As a child psychiatrist, I know that vulnerable children will continue to suffer until the NHS promises to ring-fence child mental health funding

The Government has spoken at length of the importance of early intervention, yet their rhetoric does not match their actions when it comes to actually funding child mental health services 

Jon Goldin
Friday 10 November 2017 17:10
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150 children a day are being turned away from CAMHS
150 children a day are being turned away from CAMHS

Imagine being a 15-year-old, taken to your GP by your mother in a panic because you have started to cut yourself superficially on your arms. You are worried about how you look, you are getting bullied via Instagram, your self-esteem is rock-bottom and cutting yourself seems to offer you some relief from your emotional pain. You are referred to your local Child and Adolescent Mental Health Service (CAMHS) by your GP, but you don’t meet the threshold for urgent treatment and understand that because you are not actively suicidal there is a long wait and it may be some months before you can be seen.

This is the sort of situation sadly faced by many young people today who may not get adequate mental health support until they present in a crisis or until they have attempted suicide. Even then the quality of care they will receive can be variable around the country.

The NSPCC’s report, revealing that some 150 children a day are being denied mental health treatment by NHS trusts, adds further to the weight of evidence that a mental health crisis is developing among the country’s children and that young people with mental health problems are not getting the help that they need. Jeremy Hunt has acknowledged this himself and recognised that things have to improve. We know that more than half of all mental ill-health begins by the age of 14 and it is estimated that one in ten children aged 5-16 years has a diagnosable mental health disorder. The Five Year Forward View for Mental Health (FyFV) aims for 35 per cent of children and young people with a diagnosable mental health condition to get NHS treatment by 2020. This is a welcome improvement on current provision but even if this is achieved, it leaves 65 per cent of children with mental ill-health without help.

We do not actually fully understand the extent of the problem as good data is not out there. Much of what we have derives from FOI requests but CCGs are not required to publish their figures on children who are turned away from treatment, and in this survey around one in five failed to respond. There is no national waiting time target covering all children with mental health problems and no data on how many children are turned away from treatment. To truly assess whether promises are being delivered, we need adequate data on waiting times and access.

A central part of the issue clearly relates to inadequate funding for mental health services nationally, specifically for CAMHS services. Promises are made about increased funding for CAMHS and Theresa May has said that it is a priority for her Government to address the deficits nationally in mental health services. There is an issue however about rhetoric from politicians not matching the reality on the front line. If money that is promised is not ring-fenced we cannot ensure that funding will reach the frontline. Many CCGs nationally are struggling financially so that the increased money allocated for CAMHS often ends up getting spent on paying off other debts or propping up other services. The RCPsych has uncovered that 22 CCGs cut their overall mental health funding in real terms from 2015-16 to 2016-17. Twelve CCGs cut their mental health budgets in cash terms.

There is wide national variation in service provision, which can lead to young people having to travel long distances across the county to receive adequate specialist treatment. This is not acceptable for young people and their families at the most vulnerable time of their lives. If some areas maintain minimal services while others invest in robust facilities, there is a danger that children presenting with complex conditions in an underfunded CCG will be sent out of area for treatment because their local services are ill-equipped to look after them. Some areas are also less attractive to work in so staff will vote with their feet if services are not adequately resourced or invested in.

Nationally efforts are being made to improve CAMHS. For example, £150m has been invested in improving eating disorder services for young people and this money, which is ring-fenced for these services, is starting to bear fruit. Eating disorders is an area where intervening early is crucial to prevent problems becoming more intractable and chronic. It is not just about money though because there also needs to be an adequate workforce available and so investment needs to be made in recruitment of CAMHS professionals, staff training and retention.

Finally, we need to consider the broader socio-economic and cultural determinants of child mental health problems. There is a clear link between child poverty and mental health difficulties and the gap between rich and poor in our society has been increasing in recent years. There is also too much pressure on our young people to grow up too fast with, for example, excessive testing and exams at schools at too young an age. Children need to be allowed to be children and schools play an important part in this. There is greater awareness of mental health issues amongst young people and schools are placing a welcome greater emphasis on SRE (Sex and Relationships Education) and PSHE (Personal, Social, Health and Economic Education).

We also know about some of the pressures that social media can place on young people and as adults we have an important part to play in mitigating these effects and ensuring our children, as far as possible, spend no more than a couple of hours/day on social media.

As adults, we need to be listening to our young people and heeding the warnings that we are receiving daily now about the crisis in their mental health. As a humane society, we have a duty to address this issue for the benefit of current and future generations.

Dr Jon Goldin is the Vice-Chair of the Child and Adolescent Psychiatry Faculty at the Royal College of Psychiatrists

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