In search of an ending: Managing treatment closure in challenging circumstances. Lauren Garland outlines the thinking, and resulting research and report.

Back in December 2016, myself and colleagues at the Anna Freud Learning Network read with interest the report published by CORC on child and parent reported outcomes in child and youth mental health services. Central to the report’s findings is that of the children, young people and families accessing mental health treatment, a significant proportion will not improve or ‘get better’ by the time the support ends.

This had us thinking – how does it feel to reach the end of a piece of work which has required time and energy, expense too perhaps, to find that some or all of the outcomes you’d hoped to see have not been realised? We wondered also whether there are any approaches that practitioners and young people find helpful when a piece of work ends in difficult circumstances. 

There seemed no better way to answer these questions than to get out and start a dialogue – with young people and with mental health practitioners across the country, and that’s exactly what we did. This was a topic our participants felt strongly about, and they shared their insights and experiences honestly, thoughtfully and generously. We have captured their perspectives in a new reportIn search of an ending: Managing treatment closure in challenging circumstances in child mental health services.

Coffee, pastries and a closer look at the issues

Practitioners, researchers and commissioners were among those who joined our breakfast briefing on 26th March, at which we launched the report and discussed the implications for policy and practice.

We were delighted to hear from practitioner Vicki Curry, who shared her reflections on when and why the end of treatment can feel like a challenging time, and Victoria, a Young Champion from the Anna Freud National Centre who shared her own experiences of two different treatment endings. It was interesting to hear from Victoria what made the first of these endings particularly challenging – a lack of communication about and planning towards the ending. That’s not to say that the second treatment ending was easy, but she found early and open communication from the service to be hugely valuable, as was the service’s help in putting in place emotional and practical supports she could draw on after her treatment ended. 

Myself and colleagues at from the Anna Freud Learning Network shared the genesis of the report and its key findings, which are wide-ranging. With regards to what can make the end of treatment feel like a particularly challenging time, some practitioners and young people struggle with feeling attached to the therapeutic relationship. Some blame themselves if the outcomes of treatment fall short of their hopes for it. Conflicting views regarding readiness to end can add to the challenge of ending a piece of work. So too can concerns about access to other kinds of support.

Recommendations of what can help are equally diverse. In the report we emphasise three areas in particular – first, the importance of drawing attention to the ending from early on in treatment, and linked to this the value of establishing realistic expectations with young people, families and other professionals working with the family. Finally, we highlight the need for further work to help young people, families and services engage with support available outside of treatment.

Read the report in full here, and do sign up to the free Anna Freud Learning Network to hear more about this and other collaborative work led by the Anna Freud National Centre for Children and Families.