As the severity of the current phase of the COVID-19 pandemic abates, across the NHS and in the media, there has been much talk of waiting lists, recovery and restoring services. Despite everyone's best endeavours over the past year, waiting times for operations, tests and hospital services have sky rocketed.
What has flown under the radar is how the pandemic has affected mental health services and, in particular, the far-reaching impact on children and young people. Responses to our latest survey of mental health trust leaders highlight an unacceptable reality that only a third are able to meet the current demand for children's care and most of them are concerned about their ability to meet anticipated demand within the next 12-18 months.
We must remember that national data trends over time show mental health services are reaching more children and young people than ever before. This reflects the welcome focus, investment and effort nationally and locally over recent years to improve access to these services; the mental health investment standard and the long term plan for mental health are significant developments.
The mental health trusts that deliver them are doing all they can to make improvements with the staff and resources available. However, those trends pre-date the pandemic and, even then, we were starting from a low base, compensating for years and years of underinvestment, with too many children and their families unable to access the care and support they need, at the earliest stage possible.
A high proportion of children and young people not previously known to services are coming forward, and they are more unwell, with more complex problems than in the past.
Interim Chief Executive
Critically the pandemic adds a significant, new factor into the mix. A high proportion of children and young people not previously known to services are coming forward, and they are more unwell, with more complex problems than in the past. One trust leader's response to that was to tell us: "This is the perfect storm". There are longstanding barriers to trusts being able to deliver the right level of mental health care for all who need it: a lack of suitable social care provision; a scarcity of inpatient beds in some areas close to home for those who are most unwell; and a shortage of specialist staff on the frontline of health and care services.
Despite all the challenges, there are a range of steps trusts have been taking and need to build upon, working with local partners, to meet the needs of as many children and young people in their local areas in the best way possible. We have heard of trusts: setting up day services to provide an alternative to admission to hospital; using digital solutions to expand access to care where appropriate; and working with schools, GPs and their partners in local authorities and the voluntary sector, to deliver services that meet individuals' needs at an earlier stage.
It is clear a more joined-up, proactive approach between education, health and social care is needed in all areas of the country, with a greater focus on prevention and earlier intervention. However, there are significant, systemic challenges to providing the right level and nature of mental health support for children and young people consistently. We need to address in the round how NHS mental health services and their partners, from schools and local authorities to the voluntary sector, are resourced to fundamentally improve the current situation for children and young people.
Funding for services needs to be allocated on a sustainable basis and focused on filling the current gaps in support available for children and their families.
Interim Chief Executive
Funding for services needs to be allocated on a sustainable basis and focused on filling the current gaps in support available for children and their families – for example when someone first starts to ask for help, or after they receive a diagnosis. Trusts have stressed frustration that they may carry out autism assessments – the waits for which can span years – but there may be no services available in the local area to provide care and support for those they diagnose.
We also need to see a fully funded, national workforce plan that builds on the steps already being taken to grow and develop the mental health workforce. Trusts know they also have a crucial role to play here: by improving staff experience and support so people stay working in the NHS, and making the most out of current funding available to them for recruitment.
One trust leader told us, there are "good levels of funding coming in to expand community and early intervention services, but the biggest challenge is finding the workforce and retaining them given the demands and pressures". It's not enough for us to simply 'weather the storm'.
A better system of care for children and young people is possible: we can and must do more to prioritise the delivery of it in all parts of the country without further delay. And we need to make sure that we focus equally on the mental health service's recovery from COVID-19.
This blog was first published by the Independent
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