We must ensure that the system of addressing children’s mental health needs is made sustainable, otherwise the younger population with the greatest needs is likely to suffer the most. By Nick Waggett
Readers of HSJ will be aware that the mental health needs of children and young people are currently attracting a lot of attention and have been identified as a priority by the government. The prime minister has stated that a transformation of children and young people’s mental health provision is necessary.
Along with many others, Association of Child Psychotherapists registered child psychotherapists would support that view and welcome the attention child mental health is receiving. There are well documented and widely reported difficulties for children and their families attempting to access timely, effective and local services.
The Time to Deliver report found that two thirds of young people aged 16-34 who had attempted suicide had not subsequently received medical or psychological help. Their research also identified that specialist mental health services are on average turning away nearly a quarter of the young people referred to them for treatment.
A 2017 survey of psychotherapists and counsellors working with children and young people in the NHS found that 84 per cent say children now need to have more severe levels of illness in order to get help, whilst 67 per cent say waiting times have got longer over the last five years.
Research by the Royal College of Psychiatrists for the 2016-17 financial year estimates that 25 of the CCGs in England planned to spend less than £25 a head on mental health services for the children in their communities, while 10 areas will receive less than £10 per head
Given the clear evidence of a “treatment gap”, and the severity of the needs of many vulnerable children, readers may be surprised to learn that the current attention is not being translated into action, or spending, in many areas of the country.
Research by the Royal College of Psychiatrists for the 2016-17 financial year estimates that 25 of the Clinical Commissioning Groups in England planned to spend less than £25 a head on mental health services for the children in their communities, while 10 areas will receive less than £10 per head.
Furthermore, a YoungMinds survey of CCGs highlighted their misuse of the government’s pledge of an extra £1.4 billion over five years for children’s mental health services, with nearly two thirds using it to backfill cuts or to spend on other priorities.
In these circumstances, the government’s green paper, Transforming Children and Young People’s Mental Health Provision, is timely. Unfortunately, the proposals for a limited schools based service fail to address many of these concerns as they are not directed at transforming or significantly improving the core NHS services for children and young people with mental health problems.
Whilst school based services have their place, they will not be resourced, or have the expertise, to address the treatment gap. The proposed teams in schools are planned to cover, at most, a quarter of the country by 2022-23. Early intervention is crucial in preventing problems developing and worsening but these proposals, aimed at school age children, fail to provide genuine early intervention as they do not address the first 1001 critical days of a child’s life.
A child’s mental health is influenced from before the point of conception and many risk factors of later mental health problems occur in the first two years of life.
In particular, there is a continuing lack of focus and resources for those children and young people with severe, complex and long standing difficulties.
The green paper does not recognise the difficulties faced by many children and young people, and their families, or the depth of the challenge faced by the services and professionals tasked with supporting them
The absence of comprehensive specialist NHS services is evidenced in the extent to which children and young people with poor mental health harm themselves, use accident and emergency and other services inappropriately, become not in education, training or employment (NEETs) or are caught in the youth justice system, and often continue to suffer into adulthood from conditions that should have been met with an effective treatment at the appropriate time.
Where there has been recent investment, such as with The Children and Young People’s Improving Access to Psychological Therapies programme, this has been targeted at mild to moderate illness and not at those children and young people with complex conditions, often linked to adverse childhood experiences, abuse, trauma and also to parental mental health, domestic violence and substance abuse.
The focus of current service transformations in many NHS trusts has led to the reduction of genuinely specialist care from multidisciplinary teams for those children and young people who most need it.
Given the prime minister’s commitment to transform mental health support, starting in childhood, and the government’s commitment to parity of esteem between mental and physical illness, the limited scope and ambition of the green paper is surprising. It does not recognise the difficulties faced by many children and young people, and their families, or the depth of the challenge faced by the services and professionals tasked with supporting them.
The ACP is campaigning to protect specialist child and adolescent mental health services. The Treat Them Right campaign calls on all services to have access to an ACP registered child psychotherapist, so every child can benefit from their skills, expertise and experience.
The consultation on the green paper closes on 2nd March. We must ensure that the system is made sustainable, otherwise the children with the greatest needs are likely to suffer the most.
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