Mental health has long been the “Cinderella” of healthcare provision. Last in line for funding, low in any list of priorities and, until recently, not important enough to have NHS constitutional performance standards. If we look at the state of mental health services for children and young people (usually known as CAMHS), we can see it truly is the Cinderella.
Dedication to change
Thanks to the courage of politicians such as former health minister Norman Lamb MP, an army of tireless campaigners, including the Times’ Time to Mind campaign, the continued dedication of frontline staff in NHS, and cross-party commitment to improving services, things are starting to change. But for children and young people this change hasn’t come soon enough, or gone far enough.
If we look at the state of mental health services for children and young people, we can see it truly is the Cinderella of the healthcare provision.
director of policy and strategy
The Royal Princes’ Heads Together campaign is really helping chip away at the stigma surrounding mental health. This is encouraging more and more people come forward for treatment. This is a good thing. It is progress. But therein lies a problem too: right now services can barely meet current levels of demand for services, let alone manage even more people coming through their doors.
This is a very familiar story for children and young people’s mental health. In our recent survey, mental health trust leaders revealed how concerned they are about the future for mental health services, in particular CAMHS. Inpatient mental health services can be more than 100% full. Particularly concerning is the increase in children attending A&E for psychiatric reasons and the 44% growth in all CAMHS referrals over the past three years. Over 90% of mental health leaders told us they expect demand for CAMHS and mental health crisis care to grow.
Right now services can barely meet current levels of demand for services, let alone manage even more people coming through their doors.
director of policy and strategy
So where does this demand come from? One trust told us “Demand is rising as the other safety nets are removed as a result of local government cuts.” Children and young people are a vulnerable group who rely heavily on an interconnected set of services, not just the NHS. Cut a council funded service like school nursing and demand for an interconnected NHS service for young people rises.
Extra funding
The government has committed over a billion pounds of extra funding over the next five years to improve CAMHS provision and some of this spending is coming through. However, overall, 80% of mental health trust leaders were worried that this is not enough and would not be spent where it is needed most. Too often trust leaders report that any extra funding is just used to fill existing gaps or to manage the current high levels of demand, not improve quality or widen access to services.
The right staff and skills in the right place is the only way to improve mental health services.
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The right staff, with the right skills in the right place is the only way to improve mental health services on the ground. But mental health trust leaders are struggling to find sufficient staff to deliver their services, let alone find new staff to extend, transform or innovate. And where are concerns about workforce shortages greatest? CAMHS and crisis care - the areas where demand is greatest and where it is still growing.
So what does this all mean for access to services and the quality of services? Critically, for children’s and young people’s services over 50% of trust leaders said they were unable to meet demand. Fewer than 10% believed they would be able to meet the demand they were expecting to receive in future. This is shocking when we are treating 85-95% of physical conditions like cancer and elective surgery within tightly specified time deadlines.
On the ground, this translates in to services which simply cannot respond as we would all want them to. And overwhelming demand means we are still sending far too many young people many miles from home to receive the care they need. Recent figures obtained by the BMA show that in 2016/17 69% of young people admitted for mental health treatment were classed as “out of area”, up from 57% the previous year. A shortage of beds for CAMHS means we are failing far too many young people.
Overwhelming demand means are still sending far too many young people many miles from home to receive the care they need.
director of policy and strategy
At the same time, spiralling demand also means that young people have to be more unwell and wait longer before they receive treatment, meaning their condition may deteriorate further.
The Children’s Commissioner’s shocking report on vulnerability, published earlier this week, also shows 800,000 children and young people living with mental health difficulties and many more flying under the radar.
The story needs to change
There may never be a fairy tale ending for this Cinderella service, although we have come a long way. We must demand rapid change and clear investment in transformation. Talk to the parent of child with depression or who is self-harming, a teenager with an eating disorder, a student suddenly experiencing psychosis, a confused child with behavioural problems, or imagine the fate of a looked after child in the local authority care system, also facing cuts, with a mental health problem.
They all need the story to change.
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