This is HSJ’s new fortnightly briefing covering quality, performance and finances in the mental health sector.
Feedback and comments are welcome, so please feel free to email me in confidence.
A cause célèbre
Children and young people’s mental health has never been so loudly championed from the top of government, and has never seen such scrutiny before.
But while child and adolescent mental health services has become a cause célèbre, we know it is not necessarily a cause for celebration.
The first phase of the thematic review into child and adolescent mental health services promised by prime minister Theresa May was published in late October.
Dubbed by some in the sector as a “review of reviews”, the report outlined the “fragmented” nature of CAMHS services nationwide, flagging up safety and access to services as the greatest concerns.
Led by the Care Quality Commission, the report also pointed out that on the whole, when children and young people do manage to access services the care is generally good. Inspection reports of 101 CAMHS found the majority of community and inpatient services were rated good or outstanding.
No bed of roses
But the general good quality of CAMHS does not mean that everything is a bed of roses.
HSJ has revealed a number of problems across four independent inpatient CAMHS units over the last couple of months, including the permanent closure of the Cygnet CAMHS unit at its hospital in Woking last week.
The CQC has raised concerns about the other three units, with Cygnet’s Sevenoaks and Sheffield units being closed temporarily to new patients and Huntercombe’s Torquay unit closed indefinitely to new patients.
These could well be isolated incidents, but they highlight a number of fears about CAMHS services – the gravest around capacity.
Figures from 2014 show that there are about 1,300 CAMHS beds across the country, and this number has remained fairly static because of NHS England’s moratorium on all secure and tier four mental health beds.
In a high profile case earlier this year, the country’s most senior family judge, Sir James Munby, said the nation will have “blood on its hands” if an NHS hospital bed could not be found for a teenage girl who was at acute risk of taking her own life.
Although the national body has announced it will commission an extra 150-180 beds by 2019, if small units such as Woking are closed, or shut to new admissions, then this will reduce the number of beds available in the meantime.
The lack of inpatient provision and long waits to access CAMHS are not new problems.
But tucked away in the CQC’s report last week were a number of further concerns which should give sector leaders food for thought.
Data black holes
Data is becoming an ever present theme of these newsletters, but it is impossible to understate its importance if mental health services are going to improve.
In thematic review the CQC was explicit that the “lack of accurate and comprehensive data undermines attempts to provide care that meets the mental health needs of children and young people”.
This is pertinently highlighted by the fact that the latest available prevalence data on mental health problems in children and young people is for 2004.
The danger – rightly highlighted by the watchdog – is that commissioners are using incomplete or out-of-date data about the scale and nature of demand when commissioning services.
Good work undone
And there is an additional worry, which has the potential to derail the implementation of the Five Year Forward View for Mental Health.
This is the publication next year of the latest prevalence data for mental health problems in children and young people.
Although we do not know what it will reveal, many expect it to show that the number of children and young people affected by mental illness is much higher than previously believed.
A major increase in prevalence would potentially undermine the plans in the forward view to increase the proportion of children able to access CAMHS.
If the prevalence of mental illness in children and young people has increased, then this could expose a large gap between the expansion in provision by 2020-21 planned under the forward view, and what the population actually needs.
The question is, if the system is already buckling under the demand we know about, what can be done with the limited resources available to meet an even greater need? It will be interesting to see if the system is able to change its plans to accommodate any such new facts.
While we will have to wait for the new data to be published next year, this clearly poses a risk to the credibility of current plans and the ability of the system to meaningfully increase access to CAMHS.