According to a report in The Guardian yesterday, four in ten GPs are now telling parents with children who have mental health issues to seek private treatment.
Per The Guardian’s report, this is due to GPs feeling that NHS child and adolescent mental health services (CAMHS) are overwhelmed, heavily rationed and can involve delays of up to 18 months between referral and the child starting treatment.
We are sure we were not the only ones who were very saddened when we read this.
Even more saddening news is that, earlier today, The Guardian published the details of an investigation by the specialist medical publication Pulse showing that a third of NHS mental health trusts only accept patients whose condition is classified as ‘severe’ or ‘significant’ for specialist child and adolescent mental health services. Worryingly, only one in five NHS mental health trusts accept referrals for children with any level of condition too.
The issue with mental health services
The NHS is one of the UK’s greatest achievements and one that we should all rightly be very proud of. The work CAMHS does is also very important and we commend the work of its’ practitioners to treat children and young people who are need of mental help support.
However, all GPs should feel confident when referring their patients to other parts of the NHS for more specialist care. For GPs to feel confident, the NHS needs to be fit for purpose though. We would argue treating those in need promptly is central to the service being fit for purpose, as is early intervention. Prevention is better than cure, particularly for children and young people, where ill health early in life can shape their lives going forward.
As part of this, we, as a society, arguably need to change the way we view mental health and those who have difficulties with their mental health too.
We do not question those with visible physical health issues needing treatment. However, it could be argued that we do not treat less visible health issues, including mental health issues, with the same level of seriousness. As Dr Nihara Krause, a consultant clinical psychologist and founder of the mental health charity Stem4, says in The Guardian’s article:
“Parents whose child has cancer or a serious physical health condition would never have to pay for private care, so why should it be OK for those whose children have mental health problems to be told to do that? This again shows that the much-vaunted ‘parity of esteem’ between physical and mental health services is still a far-off goal.”
We cannot accept anyone, particularly the youngest in society, not being able to access mental health services promptly when they are in need. Ultimately, a person’s mental health is just as important as their physical health.
The scale of the need
There is a clear and sizeable need for mental health support and treatment service among the country’s young people too. Based on the latest available figures from the NHS, 377,866 under-18s accessed mental health treatment by NHS-funded community services in England between April 2018 and March 2019. Unfortunately, the NHS does not state how many children were referred for treatment in that time period though.
We have to rely on figures from other sources then. An article by The Independent last year highlighted a report from the charity The Children’s Society estimating that more than 100,000 10 to 17-year-olds were turned away from child and adolescent mental health services in 2017.
This estimate is based on data obtained by the charity through Freedom Of Information (FOI) requests, with the charity estimating that up to 185,000 young people aged 10-17 were referred to specialist mental health services in 2017. However, only 79,000 received treatment in the same year according to the charity’s figures. By these estimates then, around 60 per cent of those referred were not treated that year.
Of course, these claims are based on the charity’s own estimates. Thus, they should be taken with a pinch of salt to a certain degree, as it is likely that some of 2017’s 185,000 figure form part of the 377,866 people that accessed NHS-funded services between April 2018 and March 2019. However, if The Children’s Society’s figures are correct, it is very troubling to say the least.
Cause for further worry
Last year, the Children’s Commissioner, Anne Longfield, also highlighted that more than a third of England’s Clinical Commissioning Groups (CCGs) had cut spending on early intervention services for children’s mental health.
What we find even more concerning is that, in the same report, Ms. Longfield highlighted the case of a girl who tried to “take her own life by drinking bleach” after repeatedly trying and failing to get help. Furthermore, the same report said that three-quarters of young people referred to CAMHS said their condition had deteriorated by the time they were seen.
If CAMHS know that a child is in need of support, and it fails to start treating that child within a reasonable amount of time, it has to be asked if that potentially constitutes medical negligence? Particularly if the child’s condition then significantly deteriorates or they attempt to seriously harm themselves.
This is clearly a very complex and sensitive issue that cannot be resolved in the space of a blog post – there are many other issues that need to be considered, for example, such as the level of funding CAMHS receives and how this affects its’ capability to deal with demand.
This is also an issue that is far too important to get wrong though. We sincerely hope the situation improves and those four in ten GPs begin to feel that they can refer children to CAMHS with confidence again.