Treatment and care for children’s mental health services in the public sector are facing a crisis in confidence. According to a January 2020 report in The Guardian, four in 10 GPs tell 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:
- subject to heavy rations, 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 The Guardian published the details of an investigation by the specialist medical publication Pulse. It shows 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 children’s 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. Ultimately, they endeavour 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. However, for GPs to feel confident, the NHS must be fit for purpose. We’d argue that:
- prompt treatment of those in need is central to the service becoming fit for purpose;
- as is early intervention.
Prevention is better than cure, particularly for children and young people. In these cases, 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, some might argue we don’t treat less visible health issues (i.e. mental health issues) as seriously.
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 society’s youth, being unable to promptly access mental health services when in need of them. 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 conditions gaining support and treatment service among the country’s young people too. Based on the latest available figures from the NHS, 377,866 under-18s access NHS mental health treatment. This information and support refer to NHS-funded community services in England between April 2018 and March 2019 for young persons. Unfortunately, the NHS doesn’t state the number of referrals of children for treatment in that time period though.
We have to rely on figures from other sources then regarding children and adolescents. 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 the child and adolescent mental health services in 2017.
This estimate is based on data on supply from the charity through Freedom Of Information (FOI) requests. In short, estimates suggest nearly 185,000 (ages 10-17) got a referral 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% of those referrals got no treatment 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. In short, some of 2017’s 185,000 forms part of the 377,866 accessing NHS-funded services from April 2018 to March 2019. However, if The Children’s Society’s figures are correct, it is very troubling, to say the least.
Cause for further worry about children’s mental health
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 highlights the case of one girl. The youth tried to “take her own life by drinking bleach” after repeatedly trying and failing to get help. Furthermore, the report says three-quarters of CAMHS referrals say their condition deteriorates 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;
- One must ask if that potentially constitutes medical negligence?
Particularly if the child’s condition then significantly deteriorates or they attempt to seriously harm themselves. Friends and family, not to mention mental health and wellbeing groups, will take it all under advisement, particularly:
- Branches of the Children and Young People’s Mental Health Service (CYPMHS) – depending on where you live;
- Youth support services;
- School nurses;
- Youth offending teams;
- Social services;
- Other forms of youth mental health support;
- Even adult mental health services, who may inherit the problems as children grow.
This is clearly a very complex and sensitive issue that cannot be resolved in the space of a blog post. Moreover, there are many other issues to consider as youth services are supported by social groups. For example, 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: those four in ten GPs need to feel that they can refer children to CAMHS with confidence.