thresholds’ - will Transforming Care Programmes help?

Updated: May 12

Some of the most upsetting and frustrating cases I have been involved with are those where rigid application of thresholds result in serious, acute and long term damage. Sadly, there are children out there whose lives are just really, really complicated; with special educational needs but also neglect, substance misuse, domestic abuse, substandard housing, poverty or any one of a multitude of issues. 

From my personal experience it can be difficult to know where to start. When I am faced with a complex situation, with a family at the end of their tether, who do I call first? The school, the GP for a Child and Adolescent Mental Health referral, or Social Services for child/family support?

Imagine the frustration when each one of those agencies firmly closes their door - saying “Sorry - the child doesn’t meet our threshold”. It’s a bad day for me: but it’s much more devastating for a family who have finally reached out for help, and been roundly turned away. Parents start to wonder if they really do deserve the help and they begin to think, is it really our fault? Ultimately, all but the most resilient stop asking… and quietly sink. 

Why is this?

It's often more pointed as children get older. They may not be ‘far enough behind’ academically, and ‘not causing enough issues’ in school to meet SEND funding ‘thresholds’. They also may not ‘be eligible’ for social care support because they are ‘not at immediate risk’ and/or ‘have no clear diagnosis’, so they ‘don’t get enough ‘points’’. Lastly, they don’t get Child and Adolescent Mental Health support because they ‘aren't ill enough’... yet! 

So; we may have a teenager with special educational needs, rapidly deteriorating mental health issues and multi-complex domestic issues with no support at all. What happens? Simply, they head towards family breakdown, mental health crisis, or the edge of offending. 

The solution?

We all know that early support is key, and prevents the inevitable downwards spiral for these children - so why do we fail our children? The costs of a bed on an acute mental health ward, or, God forbid, a young offender’s institution comes to tens of thousands per week. Both institutions are full of these children - we know this.

Behind every acute mental health admission is a catalogue of missed opportunities, and often the solutions really weren’t rocket science! Why can’t we divert those funds into better early support and interventions? For example, why can’t we divert it into the voluntary sector, who do holistic, common sense support so well?

We need that holistic and common sense approach, with joined up services, with professionals and commissioners who recognise that providing funding for prevention is not only better than funding crisis, but is also very significantly cheaper. 

The issue is often that the cause is far removed from the ultimate crisis, maybe years hence, and it’s not the ‘causes’’ budget being affected. Very often, the budget most severely affected is the NHS, and I was heartened to see this issue recognised in the Transforming Care Programme. We as professionals need to get behind this - challenging one dimensional thinking, and breaking down individual budget based thinking. 

We can all engage with community-based programmes which seek to deliver innovative, solution focused, localised support for families, and if those programmes aren’t there - we should be asking why!

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