Investment in improving access to children and adolescent mental health services and tackling its causes through a prevention first approach is the need of the hour, says Paul Burstow
In 2014, Simon Stevens called for a “radical upgrade in prevention and public health” to reduce the “stock” of population health risks to stem the “flow” of costly NHS treatments. He was right.
But where to start? Start young. That is the message from the University of Birmingham Mental Health Commission, whose report, Investing in a Resilient Generation was published recently.
Right help at the right time
The news that the government is committing an extra £20bn to the NHS is welcome. But we will be back here again unless at least some of the money is used to tackle the “flow”.
By 2021, one in three children and young people who could benefit from accessing support from specialist CAMHS will have the opportunity
NHS England has already made clear that children and young people’s mental health will benefit from the prime minister’s funding pledge. Investment in improving access to the right help and treatment at the right time is essential, but not sufficient.
By 2021, one in three children and young people who could benefit from accessing support from specialist Children and Adolescent Mental Health Services will have the opportunity. Access will remain a lottery and productivity and quality concerns remain.
A study by the NHS Benchmarking Network for the Commission looked at the cost and workforce implications of increasing access. It found that if every child who needed help from CAMHS was to be able to access a service it would require an extra 23,800 staff at a cost of £1.77bn a year.
Even if the money were allocated could the staff be? Staffing is already the biggest risk to delivering the current Five Year Forward View for mental health.
A study found that if every child who needed help from CAMHS were to access a service it would require an extra 23,800 staff at a cost of £1.77bn a year
There may be scope to improve productivity and digital channels could play a part too. But without addressing the drivers of demand any attempt to scale up access to treatment risks missing the target.
The commission’s case for change and call for action is simple, by systematically deploying evidence informed practices and programmes that maximise resilience and minimise risk factors, it is within our grasp to halve the number of people living with life long mental health problems in a generation.
The commission sets out four building blocks for a prevention first approach: positive family, peer, and community relationships; minimising adverse experiences and exclusions; mentally friendly education and employment; and responding early and responding well to first signs of distress.
Each of these already has promising and well evidenced interventions and approaches.
Scaling up access to treatment alone would be a mistake. Just chasing demand without tackling its causes is like a lifeguard pulling drowning people out of the sea too busy to ask why they got into difficulties in the first place.
The risks of poor mental health are not evenly distributed across society. Those that face disadvantage or exclusion are far more likely to experience mental health difficulties.
For example, 17 per cent of 11 year olds from families living in the bottom fifth of income distribution have severe mental health problems compared with only 4 per cent amongst families in the top fifth.
Taking a population health approach and tackling health inequalities is part of the mission of sustainability and transformation partnerships. They are the keys to a new business as usual.
Last year, Public Health England, which welcomed the commission’s report, launched its Prevention Concordat. It set out the return on investment case for mental health promotion and illness prevention “best buys”.
Winds of change
Thirty years ago, the Treasury changed the way we account for capital spending.
The aim was to protect investment in our infrastructure from day to day reactive spending. Prevention spending still has to compete with today’s pressing need.
The commission argued for changes to the way we account for prevention spending so that we make visible the cost of underinvesting in the nation’s mental health.
Three quarters of life long mental illness has its first signs by the age of 25. Today, the NHS spends 0.7 pence in the pound on children and young people’s mental health.
The NHS 10 year plan must improve access to treatment, but unless it also invests in tackling the causes and mobilising the whole society, effort that will require it will never stem the flow.