Children's mental health: Government needs to scale up its ambition

Eight year old Abigail was rejected by her local Child and Adolescent Mental Health Service because she wasn’t “risky” enough to meet their thresholds. Abigail grew up in a tense environment with constantly fighting parents. Her dad left and her mum found out she was having another baby. When the baby was born, Abigail’s mum struggled to cope and Abigail saw her mum veer from crying with desperation to shouting with rage in their one bedroom, damp flat.

When Abigail’s only friend moved away, this vulnerable child lost everything that was good. Her mum was always working, always crying and always shouting; the other children at school called her smelly and made fun of her. So she stopped going to school, staying at home instead and crying with unbearably painful stomach aches.

Children are not considered “risky” unless they make an attempt on their life. No child should ever get to that point before they are given help

Abigail may not have been “risky”, the threshold for accessing mental health support, but she was desperately unhappy, a situation that was likely to deteriorate without help… Children are not considered “risky” unless they make an attempt on their life. No child should ever get to that point before they are given help.

Overdue recognition

As a doctor specialising in mental health, I am relieved to finally see the long overdue recognition of the importance of children’s mental health. The government’s recent Children and Young People’s Mental Health Green Paper was a welcome step in the right direction – but given how many children are in Abigail’s positon, the ambition fell far short of what was needed.

We know Mental Health Support Teams can’t be created overnight but it must be possible to set up a programme in under 10 years otherwise a quarter of a million children and young people who could be helped will still be missing out because of the time it takes to roll out the proposals

Under the current proposals, it will take 10 years to introduce mental health support in every school. This means that children like Abigail who are eight now could leave school at 18 without seeing any changes or receiving support at all.

The green paper recommends that every school create a senior designated mental health lead. Although, the government says it will incentivise schools to create a lead, the role will be voluntary. The Royal College of Psychiatrists believes this role should be made mandatory with standardised, evidence based training to ensure every child is supported no matter where they go to school.

Senior designated mental health leads will link with Mental Health Support Teams. These teams will work with clusters of schools in one area to provide evidence based treatments and support for children with mild to moderate mental health problems. These teams could make a significant impact on children’s lives but the green paper currently aims for full rollout by 2028.

We know Mental Health Support Teams can’t be created overnight but it must be possible to set up a programme in under 10 years otherwise a quarter of a million children and young people who could be helped will still be missing out because of the time it takes to roll out the proposals.

Role of clinicians

As the green paper is a consultative document, I would welcome clarification from the government what role clinicians like myself will have in determining what treatment a child might need. The medical expertise of clinically trained staff would ensure any treatment offered to children is beneficial and evidence based.

We also need to make sure we look at the waiting time between first assessment and starting treatment and the number of experienced staff in each CAMHS team delivering assessments

Although the government hopes that these plans will reduce the need for specialist child and adolescent mental health services, it is likely that in the short term referrals will increase as schools identify more children in need of specialist help, whose needs are currently going unmet. But we currently already have a crisis with children not being able to access treatment. Without additional investment we won’t be able to meet the additional demand.

There are far too many children and young people falling into crisis because they cannot get the help they need and deserve early enough. The final green paper recommendation to trial a four week waiting time to access specialist NHS Child and Adolescent Mental Health Services will ensure we can help more children earlier.

However, there has been a 6.6 per cent reduction in the number of child and adolescent psychiatrists since 2013. It will be incredibly difficult to meet the waiting time if we don’t have the staff to do assessments.

A recent mental health workforce plan committed to 100 extra consultant CAMHS psychiatrists – but none were for community services. We must have more community CAMHS psychiatrists to meet the four week waiting time and play an active role in the Mental Health Support Teams.

We also need to make sure we look at the waiting time between first assessment and starting treatment and the number of experienced staff in each CAMHS team delivering assessments. This should ensure children get a quality assessment and are not left in limbo after the first appointment.

In the midst of much government focus on Brexit, I gave evidence last week to the health and education select committee on the green paper. The message to the government was that it needs to scale up its ambition.

They have already taken the bold and important step of co-producing this paper between the Department for Education and Department of Health and Social Care – now we urge them to go one step further by making provision for their proposals to be implemented sooner to seize this important opportunity to make sure that Abigail and the thousands of children like her get help before it is too late.