A recent report from the Independent Commission on Children and Young People’s Mental Health is the latest in a long string of research drawing attention to the poor state of children and adolescent mental health services (CAMHS).
What do we know about these problems and what can be done?
Access is patchy
For a start, children and young people often have trouble accessing treatment, information and support for their mental health.
Nearly a quarter of children referred to children and adolescent mental health services (CAMHS) are being turned away. The reason? Their condition is not seen to be serious enough; in some areas their referral is only accepted if the condition has a major impact on “the child’s life such as an inability to attend school or a major breakdown in family relationships”.
We also know that there is wide variation in how long children and young people (CYP) wait to access CAMHS. The median waiting time across all providers is one month for a first appointment and two months until start of the treatment. However, some children and young people may wait as long as six months for a first appointment and 10 months for start of treatment. Late intervention has not only a significant human and social – potentially irreversible – cost on the lives of children, young people and their families, but also a financial one.
Young people don’t know where to turn for help
Secondly, we know that there are very high rates of self-harm in younger people yet, when in crisis, they often don’t know where to seek help.
The 2014 Adult Psychiatric Morbidity Survey found that self-harm has been increasing over time. In 2014 one in five young adults aged 16-24 had self-harmed; young women twice as much as young men (25.7 per cent vs 9.7 per cent). Likewise, at a recent conference, Dudley Youth Health Researchers presented figures from their survey of over a thousand people aged 11-19, and found that almost half (44 per cent) of those surveyed or someone they knew had been affected by self-harm, while 33 per cent had been affected by an eating disorder.
Yet one in five respondents said that they would not know where to seek help or information in these situations. This reflects national statistics. Hospital admissions as a result of self-harm for CYP are on the rise, as are A&E attendances in under 18s with a primary diagnosis of psychiatric condition or intentional self-harm. While these increases may be a good thing – the result of more awareness and more CYP reporting and seeking care – they could also be a signal that CYP don’t know where to turn when they need help early on.
CYP seek help in different ways
Despite the frequent use of the internet and social media, the majority of young people said they would prefer to speak about their health problems face to face – mainly to parents/carers, followed by a doctor and friends. These findings are consistent with those of the Adult Psychiatric Morbidity Survey which shows that young people seek help after a suicide attempt in a different way to adults, who were more likely to go to hospital or a specialist service. Therefore the help available has to be based on an understanding of these behaviours and better tailored to the needs of the young.
Surveys have their limitations, but taking their findings together with the nationally available figures is truly worrying. So how do we respond to these challenges?
More funding for CAMHS
One of the biggest barriers to progress in CAMHS identified by an Education Policy Institute (EPI) review was poor staff recruitment, which results in large expenditure on agency staff. Despite the increase in funding to local areas, high agency spending means that any additional funding granted to CAMHS may not ultimately be used for mental health services for CYP at all.
A greater focus on prevention
However, in spite of funding challenges, there is lots of good work underway that we can learn from. The EPI review provided some excellent recommendations around prevention, early intervention and the need to deliver better treatment. One of the key pillars of early intervention was a stronger focus on health and wellbeing at school and easy access to appropriate care – through drop-ins or self-referral.
More innovative services
There are many passionate professionals, CYP, parents and carers who seem to be getting it right and it is important to celebrate these. For example, the city centre hub called "Pause" in Birmingham – part of Forward Thinking Birmingham – which plans to revolutionise mental health care for CYP by providing a safe, comfortable and supported space for young people to come, sit, relax and access therapy. Hearing from a young person who is a client of "Pause" recently made it clear that relatively simple solutions can have a huge impact on people's lives.
Another great example is the Well Centre in Lambeth, a one-stop-shop drop-in centre (with a youth worker, CAMHS nurse and GPs) for young people with any physical or emotional concern. This service demonstrates the importance of youth-friendly, flexible and accessible services for CYP.
The Nuffield Trust also looked at some of the new (and not-so-new) models of care for CYP earlier this year and found that many of them were providing easy and flexible access to high quality care.
A way forward
National Mental Health Day may have been last month, but for a lot of young people, every day is a ‘mental health day’. Without addressing some of the barriers to treatment – and an urgent look at funding – more children and young people may be denied access to lifelines when they need them the most.
But we don’t have to wait for national policy change or additional funding to take action. We all have a collective duty to help the youngest and most vulnerable in our society. New and innovative models like Pause and the one-stop-shop offer hope on the horizon, and the NHS can learn a lot from these services. However, we can all make a contribution to helping our young by making small changes – every contact counts.
Kossarova L (2016) 'How can we improve access to children’s mental health services?' Nuffield Trust comment, 5 December 2016. https://www.nuffieldtrust.org.uk/news-item/how-can-we-improve-access-to-children-s-mental-health-services